Multisection dynamic CT perfusion for acute cerebral ischemia: the "toggling-table" technique

Area of Science:

• Radiology
• Neurology
• Medical Imaging

Background:

• Acute ischemic stroke, particularly middle cerebral artery (MCA) occlusion, requires rapid diagnosis.
• Conventional CT perfusion (CTP) may have limited anatomic coverage, potentially missing ischemic areas.
• Advanced CTP techniques are needed to optimize the assessment of brain perfusion.

Purpose of the Study:

• To evaluate a new CT perfusion technique with extended anatomic coverage using a toggling-table approach.
• To assess the efficacy of this technique in patients with suspected acute MCA ischemia.
• To compare the findings with follow-up imaging and diffusion-weighted MRI.

Main Methods:

• A multidetector CT scanner was used to acquire CTP data.
• A toggling-table technique was employed, acquiring scans at two distinct positions during a single contrast bolus.
• Perfusion parameter maps were generated and analyzed.

Main Results:

• Nine out of 12 patients demonstrated focal perfusion abnormalities, primarily on mean transit time maps.
• The toggling-table approach successfully covered extended anatomic areas, avoiding underestimation or missed diagnoses.
• In three patients, CTP showed no abnormalities; diffusion MRI confirmed no tissue injury in two of these cases.

Conclusions:

• The toggling-table CT perfusion technique provides extended anatomic coverage for evaluating acute MCA ischemia.
• This method improves the detection and extent assessment of perfusion deficits in suspected stroke.
• It offers a valuable tool for identifying ischemic tissue in acute stroke patients.