Reperfusion phenomenon masking acute and subacute infarcts at dynamic perfusion CT: Confirmation by fusion of CT and diffusion-weighted MR images

Veena A. Nagar, Alexander M. McKinney, Ayse Tuba Kendi, Charles L. Truwit

Research output: Contribution to journalArticle

16 Citations (Scopus)

Abstract

OBJECTIVE. The purpose of this study was to evaluate cerebral blood flow, cerebral blood volume, mean transit time, time to peak, and delay in a selected sample of patients with visually normal or increased cerebral blood volume to facilitate detection of a postischemic CT perfusion hyperperfusion-reperfusion phenomenon that may mask subacute and acute infarcts. MATERIALS AND METHODS. Ten patients were included who had visually normal or elevated cerebral blood volume in infarcts larger than 1.5 cm confirmed on diffusionweighted MR images within 48 hours of perfusion CT. The cases were selected from 371 perfusion CT studies of stroke patients (99 associated with positive diffusion-weighted imaging findings) reviewed over 2.5 years on a 64-MDCT scanner. The perfusion CT images were fused to the diffusion-weighted images for measurement of cerebral blood volume, cerebral blood flow, mean transit time, time to peak, and delay in each infarct versus the contralateral hemisphere. Two neuroradiologists reviewed the images in consensus. RESULTS. The mean time between symptom onset and perfusion CT was 3.9 days. Infarcts were in the middle cerebral artery (n = 7) and posterior cerebral artery (n = 3) distributions. Significant differences versus the contralateral finding were found in cerebral blood volume (p = 0.016; mean increase, 30.0%), mean transit time (p = 0.007; mean increase, 38.1%), time to peak (p = 0.005; mean increase, 17.7%), and delay (p = 0.030; mean increase, 124.9%). The difference in cerebral blood flow (p = 0.785; mean increase, 1.8%) was not statistically significant. Infarcts became enhanced on the dynamic perfusion CT images of eight of 10 patients and on the contrast-enhanced T1-weighted MR images of six of nine patients. CONCLUSION. Visual inspection of cerebral blood volume and cerebral blood flow maps alone is insufficient in the evaluation of infarcts. Mean transit time, time to peak, and delay maps also should be reviewed with dynamic source images to prevent misinterpretation of findings as false-negative. This phenomenon is unlikely to occur hyperacutely (< 8 hours after onset).

Original languageEnglish (US)
Pages (from-to)1629-1638
Number of pages10
JournalAmerican Journal of Roentgenology
Volume193
Issue number6
DOIs
StatePublished - Dec 1 2009
Externally publishedYes

Fingerprint

Reperfusion
Perfusion
Cerebrovascular Circulation
Posterior Cerebral Artery
Middle Cerebral Artery
Masks
Cerebral Blood Volume
Stroke

Keywords

  • Cerebral infarction
  • CT perfusion
  • Diffusion-weighted imaging
  • Fusion
  • Infarct
  • Stroke

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

Cite this

Reperfusion phenomenon masking acute and subacute infarcts at dynamic perfusion CT : Confirmation by fusion of CT and diffusion-weighted MR images. / Nagar, Veena A.; McKinney, Alexander M.; Tuba Kendi, Ayse; Truwit, Charles L.

In: American Journal of Roentgenology, Vol. 193, No. 6, 01.12.2009, p. 1629-1638.

Research output: Contribution to journalArticle

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abstract = "OBJECTIVE. The purpose of this study was to evaluate cerebral blood flow, cerebral blood volume, mean transit time, time to peak, and delay in a selected sample of patients with visually normal or increased cerebral blood volume to facilitate detection of a postischemic CT perfusion hyperperfusion-reperfusion phenomenon that may mask subacute and acute infarcts. MATERIALS AND METHODS. Ten patients were included who had visually normal or elevated cerebral blood volume in infarcts larger than 1.5 cm confirmed on diffusionweighted MR images within 48 hours of perfusion CT. The cases were selected from 371 perfusion CT studies of stroke patients (99 associated with positive diffusion-weighted imaging findings) reviewed over 2.5 years on a 64-MDCT scanner. The perfusion CT images were fused to the diffusion-weighted images for measurement of cerebral blood volume, cerebral blood flow, mean transit time, time to peak, and delay in each infarct versus the contralateral hemisphere. Two neuroradiologists reviewed the images in consensus. RESULTS. The mean time between symptom onset and perfusion CT was 3.9 days. Infarcts were in the middle cerebral artery (n = 7) and posterior cerebral artery (n = 3) distributions. Significant differences versus the contralateral finding were found in cerebral blood volume (p = 0.016; mean increase, 30.0{\%}), mean transit time (p = 0.007; mean increase, 38.1{\%}), time to peak (p = 0.005; mean increase, 17.7{\%}), and delay (p = 0.030; mean increase, 124.9{\%}). The difference in cerebral blood flow (p = 0.785; mean increase, 1.8{\%}) was not statistically significant. Infarcts became enhanced on the dynamic perfusion CT images of eight of 10 patients and on the contrast-enhanced T1-weighted MR images of six of nine patients. CONCLUSION. Visual inspection of cerebral blood volume and cerebral blood flow maps alone is insufficient in the evaluation of infarcts. Mean transit time, time to peak, and delay maps also should be reviewed with dynamic source images to prevent misinterpretation of findings as false-negative. This phenomenon is unlikely to occur hyperacutely (< 8 hours after onset).",
keywords = "Cerebral infarction, CT perfusion, Diffusion-weighted imaging, Fusion, Infarct, Stroke",
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T1 - Reperfusion phenomenon masking acute and subacute infarcts at dynamic perfusion CT

T2 - Confirmation by fusion of CT and diffusion-weighted MR images

AU - Nagar, Veena A.

