Multimodal CT assessment of acute ischemic stroke

Aim of the workTo evaluate the role of multimodal CT [non-enhanced CT (NECT), CT perfusion (CTP), and CT angiography (CTA)] in selection of acute ischemic stroke patients for reperfusion therapy.Patients and methodsThis prospective study included 35 patients with evidence of acute stroke in the middle cerebral artery territory of less than 12 h duration. Patients underwent multimodal CT including: (1) NECT (2) CTP (3) CTA. Qualitative and quantitative interpretation of the CTP was done to differentiate penumbra and infarction. CTA was evaluated for arterial occlusion or stenosis and the presence of collaterals.ResultsThe areas of infarction showed a significant decrease in CBF (p = 0.03) and CBV values (p = 0.01) compared to the corresponding area in the contralateral normal hemisphere. The areas of penumbra showed a significant decrease in CBF (p = 0.04) and insignificant difference in CBV (p = 0.2) compared to the corresponding area in the contralateral normal hemisphere. Cutoff values of 2.0 for the CBV and MTT > 130% of the contralateral normal hemisphere allowed the best differentiation of infarction and penumbra.ConclusionMultimodal CT imaging fulfills all the requirements for selection of patients for reperfusion therapy and so helps in stroke treatment decisions.