CT perfusion for acute stroke: Current concepts on technical aspects and clinical applications

Abstract CT perfusion imaging (CTP) is one of the techniques widely applied for assessing perfusion abnormalities of patients with acute stroke and is expected to help in improving patient outcomes in thrombolysis. CTP has certain advantages over MR perfusion. CTP can be swiftly performed with ease immediately after non-contrast CT, which is a prerequisite for deciding the indication of thrombolysis. CTP can routinely provide quantitative data because of the adequate quality of the source images. However, radiation exposure during CTP may be unexpectedly high. Therefore, low-dose protocols with denoising techniques are essential to maintain the radiation dose at less than 200 mGy. With regard to its quantitativeness, CTP data are unreliable. Quantitative values significantly vary among various software mainly because of differences in deconvolution algorithms. Although CTP has many advantages as a perfusion imaging technique, its clinical significance in acute stroke management has not yet been established. Standardization of the procedure and data processing are necessary to elucidate whether CTP can improve patient outcome following thrombolysis.

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