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Case Studies | Radiology and Medical Imaging Sciences | India | Volume 13 Issue 6, June 2024 | Rating: 5 / 10
CT Perfusion in Early Stroke Detection: Assessing the Accuracy and Diagnostic Value Over NCCT (A Study Of 50 Patients)
Dr. Sahil Patel | Dr. Maulik Jethva [2] | Dr. Anjana Trivedi [5] | Dr. Shefali Kamdar
Abstract: Introduction: A stroke is defined by abrupt onset of a neurologic deficit that is attributable to disruption of blood flow to a focal region of the brain due to a focal vascular cause. Stroke can be classified in to two categories: 1) Ischemic stroke 80 - 85% and 2) Hemorrhagic stroke 15 - 20%. Brain stroke is one of the most important causes of death and disability. It is third most common cause of death worldwide. Age adjusted prevalence rate of stroke in India is 250 - 350/100, 000. Estimated stroke related death is 1.2 % of the total deaths. CT scanning has become a versatile tool in assessing stroke. Limitation of a NCCT scan is that up to 40% of stroke patients have normal scan in first few hours. It cannot detect early signs of ischemia. Recent advance in the field has come up with MDCT in evaluation of ischemic cerebral penumbra. Purpose of present study was to determine role of CT PERFUSION in early detection of stroke. CT PERFUSION parameter images enable us to make distinction between irreversibly damaged infarct core & the potentially reversibly damaged penumbra. Stroke imaging involves evaluation of 4 "P"s: 1) Evaluation of Parenchyma.2) Evaluation of cerebral blood vessels (Pipes).3) Evaluation of Perfusion and 4) Penumbra. This study principally aims to highlight the role of CT PERFUSION to diagnose & confirm the occurrence of stroke as early as possible, to assess potentially salvageable brain tissue and irreversibly infracted tissue, to increase the sensitivity and specificity of stroke diagnosis over that of NCCT and to provide diagnostic value in differentiation between reversibly and irreversibly damaged brain tissue. Materials and Method: CT PERFUSION Scan of 50 patients who presented with hemiplegia within12 hours of clinical signs and symptoms were analyzed and findings of CT PERFUSION Scan were correlated with relevant clinical history/investigations pertaining to patient?s complaint and was evaluated for diagnosis from the case records/registers. The present study was conducted in the Department of Radio diagnosis and Imaging, at our hospital from December 2022 to December 2023. Results: Among 50 patients, 30 males (60%) and 20 females (40%) were studied. Patients were followed up by NCCT scan.10 patients (20%) showed infarct on NCCT, no evidence of penumbra on perfusion scan, no change in follow up scan as compared to initial scan.20 patients (40%) showed normal initial NCCT scan, no evidence of penumbra on perfusion scan & normal follow up scan; suggested Transient Ischemic Attack (TIA), with no damage to cerebral parenchyma.20 patients (40%) showed early signs of ischemia but no hypodense area (infarct) on initial NCCT, there was evidence of penumbra with infarct core on perfusion scan, which on follow up scan developed in to infarct. CT PERFUSION detected presence & absence of penumbra in all 30 patients. CT PERFUSION had differentiated between penumbra & infarct core in all 30 patients; hence accuracy was 100%. Conclusion: CT PERFUSION remains accurate & helpful in early diagnosis & confirmation of stroke over NCCT & differentiation between potentially salvageable brain tissue and irreversibly infracted tissue. This is very helpful to decide thrombolytic therapy in management of acute stroke patients which would be beneficial to restrict infarct size.
Keywords: Stroke, CT PERFUSION, NCCT, Infarct
Edition: Volume 13 Issue 6, June 2024,
Pages: 1553 - 1561