Perfusion imaging with computed tomography: brain and beyond

The availability of rapid imaging with multidetector CT systems and commercial analysis software has made perfusion imaging with CT an everyday technique, not only for the brain but also for other body organs. Perfusion imaging is usually performed as an adjunct to a conventional CT examination and is therefore particularly appropriate when a conventional CT is part of routine clinical protocols. The derived values are reproducible and have been validated against a range of reference techniques. Within neuroradiology, perfusion CT has attracted interest in the assessment of acute stroke but can also be used to assess secondary injury in head trauma and as an adjunct to CT angiography to evaluate cerebral spasm in subarachnoid haemorrhage. Within oncology, perfusion CT provides an imaging correlate for tumour vascularity that can be used to discriminate benign and malignant lesions, as an indicator of tumour aggressiveness, to reveal occult tumour and improve the delineation of tumours during radiotherapy planning, and as a functional assessment of tumour response to therapy. By exploiting the ability of CT systems to quantify contrast enhancement, CT perfusion imaging uses contrast media to assess vascular physiology and so improve diagnosis, prognosis, treatment selection and therapy monitoring.