Neurovascular Imaging Laboratory, Ingham Institute for Applied Medical Research, Clinical Sciences Stream, Sydney, Australia; University of New South Wales (UNSW), South Western Sydney Clinical School, NSW, Australia.
Neurovascular Imaging Laboratory, Ingham Institute for Applied Medical Research, Clinical Sciences Stream, Sydney, Australia; Department of Neurology - Neurophysiology, Liverpool Hospital - South West Sydney Local Health District (SWSLHD), Sydney, Australia;University of New South Wales (UNSW), South Western Sydney Clinical School, NSW, Australia; Ingham Institute for Applied Medical Research, Stroke - Neurology Research Group, Sydney, Australia; NSW Brain Clot Bank, NSW Health Statewide Biobank and NSW Health Pathology, Sydney, NSW, Australia;Thrombolysis and Endovascular WorkFLOw Network (TEFLON), Sydney, Australia.
Diagn Interv Radiol. 2021 Nov;27(6):774-785. doi: 10.5152/dir.2021.20805.
Noninvasive imaging plays an important role in acute stroke towards diagnosis and ongoing management of patients. Systemic thrombolysis and endovascular thrombectomy (EVT) are proven treatments currently used in standards of care in acute stroke settings. The role of computed tomography angiography (CTA) in selecting patients with large vessel occlusion for EVT is well established. However, the value of CT perfusion (CTP) imaging in predicting outcomes after stroke remains ambiguous. This article critically evaluates the value of multimodal CT imaging in early diagnosis and prognosis of acute ischemic stroke with a focus on the role of CTP in delineating tissue characteristics, patient selection, and outcomes after reperfusion therapy. Insights on various technical and clinical considerations relevant to CTP applications in acute ischemic stroke, recommendations for existing workflow, and future areas of research are discussed.
非侵入性影像学在急性中风的诊断和患者的持续管理中发挥着重要作用。目前，系统溶栓和血管内血栓切除术（EVT）已被证实为急性中风治疗标准中的有效治疗方法。计算机断层血管造影（CTA）在选择接受 EVT 的大血管闭塞患者方面的作用已得到充分证实。然而，CT 灌注（CTP）成像在预测中风后结局方面的价值仍存在争议。本文批判性地评估了多模态 CT 成像在急性缺血性中风早期诊断和预后中的价值，重点关注 CTP 在描绘组织特征、患者选择和再灌注治疗后结局方面的作用。讨论了与急性缺血性中风中 CTP 应用相关的各种技术和临床注意事项、对现有工作流程的建议以及未来的研究领域。
