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Related Concept Videos

Ischemic Stroke l: Introduction01:15

Ischemic Stroke l: Introduction

Ischemic stroke is an acute cerebrovascular condition in which blood flow to a brain region is suddenly interrupted, leading to tissue infarction. Neurons depend on continuous oxygen and glucose supply, so even brief reductions in perfusion cause energy failure, ionic imbalance, and irreversible injury. Ischemic strokes are classified into thrombotic and embolic types based on their underlying mechanisms.Thrombotic MechanismsThrombotic stroke develops when a clot forms within a cerebral artery.
Ischemic Stroke ll: Pathophysiology01:15

Ischemic Stroke ll: Pathophysiology

An ischemic stroke occurs when a cerebral blood vessel becomes obstructed, most often by a thrombus or embolus, interrupting the delivery of oxygen and glucose to brain tissue. Because neurons rely on continuous aerobic metabolism, energy failure begins within minutes of reduced perfusion. The region receiving the least blood flow becomes the infarct core, an area of irreversible cellular death. Surrounding this core lies the penumbra, a zone of hypoperfused but still viable tissue that is...

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Non-invasive Imaging and Analysis of Cerebral Ischemia in Living Rats Using Positron Emission Tomography with 18F-FDG
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Assessing Brain Tissue Viability on Nonenhanced Computed Tomography After Ischemic Stroke.

Awad Alzahrani1,2, Xinyu Zhang3, Adel Albukhari4

  • 1Centre for Clinical Brain Sciences, University of Edinburgh, United Kingdom (A. Alzahrani).

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|January 5, 2023
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Summary

Nonenhanced computed tomography (NECT) can identify ischemic stroke penumbra using an attenuation ratio >0.87. Isolated swelling on NECT is highly specific for penumbra, aiding treatment decisions.

Keywords:
brainischemiaperfusionstroketomography

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Area of Science:

  • Neurology
  • Radiology
  • Medical Imaging

Background:

  • Extended treatment for ischemic stroke relies on computed tomography perfusion (CTP) to identify salvageable brain tissue (penumbra).
  • CTP is not universally available, necessitating alternative methods to assess penumbra.
  • Nonenhanced computed tomography (NECT) is more widely accessible and can potentially differentiate penumbra from infarct core.

Purpose of the Study:

  • To establish a threshold for brain attenuation on NECT to distinguish CTP-defined penumbra from infarct core.
  • To correlate NECT features with CTP findings in ischemic stroke patients.
  • To determine the diagnostic accuracy of NECT for identifying penumbra.

Main Methods:

  • Retrospective analysis of ischemic stroke patients with baseline NECT and concurrent CTP.
  • Measurement of brain attenuation ratios (ischemic/normal) on NECT to define penumbra and core.
  • Qualitative assessment of NECT and CTP features in 8 cerebral regions per patient.
  • Receiver operating characteristic (ROC) curve analysis to determine the optimal CT attenuation ratio for penumbra.

Main Results:

  • An optimal CT attenuation ratio >0.87 on NECT demonstrated 86% sensitivity and 91% specificity for identifying penumbra (AUC, 0.95).
  • Isolated swelling on NECT corresponded to CTP penumbra in 97% of cases.
  • Visible hypoattenuation on NECT was associated with both core (56%) and penumbra (43%), highlighting the need for attenuation ratio measurement.

Conclusions:

  • NECT can assess brain tissue viability after ischemic stroke.
  • Isolated swelling on NECT is a strong indicator of penumbra.
  • NECT attenuation ratios effectively differentiate penumbra from core, offering a potential alternative to CTP for treatment decisions.