title: [Imaging of cerebral ischemia within first hours: computed tomography (CT)].
abstract: Imaging of stroke has evolved with the development of stroke units and the CE approval of intravenous thrombolysis in the first three hours after stroke onset. The goal of imaging in the acute phase of stroke is: to make the diagnosis of stroke; to rule out other diagnosis (above all hemorrhagic strokes); to precise the location of the arterial occlusion; to assess the level of hypoperfusion; to evaluate the viability and reversibility of brain lesions; to understand the origin of the stroke by evaluating cervical arteries. Constraints of imaging in the acute phase of stroke are: the need to be performed as fast as possible to not delay IV thrombolysis (time is brain); machines must be available 24 hours a day, 7 days a week as close as possible to the stroke unit. The aim of imaging are: in routine practice to evaluate the likely benefits (provided by penumbra imaging) and risks of IV thrombolysis; in term of "evidence based medicine" to better evaluate new specific stroke therapies in randomized studies (IV thrombolysis between 3 to 4 hours, use of anti GpIIbIIIa, intra-arterial mechanical or chemical thrombolysis...). Magnetic resonance imaging is considered the goal standard of stroke imaging allowing to evaluate in a "one stop shopping" the level of arterial occlusion, hypoperfusion and brain viability. However, stroke management is a regional issue and performing MR in extreme emergency is almost impossible in all stroke units outside or even within university hospitals 24 hours a day. CT-perfusion and CT angiography are therefore an accurate alternative tool for acute stroke imaging. Multislice CT is indeed available in almost all stroke units. The examination is very time-saving and clinically relevant to make the decision for IV thrombolysis.
authors.affiliation: Service de Neuroradiologie Diagnostique et Thérapeutique, Hôpital Purpan et Hôpital Rangueil, place du Docteur-Baylac, TSA 40031, 31059 Toulouse Cedex. januel.ac@chu-toulouse.fr
authors.forename: A-C
authors.initials: AC
authors.lastname: Januel
authors.forename: T
authors.initials: T
authors.lastname: Tailleur
authors.forename: F
authors.initials: F
authors.lastname: Loubes-Lacroix
authors.forename: I
authors.initials: I
authors.lastname: Catalaa
authors.forename: M
authors.initials: M
authors.lastname: Irsutti-Fjortoft
authors.forename: S
authors.initials: S
authors.lastname: Molinier
authors.forename: P
authors.initials: P
authors.lastname: Tall
authors.forename: C
authors.initials: C
authors.lastname: Manelfe
authors.forename: C
authors.initials: C
authors.lastname: Cognard
mesh_terms: D000328:Adult; D000368:Aged; D002545:Brain Ischemia / Q000000981:diagnostic imaging* / Q000188:drug therapy; D002533:Cerebral Angiography / Q000379:methods; D002544:Cerebral Infarction / Q000000981:diagnostic imaging / Q000188:drug therapy; D002560:Cerebrovascular Circulation / Q000502:physiology; D003657:Decision Making; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000379:methods; D008297:Male; D019039:Platelet Glycoprotein GPIIb-IIIa Complex / Q000627:therapeutic use; D012307:Risk Factors; D015912:Thrombolytic Therapy; D013997:Time Factors; D014022:Tissue Survival / Q000502:physiology; D014057:Tomography, X-Ray Computed / Q000379:methods*; D016896:Treatment Outcome
chemical_list: D005343:Fibrinolytic Agents; D019039:Platelet Glycoprotein GPIIb-IIIa Complex