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Fig. 2A —Pretreatment and early posttreatment imaging in 64-year-old
man with 2 hours of aphasia and right hemiparesis who underwent IV recombinant
tissue plasminogen activator therapy within 3-hour time window recommended for
IV therapy. Pretreatment axial maximum-intensity-projection image from CT
angiogram (A) shows almost complete occlusion of M1 segment of the left
middle cerebral artery. Pretreatment perfusion CT image (B) shows
cerebral blood volume deficit (dark blue) in posterior left temporal
lobe with sparing of anterior left temporal lobe. However, cerebral blood flow
image (C) shows decreased cerebral blood flow and mean transit time
(MTT) image (D) shows prolonged MTT (dark blue) in both
anterior portion and posterior portion of left temporal lobe. Thus, posterior
temporal lobe likely represents infarcted tissue (both MTT/cerebral blood flow
and cerebral blood volume abnormality) and anterior temporal lobe may
represent salvageable tissue or ischemic penumbra (MTT/cerebral blood flow
abnormality with normal cerebral blood volume).
