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Advances in CT Technology: Implications for the Diagnosis and Treatment of Stroke

Advances in CT Technology: Implications for the Diagnosis and Treatment of Stroke . Stephen Huff, MD Associate Professor Department of Emergency Medicine University of Virginia. Disclosures. Executive Board, Foundation for Education and Research in Neurologic Emergencies. CTA and CTP.

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Advances in CT Technology: Implications for the Diagnosis and Treatment of Stroke

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  1. Advances in CTTechnology:Implications for the Diagnosis and Treatment of Stroke

  2. Stephen Huff, MDAssociate ProfessorDepartment of Emergency MedicineUniversity of Virginia

  3. Disclosures • Executive Board, Foundation for Education and Research in Neurologic Emergencies

  4. CTA and CTP • Essential questions • Is there hemorrhage? • Is there a stroke? • Is there large vessel occlusion? • Is there “irreversibly” infarcted core? • Is there “at risk” penumbra? • One contrast bolus yields two datasets • Vessel patency • Infarct versus salvageable penumbra

  5. CT Angio & Perfusion

  6. CT Perfusion Terminology Blood Flow Blood Volume Mean Transit Time or Time to Peak

  7. Definitions

  8. Changes in Cerebral Vascular Physiology with Worsening Circulatory Impairment

  9. Relationship between CBV, CBF, and MTT Blood Flow Blood Volume Mean Transit Time or Time to Peak MTT= Blood Flow / Blood Volume

  10. Case:Value of CTA/CTP within 3 hour window • 50 yo male • CT within hour of symptom onset • Awake, alert, dysarthric • Fixed right sided gaze • Left sided weakness Initial

  11. Case:Value of CTA/CTP within 3 hour window

  12. Case:Value of CTA/CTP within 3 hour window Initial BF BV TTP

  13. Case:Value of CTA/CTP within 3 hour window Initial BF BV TTP 3 day fu

  14. Case:“Wake up” Stroke 0735 at outside hospital

  15. Case: “Wake up” Stroke

  16. Case: “Wake up” Stroke 1030 at stroke center

  17. Case: “Wake up” Stroke 24 hours later at stroke center

  18. Conclusions CTA identifies an occlusive lesion Core infarct (not reversible): Poor blood flow and blood volume with extremely long transit time Ischemic penumbras (reversible): Poor blood flow with increased blood volume and some increase in transit time CTA can distinguish these two Perhaps IV tPA use can be optimized Standard: give IV tPA if within 3 hours

  19. Questions?J. Stephen Huffhuff@virginia.eduwww.ferne.org ferne_emra_2007_caseconf_huff_cta_100907_finalcd 8/5/2014 3:42 AM

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