Advances in cerebral perfusion imaging techniques in acute ischemic stroke

Area of Science:

• Neuroradiology
• Interventional Neurology
• Medical Imaging Technology

Background:

• Cerebral perfusion imaging is crucial for assessing acute ischemic stroke (AIS) and large artery occlusion (LAO), guiding triage and treatment decisions.
• Current methods like CT perfusion (CTP) and MRI perfusion are effective but can increase door-to-reperfusion times due to patient transport.
• Reducing time to treatment is critical for improving outcomes in AIS patients.

Purpose of the Study:

• To review the efficacy and theoretical basis of C-arm cone-beam CT (CBCT) for AIS diagnosis and treatment.
• To compare CBCT with existing CTP and MRI perfusion techniques in terms of diagnostic capabilities and workflow efficiency.
• To provide guidance for establishing rapid and effective clinical workflows for AIS and LAO patients using advanced imaging.

Main Methods:

• Review of current evidence on CBCT and other cerebral perfusion imaging techniques.
• Analysis of CBCT's capabilities in diagnosing ischemic core and tissue at risk.
• Comparison of workflow efficiency and door-to-reperfusion times between CBCT and traditional methods.

Main Results:

• CBCT integrates 2D radiography and 3D CT imaging on a digital subtraction angiography platform.
• When combined with angiography or therapy, CBCT acts as a "one-stop-shop" for AIS diagnosis and treatment.
• CBCT has the potential to significantly reduce door-to-reperfusion times compared to CTP and MRI.

Conclusions:

• CBCT offers a promising integrated approach for managing acute ischemic stroke patients with large artery occlusion.
• This technology can streamline the diagnostic and therapeutic process, leading to faster treatment initiation.
• Further clinical implementation and workflow optimization of CBCT are recommended for AIS management.