title: Whole-brain perfusion CT using a toggling table technique to predict final infarct volume in acute ischemic stroke.
abstract: OBJECTIVE
  To evaluate how accurately final infarct volume in acute ischemic stroke can be predicted with perfusion CT (PCT) using a 64-MDCT unit and the toggling table technique.
  
  
  METHODS
  Retrospective analysis of 89 patients with acute ischemic stroke who underwent CCT, CT angiography (CTA) and PCT using the "toggling table" technique within the first three hours after symptom onset. In patients with successful thrombolytic therapy (n = 48) and in those without effective thrombolytic therapy (n = 41), the infarct volume and the volume of the penumbra on PCT were compared to the infarct size on follow-up images (CT or MRI) performed within 8 days. The feasibility of complete infarct volume prediction by 8 cm cranio-caudal coverage was evaluated.
  
  
  RESULTS
  The correlation between the volume of hypoperfusion on PCT defined by cerebral blood volume reduction and final infarct volume was strongest in patients with successful thrombolytic therapy with underestimation of the definite infarct volume by 8.5 ml on average. The CBV map had the greatest prognostic value. In patients without successful thrombolytic therapy, the final infarct volume was overestimated by 12.1 ml compared to the MTT map on PCT. All infarcts were detected completely. There were no false-positive or false-negative results.
  
  
  CONCLUSIONS
  Using PCT and the "toggling table" technique in acute stroke patients is helpful for the rapid and accurate quantification of the minimal final infarct and is therefore a prognostic parameter which has to be evaluated in further studies to assess its impact on therapeutic decision.
  
  
  CONCLUSIONS
  ▶ Using PCT and the “toggling table technique” allows accurate quantification of the infarct core and penumbra. ▶ It is possible to record dynamic perfusion parameters quickly and easily of almost the entire supratentorial brain volume on a 64-slice MDCT unit. ▶ The technique allows identification of those patients who could profit from thrombolytic therapy outside the established time intervals.
authors.affiliation: Department of Radiology and Nuclear Medicine, Städtisches Krankenhaus Kiel.
authors.forename: I
authors.initials: I
authors.lastname: Schrader
authors.forename: D
authors.initials: D
authors.lastname: Wilk
authors.forename: O
authors.initials: O
authors.lastname: Jansen
authors.forename: C
authors.initials: C
authors.lastname: Riedel
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001810:Blood Volume / Q000187:drug effects; D001921:Brain / Q000098:blood supply; D002533:Cerebral Angiography / Q000379:methods*; D002544:Cerebral Infarction / Q000175:diagnosis* / Q000188:drug therapy; D003287:Contrast Media; D038524:Diffusion Magnetic Resonance Imaging / Q000379:methods; D005260:Female; D006801:Humans; D007090:Image Interpretation, Computer-Assisted / Q000379:methods*; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography / Q000379:methods*; D055420:Perfusion Imaging / Q000379:methods*; D011379:Prognosis; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D015912:Thrombolytic Therapy / Q000379:methods; D017585:Ultrasonography, Doppler, Transcranial
chemical_list: D003287:Contrast Media