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[Evaluation of cerebral hemodynamics with perfusion CT]
Yuzo Araki1, Masahiro Furuichi, Hiroaki Nokura
1Department of Neurosurgery, Inuyama Central Hospital, 6 Futagozuka, Goromaru, Inuyama City, Aichi 484-8511, Japan.
Insights
Perfusion CT effectively evaluates cerebral ischemic lesions by analyzing cerebral blood flow (CBF), cerebral blood volume (CBV), and mean transit time (MTT). This method allows for a 4-stage classification of cerebral ischemia progression.
Area of Science:
- Neurology
- Radiology
- Medical Imaging
Background:
- Cerebral ischemia evaluation is critical for diagnosing and managing cerebrovascular diseases.
- Perfusion CT offers a non-invasive method to assess hemodynamic parameters in the brain.
Observation:
- Cerebral blood flow (CBF), cerebral blood volume (CBV), and mean transit time (MTT) were analyzed in 52 patients with ischemic cerebrovascular disease.
- Measurements were taken using the box-modulation transfer function method with contrast medium injection.
- Significant differences in CBF and MTT were observed between unaffected and affected (lesion side) middle cerebral artery (MCA) territories.
Findings:
- Perfusion CT demonstrated strong correlations with Xe-CT for CBF values in MCA territories (r = 0.645).
- MTT showed positive correlation with CBV (r = 0.526) below 4.1 seconds and negative correlation with CBF (r = 0.818) above 4.1 seconds.
- A 4-stage classification system for cerebral ischemia progression was proposed based on CBF, CBV, and MTT changes.
Implications:
- Perfusion CT provides valuable quantitative data for assessing the severity and progression of cerebral ischemia.
- The proposed 4-stage classification may aid in clinical decision-making and treatment planning for stroke patients.
- This imaging technique enhances the understanding of cerebrovascular hemodynamics in ischemic conditions.
Abstract:
We report on the evaluation of cerebral ischemic lesions with perfusion CT. Cerebral blood flow (CBF), cerebral blood volume (CBV) and mean transit time (MTT) of 52 patients mostly with ischemic cerebrovascular disease were analysed using the box-modulation transfer function method with 30 ml of contrast medium intravenously injected at 5 ml/sec. CBF, CBV and MTT of the middle cerebral artery (MCA) territory were 43.5 +/- 4.6 ml/100 g/min, 1.9 +/- 0.2 ml/100 g and 2.9 +/- 0.6 seconds at the unaffected side, and 37.7 +/- 7.3 ml/100 g/min, 2.1 +/- 0.3 ml/100 g, 3.7 +/- 0.9 seconds at the lesion side with stenosis or occlusion in the main MCA trunks or internal carotid artery, respectively. A statistically significant difference was shown in CBF and MTT values. Furthermore, there was a close correlation in CBF values of MCA territories between Xe-CT and perfusion CT (r = 0.645, n = 76, p < 0.0001). MTT showed a positive correlation with CBV in those subjects when MTT was below 4.1 seconds (r = 0.526, p < 0.0001, n = 83). MTT also showed a negative correlation with CBF in those patients when MTT indicated more than 4.1 seconds (r = 0.818, p < 0.001, n = 21). These results suggest that the progression of cerebral ischemia may be classified in 4 stages using perfusion CT. The stages are as follows: stage 0; normal CBF without prolonged MTT and increased CBV, stage 1; relatively increased CBV, stage 2; significantly prolonged MTT, and stage 3; significantly decreased CBF with prolonged MTT.