Supratentorial dynamic computed tomography for the diagnosis of vertebrobasilar ischemic stroke

Dynamic computed tomography (CT) is an established method for the evaluation of perfusion in acute ischemic stroke, but is not frequently used to assess infratentorial ischemia. Eleven patients with vertebrobasilar ischemia underwent dynamic CT on admission and/or during the follow-up period. The time of appearance (TA) and time to peak (TTP) were mapped and differences in TA (deltaTA) and TTP (deltaTTP) between the bilateral middle cerebral artery and posterior cerebral artery (PCA) territories were calculated. Conventional angiography and brain imaging including CT and magnetic resonance imaging were also performed. The TA and TTP maps obtained within 48 hours after onset exhibited time delay in eight of nine patients in the bilateral PCA territories. deltaTA and deltaTTP were greater in patients with stenosis or occlusion of the bilateral vertebral arteries or the basilar artery, and in patients without collateral circulation via the posterior communicating arteries than in control subjects. Furthermore, TA and TTP normalized dramatically in patients with recanalization of the arteries. deltaTA and deltaTTP were also normalized. deltaTA and deltaTTP were negatively correlated with the time from onset to examination. Dynamic CT can provide important information in patients with vertebrobasilar ischemic stroke, and may allow the diagnosis of acute ischemia and monitoring of the course.