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Published on: February 16, 2016
Visualization of ischaemic penumbra using a computed tomography perfusion method
R T F Cheung1, Pui W Cheng, Wai M Lui
1University Department of Medicine, Queen Mary Hospital, Hong Kong. rtcheung@hkucc.hku.hk
Abstract:
A computed tomography (CT) perfusion imaging and a diffusion/perfusion magnetic resonance imaging (MRI) were performed in a 51-year-old man at 15 and 15.5 h of onset of left middle cerebral artery infarction, respectively. The established infarct, as revealed by the diffusion-weighted MRI, had low values of cerebral blood flow (CBF) and cerebral blood volume (CBV) on the CT perfusion study. The ischaemic penumbra, as reflected by the perfusion-diffusion mismatch on MRI, had reduced CBF, prolonged mean transit time (MTT) and compensated CBV. Spontaneous bleeding occurred in the medial part of the left lentiform nucleus, immediately following decompressive craniectomy. CT measurements of CBF, CBV and MTT may visualize the ischaemic penumbra and explain the site of bleeding after surgical decompression.
Insights
Computed tomography (CT) perfusion imaging visualized the ischemic penumbra in a stroke patient. CT perfusion may also explain bleeding after decompressive surgery for stroke.
Area of Science:
- Neurology
- Radiology
- Medical Imaging
Background:
- Assessing acute ischemic stroke requires accurate imaging to differentiate infarct core from penumbra.
- Computed tomography (CT) perfusion and magnetic resonance imaging (MRI) are advanced neuroimaging techniques used for stroke evaluation.
Observation:
- A 51-year-old male patient with left middle cerebral artery infarction underwent CT perfusion and diffusion/perfusion MRI at 15 and 15.5 hours post-onset, respectively.
- Diffusion-weighted MRI identified the established infarct, which showed low cerebral blood flow (CBF) and cerebral blood volume (CBV) on CT perfusion.
- The ischemic penumbra, visualized as a perfusion-diffusion mismatch on MRI, exhibited reduced CBF, prolonged mean transit time (MTT), and compensated CBV on CT perfusion.
Findings:
- CT perfusion imaging successfully visualized the ischemic penumbra by demonstrating reduced CBF and prolonged MTT.
- The established infarct core correlated with low CBF and CBV values on CT perfusion.
- Spontaneous bleeding occurred in the left lentiform nucleus post-decompressive craniectomy, a site potentially identifiable by CT perfusion parameters.
Implications:
- CT perfusion parameters (CBF, CBV, MTT) can help identify the ischemic penumbra in acute stroke.
- CT perfusion may aid in predicting the risk and location of hemorrhagic transformation after decompressive surgery for stroke.
- These findings highlight the complementary roles of CT perfusion and MRI in acute stroke management and surgical planning.
