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Perfusion CT of the Brain Using 40-mm-Wide Detector and Toggling Table Technique for Initial Imaging of Acute Stroke

¹ Department of Radiology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam-si, 463-707, Korea.
² Department of Neurology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam-si, Korea.

View larger version (15K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1 —Toggling table technique. Scanning with 40-mm coverage in z-axis starts at upper half of object (A). Then table moves upward to locate lower half of object under x-ray tube (B) and next scan (C) is performed. Next, table moves backward to original position (D) and second cycle of scanning (A*) is repeated.

View larger version (94K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2 —Perfusion maps of cerebral blood volume (CBV), cerebral blood flow (CBF), mean transit time (MTT), and time to peak (TTP) obtained by toggling table technique in 71-year-old woman with occlusion of right middle cerebral artery.

View larger version (67K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3 —84-year-old woman (patient 2) with large perfusion abnormality in left middle cerebral artery territory. Cerebral blood volume (CBV) decreases focally in left periventricular region (arrows), whereas cerebral blood flow (CBF) decreases more widely (arrows). Mean transit time (MTT) and time to peak (TTP) are also prolonged (arrows). Twenty-millimeter-coverage perfusion CT at basal ganglia level also detected lesion. Follow-up MR angiography (MRA) and diffusion-weighted imaging (DWI) show occlusion of left internal carotid artery through left middle cerebral artery (arrow) and large acute infarction in left corona radiata (arrows), respectively.

View larger version (73K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4 —67-year-old woman (patient 28) with large perfusion abnormality in entire territory of posterior circulation. Cerebral blood volume (CBV) increases in brainstem, cerebellum, thalamus, and occipital lobes bilaterally (arrows), whereas cerebral blood flow (CBF) is near normal (arrows). Mean transit time (MTT) and time to peak (TTP) are prolonged (arrows). Twenty-millimeter-coverage perfusion CT at level of basal ganglia detected lesion at thalamus and occipital lobes only. Follow-up MR angiography (MRA) and diffusion-weighted imaging (DWI) show occlusion of basilar artery and both posterior cerebral arteries (arrow) and small acute infarction in right pons (arrow), respectively.

View larger version (53K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 5 —66-year-old man (patient 36) with focal perfusion abnormality at superior cortex. Focal perfusion abnormality is found at left precentral and postcentral gyri (arrow), which was missed on 20-mm-coverage perfusion CT. Follow-up MR angiography (MRA) and diffusion-weighted imaging (DWI) show focal stenosis only at right middle cerebral artery bifurcation, but acute infarction at left superior cortex (arrows). CBV = cerebral blood volume, CBF = cerebral blood flow, MTT = mean transit time, and TTP = time to peak.

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