Automated CT perfusion imaging for acute ischemic stroke: Pearls and pitfalls for real-world use.

Abstract:

:Recent positive trials have thrust acute cerebral perfusion imaging into the routine evaluation of acute ischemic stroke. Updated guidelines state that in patients with anterior circulation large vessel occlusions presenting beyond 6 hours from time last known well, advanced imaging selection including perfusion-based selection is necessary. Centers that receive patients with acute stroke must now have the capability to perform and interpret CT or magnetic resonance perfusion imaging or provide rapid transfer to centers with the capability of selecting patients for a highly impactful endovascular therapy, particularly in delayed time windows. Many stroke centers are quickly incorporating the use of automated perfusion processing software to interpret perfusion raw data. As CT perfusion (CTP) is being assimilated in real-world clinical practice, it is essential to understand the basics of perfusion acquisition, quantification, and interpretation. It is equally important to recognize the common technical and clinical diagnostic challenges of automated CTP including ischemic core and penumbral misclassifications that could result in underestimation or overestimation of the core and penumbra volumes. This review highlights the pitfalls of automated CTP along with practical pearls to address the common challenges. This is particularly tailored to aid the acute stroke clinician who must interpret automated perfusion studies in an emergency setting to make time-dependent treatment decisions for patients with acute ischemic stroke.

journal_name

Neurology

journal_title

Neurology

authors

Vagal A,Wintermark M,Nael K,Bivard A,Parsons M,Grossman AW,Khatri P

doi

10.1212/WNL.0000000000008481

subject

Has Abstract

pub_date

2019-11-12 00:00:00

pages

888-898

issue

20

eissn

0028-3878

issn

1526-632X

pii

WNL.0000000000008481

journal_volume

93

pub_type

杂志文章,评审
  • Cerebrospinal fluid pressure in normal obese subjects and patients with pseudotumor cerebri.

    abstract::Cerebrospinal fluid (CSF) pressure was measured in four groups of patients: 116 with acute pseudotumor cerebri, 18 with chronic pseudotumor cerebri, 41 obese and 15 nonobese normal patients undergoing spinal anesthesia. Spinal fluid pressure between 200 and 250 mm H2O was found in members of each group. This suggests ...

    journal_title:Neurology

    pub_type: 杂志文章

    doi:10.1212/wnl.33.10.1386

    authors: Corbett JJ,Mehta MP

    更新日期:1983-10-01 00:00:00

  • Intravenous t-PA for acute ischemic stroke: therapeutic yield of a stroke code system.

    abstract::Subsequent to publication of the NINDS t-PA Stroke Study results, we sought to determine the proportion of patients eligible for and receiving intravenous tissue plasminogen activator (t-PA) at an active acute stroke treatment center. Over a 12-month period there were 185 stroke code activations. Of these, 134 involve...

    journal_title:Neurology

    pub_type: 杂志文章

    doi:10.1212/wnl.50.2.501

    authors: Zweifler RM,Brody ML,Graves GC,U TT,Drinkard R,Cunningham S,Rothrock JF

    更新日期:1998-02-01 00:00:00

  • Norms for the Mini-Mental State Examination in a healthy population.

    abstract:BACKGROUND:Although the Mini-Mental State Examination (MMSE) is widely used in clinical practice, few norms exist for healthy populations covering a broad range of ages. OBJECTIVE:To obtain MMSE norms specific for age, gender, and education in healthy adults. METHODS:From the population registers of seven communities...

    journal_title:Neurology

    pub_type: 杂志文章

    doi:10.1212/wnl.53.2.315

    authors: Grigoletto F,Zappalà G,Anderson DW,Lebowitz BD

    更新日期:1999-07-22 00:00:00

  • Diagnostic value of myotactic reflexes in axonal and demyelinating polyneuropathy.

    abstract::In 11 patients with chronic inflammatory demyelinating polyneuropathy (CIDP) and 11 patients with chronic idiopathic axonal polyneuropathy (CIAP), absent myotatic reflexes were significantly associated more often with CIDP than with CIAP, an absent biceps-reflex having the highest sensitivity and specificity for the d...

    journal_title:Neurology

    pub_type: 杂志文章

    doi:10.1212/wnl.53.7.1573

    authors: van Dijk GW,Wokke JH,Notermans NC,van Gijn J,Franssen H

    更新日期:1999-10-22 00:00:00

  • The long-term clinical outcome of myasthenia gravis in patients with thymoma.

