Keywords:
CT-Angiography, Neuroradiology brain, Experimental investigations, Ischaemia / Infarction
Authors:
M. A. Rios Vives1, P. Coscojuela2, V. Wijk2, S. Boned2, A. García-Tornel2, M. Muchada2, M. Ribo2, C. Molina2, M. Rubiera2; 1BARCELONA, BA/ES, 2Barcelona/ES
DOI:
10.26044/ecr2019/C-3784
Conclusion
Evaluation of CC has emerged in the last years as a relevant indicator of outcome in acute stroke patients.
This study shows the feasibility of a quick and easy method to evaluate CC on CTP: a single cortical ROI freehand-drawn on the semi-automated CTP maps generated during the acute stroke evaluation.
The absolute cCBV-ROI is immediately provided,
and if higher than 2.83 ml/cc,
the patient probably presents good CC,
and a high probability of a low infarct volume after 24 hours.
Usually,
CTA or mCTA are used to determine CC status before reperfusion treatments.
However,
knowledge of the established infarct core,
especially in doubtful cases,
may help to select those patients with better probability of a favorable outcome.
Therefore,
CTP is frequently used in combination with CTA and NCCT to obtain information about ischemic parenchyma.
Our easy method could rapidly identify in common CTP maps the degree of CC,
adding this information to the core and penumbra data from CTP,
and saving time from the complicated methodology needed to graduate CC on mCTA or previous CTP methods.
It could also bring a significant reduction in radiation dose,
if the two successive cerebral acquisitions required for the mCTA evaluation of CC were suppressed.
However,
it is interesting to remark that in our series,
the stronger predictor of low infarct volume,
and favorable clinical outcome was complete recanalization.
Even in patients with poor CC,
an early and complete recanalization would probably generate success of the reperfusion therapies.
Therefore,
the use of CC evaluation as a selection tool for reperfusion therapies is highly controversial.
On the contrary,
it may be considered as a prognostic tool,
and may indicate the need of a quick recanalization,
which can help in the decision-making of those patients requiring long transfers for endovascular reperfusion therapies.