CT Perfusion In Acute Ischemic Stroke

00:00 - Intro
01:14 - Objectives
01:38​ - Why CT perfusion?
04:23 - ASPECT scoring on non-contrast head CT
08:02 - Fundamental hemodynamic properties: CBF, CBV, MTT, Tmax
13:35 - Clinical uses: DEFUSE 3, DAWN, EXTEND
18:26 - Clinical examples
22:03 - Hypoperfusion index and multi-threshold Tmax maps
23:37 - Caveats and pitfalls: Caveats in estimating core
30:15 - Caveats and pitfalls: Caveats in estimating penumbra
35:37 - Summary
36:11 - Quality of study: Vessel selection, contrast opacification, patient motion
38:27 - Additional uses of CTP: Medium vessel occlusion
40:28 - Additional uses of CTP: Posterior circulation stroke
44:59 - Additional uses of CTP: Stroke mimics
46:52 - Can we use CTP like cardiologists use troponin?
47:58 - Summary and algorithm

Algorithm PDF may be found here: https://drive.google.com/file/d/1QLYj...

This video is intended for residents and fellows to understand the interpretation and clinical applications of CT perfusion imaging for the treatment of patients with acute ischemic stroke.

Created, produced, and narrated by:
Igor Rybinnik MD
Neurology Clerkship Director
Rutgers Robert Wood Johnson Medical School

Content experts:
Raymond Mirasol MD, Roger Cheng MD
Division of Stroke and Neurocritical Care
Department of Neurology
Rutgers Robert Wood Johnson Medical School

Sudipta Roychowdhury, MD FACR
Clinical Professor of Radiology, Neurosurgery, and Neurology
Rutgers Robert Wood Johnson Medical School
Director of Interventional Neuroradiology
Director of Magnetic Resonance Imaging
Robert Wood Johnson University Hospital

References:
1. Saver JL, et al. JAMA 2016, 316(12):1279
2. Nomani AZ, et al. Neurology 2021, 97:e2079-87
3. Sarraj A, et al. Stroke 2021, 52(1):57-69
4. Barber PA, et al. Lancet 2000;355(9216):1670-4
5. Almallouhi AZ, et al. JAMA Network Open. 2021;4(12):e2137708
6. Adapted from Sotoudeh H, et al. Acad Radiol 2019;26(11):1565-79
7. Albers GW, et al. NEJM 2018;378:708-718
8. Nogueira R, et al. NEJM 2018(1);378:11-21.
9. Ma H, et al. NEJM 2019;380(19):1795-1803
10. MacLellan A, et al. JSCVD 2022;31(1):106-208
11. Normani AZ, et al. Neurology 2021;97(21):e2079-87
12. Albers GW, Stroke 2018;49:1-5
13. Martins N, et al. Intervent Neurol 2018;7:513-521
14. Campbell BC, et al. Int J Stroke 2015;10:51–54
15. Amukotuwa SA, et al. Stroke 2021;52:3308-3317
16. Katyal A, et al. Eur J Neurol 2021;28:2657-2668
17. Tao WD, et al. Stroke 2012;43(8):2060-2065
18. Capasso R, et al. Neuroradiology 2021;63:317–330
19. Novakovic-White R, et al. Neurology 2021;97:S158-S169
20. Vagal A, et al. Neurology 2019;93(20):888-898.
21. Benson JC, et al. AJNR 2016;37:2239-44

Images adapted from:
- Articles referenced above
- Adobe Creative Cloud
- Blumenfeld H. Neuroanatomy Through Clinical Cases, 2nd ed. Sinauer, 2010.

Music:
- The Itch (Instrumental) - NEFFEX
- Icelandic Arpeggios - DivKid
- Under Cover - Wayne Jones

Disclaimer: Please note that this material was simplified for educational purposes. For patient management, please review your clinical society's guidelines and engage expert consultation where appropriate. Also, the opinions of the presenters do not necessarily reflect those of Rutgers Robert Wood Johnson Medical School, Robert Wood Johnson University Hospital, RWJBarnabus Health, or Rutgers University as a whole.