    abstract::We compared 42 myasthenia gravis (MG) patients with thymoma with 42 generalized MG patients without thymoma using a modified Osserman classification. The mean Osserman grades at diagnosis, 6 months, and 5 and 10 years post-thymectomy did not differ between groups. Our results indicate that thymoma is not a negative de...

    journal_title:Neurology

    pub_type: 杂志文章,评审

    doi:10.1212/wnl.51.4.1198

    authors: Bril V,Kojic J,Dhanani A

    更新日期:1998-10-01 00:00:00

  • Familial spinal neurofibromatosis: clinical and DNA linkage analysis.

    abstract::We studied two families with an unusual variant of neurofibromatosis (NF). The first family had spinal neurofibromas and café au lait spots (CLS), the second spinal neurofibromas without CLS. Other signs of NF1 or NF2, such as cutaneous tumors, Lisch nodules, or acoustic tumors, were absent. The inheritance pattern in...

    journal_title:Neurology

    pub_type: 杂志文章

    doi:10.1212/wnl.41.12.1923

    authors: Pulst SM,Riccardi VM,Fain P,Korenberg JR

    更新日期:1991-12-01 00:00:00

  • Different brain networks mediate task performance in normal aging and AD: defining compensation.

    abstract:OBJECTIVE:To determine whether the pathologic mechanisms of AD alter the brain networks subserving performance of a verbal recognition task. BACKGROUND:Functional imaging studies comparing task-related activation in AD patients and controls generally have not used network analysis and have not controlled for task diff...

    journal_title:Neurology

    pub_type: 杂志文章

    doi:10.1212/wnl.55.9.1291

    authors: Stern Y,Moeller JR,Anderson KE,Luber B,Zubin NR,DiMauro AA,Park A,Campbell CE,Marder K,Bell K,Van Heertum R,Sackeim HA

    更新日期:2000-11-14 00:00:00

  • Neurophysiologic study of central pain in patients with Parkinson disease.

    abstract:BACKGROUND:Patients with Parkinson disease (PD) may present with various types of pain. In some instances, no cause can be identified and pain is considered a primary disorder (primary central pain [PCP]). We hypothesized that PCP in patients with PD (PD-PCP) may be due to a dysfunction of pain pathways or the processi...

    journal_title:Neurology

    pub_type: 杂志文章

    doi:10.1212/01.wnl.0000295669.12443.d3

    authors: Schestatsky P,Kumru H,Valls-Solé J,Valldeoriola F,Marti MJ,Tolosa E,Chaves ML

    更新日期:2007-12-04 00:00:00

  • Cerebral air embolism complicating cardiac ablation procedures.

    abstract::Two patients with similar courses of neurologic impairment and subsequent recovery after cerebral air embolism complicating cardiac ablation procedures are described. Hyperbaric oxygen therapy, combined with aggressive resuscitative efforts, appears to have contributed to each patient's recovery. ...

    journal_title:Neurology

    pub_type: 杂志文章

    doi:10.1212/wnl.56.6.792

    authors: Hinkle DA,Raizen DM,McGarvey ML,Liu GT

    更新日期:2001-03-27 00:00:00

  • Infantile spasms: outcome and prognostic factors of cryptogenic and symptomatic groups.

    abstract::We reviewed the outcome (developmental, neurologic, and seizure) and prognostic factors of 57 cases of infantile spasms (17 cryptogenic, 40 symptomatic). The mean developmental score of the cryptogenic group (71.2 +/- 24.2) was significantly higher than that of the symptomatic group (48.4 +/- 24.5), as assessed by the...

    journal_title:Neurology

    pub_type: 杂志文章

    doi:10.1212/wnl.43.11.2322

    authors: Koo B,Hwang PA,Logan WJ

    更新日期:1993-11-01 00:00:00

  • Cerebral blood flow changes induced by subthalamic stimulation in Parkinson's disease.

    abstract::The authors used PET to show that the abnormal pattern of cerebral blood flow (CBF) activation described in PD is normalized by electrical stimulation of subthalamic nucleus. Improvement in bradykinesia correlated with increase in CBF due to stimulation in the supplementary motor area and anterior cingulate cortex. Co...

    journal_title:Neurology

    pub_type: 杂志文章

    doi:10.1212/01.wnl.0000052691.48076.92

    authors: Strafella AP,Dagher A,Sadikot AF

    更新日期:2003-03-25 00:00:00

  • Predictive value of the intracarotid amobarbital test in bihemispheric seizure onset.

