Automated CT perfusion imaging for acute ischemic stroke
Automated CT perfusion imaging for acute ischemic stroke
复制标题
急性缺血性脑卒中的自动 CT 灌注成像
作者：
A. Vagal;M. Wintermark;K. Nael;A. Bivard;M. Parsons;Aaron W. Grossman;P. Khatri
最近的积极试验推动了急性脑灌注成像成为急性缺血性卒中的常规评价。更新的指南指出，在距最后一次明确时间超过6小时的前循环大血管闭塞患者中，需要进行高级成像选择，包括基于灌注的选择。接收急性卒中患者的中心现在必须具备执行和解读CT或磁共振灌注成像的能力，或提供快速转移到能够选择患者进行高影响力血管内治疗的中心，特别是在延迟的时间窗内。许多卒中中心正在迅速采用自动灌注处理软件来解释灌注原始数据。随着CT灌注（CTP）在现实世界的临床实践中被吸收，了解灌注采集、量化和解释的基础知识至关重要。同样重要的是要认识到自动CTP的常见技术和临床诊断挑战，包括缺血性核心和半影错误分类，这可能导致低估或高估核心和半影体积。这篇评论强调了自动CTP的陷阱沿着实用的珍珠，以解决共同的挑战。这是特别定制的，以帮助急性中风临床医生谁必须解释自动灌注研究在紧急情况下，以作出时间依赖性治疗决策的急性缺血性中风患者。
Recent positive trials have thrust acute cerebral perfusion imaging into the routine evaluation of acute ischemic stroke. Updated guidelines state that in patients with anterior circulation large vessel occlusions presenting beyond 6 hours from time last known well, advanced imaging selection including perfusion-based selection is necessary. Centers that receive patients with acute stroke must now have the capability to perform and interpret CT or magnetic resonance perfusion imaging or provide rapid transfer to centers with the capability of selecting patients for a highly impactful endovascular therapy, particularly in delayed time windows. Many stroke centers are quickly incorporating the use of automated perfusion processing software to interpret perfusion raw data. As CT perfusion (CTP) is being assimilated in real-world clinical practice, it is essential to understand the basics of perfusion acquisition, quantification, and interpretation. It is equally important to recognize the common technical and clinical diagnostic challenges of automated CTP including ischemic core and penumbral misclassifications that could result in underestimation or overestimation of the core and penumbra volumes. This review highlights the pitfalls of automated CTP along with practical pearls to address the common challenges. This is particularly tailored to aid the acute stroke clinician who must interpret automated perfusion studies in an emergency setting to make time-dependent treatment decisions for patients with acute ischemic stroke.
影响因子：
2.9
作者：
Sporns, Peter;Schmidt, Rene;Hanning, Uta
通讯作者：
Hanning, Uta