AU - McKinney, Alexander M.

AU - Tuba Kendi, Ayse

AU - Truwit, Charles L.

PY - 2009/12/1

Y1 - 2009/12/1

N2 - OBJECTIVE. The purpose of this study was to evaluate cerebral blood flow, cerebral blood volume, mean transit time, time to peak, and delay in a selected sample of patients with visually normal or increased cerebral blood volume to facilitate detection of a postischemic CT perfusion hyperperfusion-reperfusion phenomenon that may mask subacute and acute infarcts. MATERIALS AND METHODS. Ten patients were included who had visually normal or elevated cerebral blood volume in infarcts larger than 1.5 cm confirmed on diffusionweighted MR images within 48 hours of perfusion CT. The cases were selected from 371 perfusion CT studies of stroke patients (99 associated with positive diffusion-weighted imaging findings) reviewed over 2.5 years on a 64-MDCT scanner. The perfusion CT images were fused to the diffusion-weighted images for measurement of cerebral blood volume, cerebral blood flow, mean transit time, time to peak, and delay in each infarct versus the contralateral hemisphere. Two neuroradiologists reviewed the images in consensus. RESULTS. The mean time between symptom onset and perfusion CT was 3.9 days. Infarcts were in the middle cerebral artery (n = 7) and posterior cerebral artery (n = 3) distributions. Significant differences versus the contralateral finding were found in cerebral blood volume (p = 0.016; mean increase, 30.0%), mean transit time (p = 0.007; mean increase, 38.1%), time to peak (p = 0.005; mean increase, 17.7%), and delay (p = 0.030; mean increase, 124.9%). The difference in cerebral blood flow (p = 0.785; mean increase, 1.8%) was not statistically significant. Infarcts became enhanced on the dynamic perfusion CT images of eight of 10 patients and on the contrast-enhanced T1-weighted MR images of six of nine patients. CONCLUSION. Visual inspection of cerebral blood volume and cerebral blood flow maps alone is insufficient in the evaluation of infarcts. Mean transit time, time to peak, and delay maps also should be reviewed with dynamic source images to prevent misinterpretation of findings as false-negative. This phenomenon is unlikely to occur hyperacutely (< 8 hours after onset).

AB - OBJECTIVE. The purpose of this study was to evaluate cerebral blood flow, cerebral blood volume, mean transit time, time to peak, and delay in a selected sample of patients with visually normal or increased cerebral blood volume to facilitate detection of a postischemic CT perfusion hyperperfusion-reperfusion phenomenon that may mask subacute and acute infarcts. MATERIALS AND METHODS. Ten patients were included who had visually normal or elevated cerebral blood volume in infarcts larger than 1.5 cm confirmed on diffusionweighted MR images within 48 hours of perfusion CT. The cases were selected from 371 perfusion CT studies of stroke patients (99 associated with positive diffusion-weighted imaging findings) reviewed over 2.5 years on a 64-MDCT scanner. The perfusion CT images were fused to the diffusion-weighted images for measurement of cerebral blood volume, cerebral blood flow, mean transit time, time to peak, and delay in each infarct versus the contralateral hemisphere. Two neuroradiologists reviewed the images in consensus. RESULTS. The mean time between symptom onset and perfusion CT was 3.9 days. Infarcts were in the middle cerebral artery (n = 7) and posterior cerebral artery (n = 3) distributions. Significant differences versus the contralateral finding were found in cerebral blood volume (p = 0.016; mean increase, 30.0%), mean transit time (p = 0.007; mean increase, 38.1%), time to peak (p = 0.005; mean increase, 17.7%), and delay (p = 0.030; mean increase, 124.9%). The difference in cerebral blood flow (p = 0.785; mean increase, 1.8%) was not statistically significant. Infarcts became enhanced on the dynamic perfusion CT images of eight of 10 patients and on the contrast-enhanced T1-weighted MR images of six of nine patients. CONCLUSION. Visual inspection of cerebral blood volume and cerebral blood flow maps alone is insufficient in the evaluation of infarcts. Mean transit time, time to peak, and delay maps also should be reviewed with dynamic source images to prevent misinterpretation of findings as false-negative. This phenomenon is unlikely to occur hyperacutely (< 8 hours after onset).

KW - Cerebral infarction

KW - CT perfusion

KW - Diffusion-weighted imaging

KW - Fusion

KW - Infarct

KW - Stroke

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