    abstract::The intracarotid amobarbital test (IAT) is used to lateralize language function and assess hemispheric memory. In this study 23 non-lesional epileptic patients were evaluated. The magnitude of the difference in IAT scores between the two hemispheres was significantly greater in the patients whose seizures lateralized ...

    journal_title:Neurology

    pub_type: 临床试验,杂志文章

    doi:10.1212/wnl.52.2.409

    authors: Swearer JM,Kane KJ,Phillips CA,Weaver JP,Anderson TD,Lavoie MS

    更新日期:1999-01-15 00:00:00

  • The treatment of postprandial hypotension in autonomic failure with 3,4-DL-threo-dihydroxyphenylserine.

    abstract::Postprandial hypotension occurs commonly in patients with autonomic failure and may be due to attenuation of the normal sympathetic nervous system activation in response to meal ingestion. In a randomized, double-blind, placebo-controlled study, we investigated the therapeutic effect of the norepinephrine precursor 3,...

    journal_title:Neurology

    pub_type: 临床试验,杂志文章,随机对照试验

    doi:10.1212/wnl.47.6.1414

    authors: Freeman R,Young J,Landsberg L,Lipsitz L

    更新日期:1996-12-01 00:00:00

  • Refractory status epilepticus in children with and without prior epilepsy or status epilepticus.

    abstract:OBJECTIVE:To compare refractory convulsive status epilepticus (rSE) management and outcome in children with and without a prior diagnosis of epilepsy and with and without a history of status epilepticus (SE). METHODS:This was a prospective observational descriptive study performed from June 2011 to May 2016 on pediatr...

    journal_title:Neurology

    pub_type: 杂志文章,多中心研究

    doi:10.1212/WNL.0000000000003550

    authors: Sánchez Fernández I,Jackson MC,Abend NS,Arya R,Brenton JN,Carpenter JL,Chapman KE,Gaillard WD,Gaínza-Lein M,Glauser TA,Goldstein JL,Goodkin HP,Helseth A,Kapur K,McDonough TL,Mikati MA,Peariso K,Riviello J Jr,Tasker RC

    更新日期:2017-01-24 00:00:00

  • Can ethanol intoxication affect hemocoagulation to increase the risk of brain infarction in young adults?

    abstract::We studied the effects of acute ethanol intoxication on platelet function, coagulation factors, and fibrinolytic activity in 12 healthy men. During the ethanol session, 10 of the 12 developed a transient decrease in fibrinolytic activity. Ethanol ingestion increased factor VIII coagulant activity. VIII-related antigen...

    journal_title:Neurology

    pub_type: 杂志文章

    doi:10.1212/wnl.33.3.381

    authors: Hillbom M,Kaste M,Rasi V

    更新日期:1983-03-01 00:00:00

  • Cheiro-oral topography of sensory disturbances due to lesions of thalamocortical projections.

    abstract::Sensory disturbance in the unilateral hand and ipsilateral mouth region, the cheiro-oral syndrome, may be due to cortical, thalamic, or brainstem lesions. We report five patients with this syndrome due to infarction at the border of the posterior limb of the internal capsule and the corona radiata. The sensory fibers ...

    journal_title:Neurology

    pub_type: 杂志文章

    doi:10.1212/wnl.43.1_part_1.51

    authors: Isono O,Kawamura M,Shiota J,Araki S,Hirayama K

    更新日期:1993-01-01 00:00:00

  • Gender differences in the incidence of AD and vascular dementia: The EURODEM Studies. EURODEM Incidence Research Group.

    abstract:OBJECTIVE:To study the difference in risk for dementing diseases between men and women. BACKGROUND:Previous studies suggest women have a higher risk for dementia than men. However, these studies include small sample sizes, particularly in the older age groups, when the incidence of dementia is highest. METHODS:Pooled...

    journal_title:Neurology

    pub_type: 杂志文章

    doi:10.1212/wnl.53.9.1992

    authors: Andersen K,Launer LJ,Dewey ME,Letenneur L,Ott A,Copeland JR,Dartigues JF,Kragh-Sorensen P,Baldereschi M,Brayne C,Lobo A,Martinez-Lage JM,Stijnen T,Hofman A

    更新日期:1999-12-10 00:00:00

  • Neoplastic meningitis-related encephalopathy: prognostic significance.

