Beyond ASPECTS: A Practical Guide to CT Perfusion Interpretation

Area of Science:

• Neuroradiology
• Medical Imaging
• Neurology

Background:

• Computed tomography perfusion (CTP) is vital for acute ischemic stroke (AIS) assessment.
• Accurate CTP interpretation is essential for identifying candidates for endovascular thrombectomy.
• Clinical challenges necessitate a structured approach to CTP analysis.

Purpose of the Study:

• To provide a theoretical foundation and practical guidance for interpreting CTP in AIS.
• To address real-world clinical challenges in CTP analysis.
• To enhance clinicians' knowledge for consistent and effective CTP utilization.

Main Methods:

• Review of current American Heart Association/American Stroke Association (AHA/ASA) guidelines.
• Discussion of institutional best practices for CTP interpretation.
• Integration of theoretical concepts with practical, case-based examples and annotated images.

Main Results:

• Illustrates key CTP concepts through real clinical scenarios.
• Highlights challenging cases where CTP significantly impacts treatment decisions.
• Emphasizes the importance of integrating technical understanding, clinical judgment, and modality limitations.

Conclusions:

• Effective CTP interpretation requires a structured, multi-faceted approach.
• CTP plays a pivotal role in optimizing treatment selection for AIS patients.
• This review equips clinicians with tools for consistent and effective CTP use in stroke management.