Beyond the Maps: A Radiologist's Guide to CT Perfusion Pearls and Pitfalls

Area of Science:

• Neurology
• Radiology
• Medical Imaging

Background:

• Computed tomography (CT) perfusion is a key imaging technique in acute ischemic stroke.
• It helps extend treatment eligibility and allows for personalized, tissue-based decisions.
• However, its interpretation faces challenges that can affect patient management.

Purpose of the Study:

• To highlight the common pitfalls in CT perfusion interpretation for acute ischemic stroke.
• To emphasize the importance of recognizing these issues for clinical decision-making.
• To ensure appropriate patient selection for endovascular therapy.

Main Methods:

• Review of technical, physiological, and workflow-related factors affecting CT perfusion interpretation.
• Analysis of how these factors can lead to misinterpretations.
• Discussion of strategies to mitigate these pitfalls.

Main Results:

• CT perfusion interpretation is prone to various pitfalls.
• These pitfalls can lead to incorrect assessments of ischemic tissue.
• Awareness and proper interpretation are essential for guiding treatment.

Conclusions:

• Recognizing CT perfusion pitfalls is critical for acute ischemic stroke management.
• Accurate interpretation ensures appropriate patient selection for therapies like endovascular treatment.
• Addressing these challenges improves the reliability of CT perfusion in clinical practice.