BrainWaves #160 Pluses and minuses of perfusion imaging

MedLink Neurology Podcast is delighted to feature selected episodes from BrainWaves, courtesy of James E Siegler MD, its originator and host. BrainWaves is an academic audio podcast whose mission is to educate medical providers through clinical cases and topical reviews in neurology, medicine, and the humanities, and episodes originally aired from 2016 to 2021.Originally released: April 2, 2020Perfusion imaging employs concepts that date back to the early 1830s, and it leverages hardware and software that emerged around the same time as multidetector helical CT scans. But it has only become popular in recent years for thrombectomy decision-making. If I'm being honest, I often never use it for this purpose. So what other purposes might it serve? And how does it work? This week, we review the fundamental concepts of perfusion CT, its utility in stroke care, and how it might prove useful for other neurologic conditions as well.Produced by James E Siegler. Music courtesy of Julie Maxwell, John Bartmann, Kai Engel, and Pachyderm. Our theme song was composed by Jimothy Dalton. Sound effects by Mike Koenig and Daniel Simion. Some of the voices you heard throughout the program were those of Dr. Mathias Prokop, Radbound Medical Center, Netherlands; Terri Yeager, Comprehensive Stroke Program Coordinator at Cooper University Hospital; and a recording that was produced by GE Healthcare, which is freely available on YouTube. Unless otherwise mentioned in the podcast, no competing financial interests exist in the content of this episode. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision-making. Be sure to follow us on Twitter @brainwavesaudio for the latest updates to the podcast.REFERENCESAlbers GW, Marks MP, Kemp S, et al. Thrombectomy for stroke at 6 to 16 hours with selection by perfusion imaging. N Engl J Med 2018;378(8):708-18. PMID 29364767Barber PA, Demchuk AM, Zhang J, Buchan AM. Validity and reliability of a quantitative computed tomography score in predicting outcome of hyperacute stroke before thrombolytic therapy. ASPECTS Study Group. Alberta Stroke Programme Early CT Score. Lancet 2000;355(9216):1670-4. PMID 10905241Boned S, Padroni M, Rubiera M, et al. Admission CT perfusion may overestimate initial infarct core: the ghost infarct core concept. J Neurointerv Surg 2017;9(1):66-9. PMID 27566491Campbell BC, Christensen S, Levi CR, et al. Comparison of computed tomography perfusion and magnetic resonance imaging perfusion-diffusion mismatch in ischemic stroke. Stroke 2012;43(10):2648-53. PMID 22858726Campbell BC, Weir L, Desmond PM, et al. CT perfusion improves diagnostic accuracy and confidence in acute ischaemic stroke. J Neurol Neurosurg Psychiatry 2013;84(6):613-8. PMID 23355804Campbell BCV, Ma H, Ringleb PA, et al. Extending thrombolysis to 4·5-9 h and wake-up stroke using perfusion imaging: a systematic review and meta-analysis of individual patient data. Lancet 2019;394(10193):139-147. PMID 31128925Mangla R, Ekhom S, Jahromi BS, Almast J, Mangla M, Westesson PL. CT perfusion in acute stroke: know the mimics, potential pitfalls, artifacts, and technical errors. Emerg Radiol 2014;21(1):49-65. PMID 23771605Martins N, Aires A, Mendez Bet al. Ghost Infarct core and admission computed tomography perfusion: redefining the role of neuroimaging in acute ischemic stroke. Interv Neurol 2018;7(6):513-21.