    abstract::Two cohorts of 20 patients diagnosed with neoplastic meningitis (NM) with or without encephalopathy were matched with respect to age, sex, primary tumor, and performance status. Median survival was 10 weeks (range 6 to 20 weeks) in the cohort with NM-related encephalopathy compared to 24 weeks (range 8 to 40 weeks) in...

    journal_title:Neurology

    pub_type: 杂志文章

    doi:10.1212/01.wnl.0000145599.06491.71

    authors: Chamberlain MC,Tsao-Wei D,Groshen S

    更新日期:2004-12-14 00:00:00

  • Associations with autoimmune disorders and HLA class I and II antigens in inclusion body myositis.

    abstract::Whether autoimmune mechanisms play a role in the pathogenesis of inclusion body myositis (IBM) is unknown. Human leukocyte antigen (HLA) analysis in 52 patients, including 17 with autoimmune disorders (AIDs), showed that patients were more likely to have antigens from the autoimmune-prone HLA-B8-DR3 ancestral haplotyp...

    journal_title:Neurology

    pub_type: 杂志文章

    doi:10.1212/01.wnl.0000148588.15052.4c

    authors: Badrising UA,Schreuder GM,Giphart MJ,Geleijns K,Verschuuren JJ,Wintzen AR,Maat-Schieman ML,van Doorn P,van Engelen BG,Faber CG,Hoogendijk JE,de Jager AE,Koehler PJ,de Visser M,van Duinen SG,Dutch IBM Study Group.

    更新日期:2004-12-28 00:00:00

  • Disordered swallowing due to a syrinx: correction by shunting.

    abstract::Disturbed deglutition is common in diseases of the brainstem and lower cranial nerves, but little is known about the mechanisms involved. We studied a 49-year-old man with symptoms of syringomyelia and syringobulbia lasting 7 years. Esophageal motility studies showed inability to initiate swallowing, esophageal hypomo...

    journal_title:Neurology

    pub_type: 杂志文章

    doi:10.1212/wnl.34.11.1497

    authors: Bleck TP,Shannon KM

    更新日期:1984-11-01 00:00:00

  • Tolcapone in stable Parkinson's disease: efficacy and safety of long-term treatment. The Tolcapone Stable Study Group.

    abstract::In this double-blind, placebo-controlled trial, we investigated the effect of the catechol-O-methyltransferase inhibitor tolcapone 100 or 200 mg three times daily on activities of daily living and motor function in 298 patients with parkinsonism receiving levodopa but without motor fluctuations. At 6 months, both dosa...

    journal_title:Neurology

    pub_type: 临床试验,杂志文章,随机对照试验

    doi:10.1212/wnl.49.3.665

    authors: Waters CH,Kurth M,Bailey P,Shulman LM,LeWitt P,Dorflinger E,Deptula D,Pedder S

    更新日期:1997-09-01 00:00:00

  • Head growth and neurodevelopment of infants born to HIV-1-infected drug-using women.

    abstract:OBJECTIVE:To describe neurodevelopment and head growth in HIV-1-infected and exposed uninfected infants with and without in utero exposure to opiates and cocaine. METHODS:Using data from a multicenter cohort study of HIV-1-infected women and their children, the authors fit repeated measures regression models to estima...

    journal_title:Neurology

    pub_type: 杂志文章,多中心研究

    doi:10.1212/wnl.57.8.1402

    authors: Macmillan C,Magder LS,Brouwers P,Chase C,Hittelman J,Lasky T,Malee K,Mellins CA,Velez-Borras J

    更新日期:2001-10-23 00:00:00

  • A randomized, double-blind, placebo-controlled trial of simvastatin to treat Alzheimer disease.

    abstract:BACKGROUND:Lowering cholesterol is associated with reduced CNS amyloid deposition and increased dietary cholesterol increases amyloid accumulation in animal studies. Epidemiologic data suggest that use of 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitors (statins) may decrease the risk of Alzheimer d...

    journal_title:Neurology

    pub_type: 杂志文章,随机对照试验

    doi:10.1212/WNL.0b013e318228bf11

    authors: Sano M,Bell KL,Galasko D,Galvin JE,Thomas RG,van Dyck CH,Aisen PS

    更新日期:2011-08-09 00:00:00

  • Multiple biomarkers covering distinct pathways for predicting outcomes after ischemic stroke.

    abstract:OBJECTIVE:To study the prognostic significance of multiple novel biomarkers in combination after ischemic stroke. METHODS:We derived data from the China Antihypertensive Trial in Acute Ischemic Stroke, and 12 informative biomarkers were measured. The primary outcome was the combination of death and major disability (m...

    journal_title:Neurology

    pub_type: 杂志文章

    doi:10.1212/WNL.0000000000006717

    authors: Zhong C,Zhu Z,Wang A,Xu T,Bu X,Peng H,Yang J,Han L,Chen J,Xu T,Peng Y,Wang J,Li Q,Ju Z,Geng D,He J,Zhang Y

    更新日期:2019-01-22 00:00:00

  • A randomized, double-blind, placebo-controlled trial of deprenyl and thioctic acid in human immunodeficiency virus-associated cognitive impairment. Dana Consortium on the Therapy of HIV Dementia and Related Cognitive Disorders.

    abstract::Cognitive impairment is a frequent manifestation of advanced human immunodeficiency virus (HIV) infection. The response to antiretroviral medication is often partial and poorly sustained. Recent studies suggest that free radical production within the CNS and neuronal apoptosis may play important roles in the pathogene...

    journal_title:Neurology

    pub_type: 临床试验,杂志文章,随机对照试验

    doi:10.1212/wnl.50.3.645

    authors:

    更新日期:1998-03-01 00:00:00

  • Migraine and the risk of cervical artery dissection: a case-control study.

    abstract::The association between migraine and cervical artery dissection (CAD) was explored in a hospital-based case-control study. Migraine was present in 49.1% (23/47) of patients with CAD and in 21% (11/52) of patients hospitalized for a cerebral ischemic event not related to a CAD (adjusted odds ratio = 3.6; 1.5 to 8.6, p ...

    journal_title:Neurology

    pub_type: 杂志文章

    doi:10.1212/wnl.59.3.435

    authors: Tzourio C,Benslamia L,Guillon B,Aïdi S,Bertrand M,Berthet K,Bousser MG

    更新日期:2002-08-13 00:00:00

  • Diagnosis of Creutzfeldt-Jakob disease: effect of clinical criteria on incidence estimates.

    abstract:OBJECTIVE:To assess the effect of usage of three different versions of Creutzfeldt-Jakob disease (CJD) diagnostic criteria on estimates of CJD incidence. METHODS:A total of 428 patients referred for suspected sporadic CJD between 1991 and 1997 were classified according to different criteria to be compared after analys...

    journal_title:Neurology

    pub_type: 杂志文章

    doi:10.1212/wnl.54.5.1095

    authors: Brandel JP,Delasnerie-Lauprêtre N,Laplanche JL,Hauw JJ,Alpérovitch A

    更新日期:2000-03-14 00:00:00

  • Multiple sclerosis in Saudi Arabia.

    abstract::There are indications of increasing incidence of MS in Saudi Arabia. Of 806 neurology inpatients, 16 had MS, 21 myasthenia gravis, and 10 amyotrophic lateral sclerosis, with a ratio of 1:1.3:0.6, respectively. The symptomatology and site of lesions are similar to that seen in the West, but the course and evolution mig...

    journal_title:Neurology

    pub_type: 杂志文章

    doi:10.1212/wnl.38.4.621

    authors: Yaqub BA,Daif AK

    更新日期:1988-04-01 00:00:00

  • Psychometric evaluation of a new sensory scale in immune-mediated polyneuropathies. Inflammatory Neuropathy Cause and Treatment (INCAT) Group.

    abstract:OBJECTIVE:To perform a psychometric evaluation of the inflammatory neuropathy cause and treatment (INCAT) sensory sumscore (ISS) in sensory-motor immune-mediated polyneuropathies. This new sensory scale was evaluated to strive for uniformity in assessing sensory deficit in these disorders. METHODS:The ISS comprises vi...

    journal_title:Neurology

    pub_type: 杂志文章

    doi:10.1212/wnl.54.4.943

    authors: Merkies IS,Schmitz PI,van der Meché FG,van Doorn PA

    更新日期:2000-02-22 00:00:00

  • Autonomic function in parkinsonian patients relates to duration of disease.

    abstract::Autonomic functions were studied after withdrawal of all medication in parkinsonian out-patients with short and long duration of disease and in age-matched healthy control subjects. Vagal heart control and noradrenergic response to standing were impaired and related to duration of symptoms of idiopathic parkinsonism. ...

    journal_title:Neurology

    pub_type: 杂志文章

    doi:10.1212/wnl.37.7.1173

    authors: Orskov L,Jakobsen J,Dupont E,de Fine Olivarius B,Christensen NJ

    更新日期:1987-07-01 00:00:00