title: Clinical application of perfusion computed tomography in neurosurgery.
abstract: OBJECTIVE
  Currently, perfusion CT (PCT) is a valuable imaging technique that has been successfully applied to the clinical management of patients with ischemic stroke and aneurysmal subarachnoid hemorrhage (SAH). However, recent literature and the authors' experience have shown that PCT has many more important clinical applications in a variety of neurosurgical conditions. Therefore, the authors share their experiences of its application in various diseases of the cerebrovascular, neurotraumatology, and neurooncology fields and review the pertinent literature regarding expanding PCT applications for neurosurgical conditions, including pitfalls and future developments.
  
  
  METHODS
  A pertinent literature search was conducted of English-language articles describing original research, case series, and case reports from 1990 to 2011 involving PCT and with relevance and applicability to neurosurgical disorders.
  
  
  RESULTS
  In the cerebrovascular field, PCT is already in use as a diagnostic tool for patients suspected of having an ischemic stroke. Perfusion CT can be used to identify and define the extent of the infarct core and ischemic penumbra core, and thus aid patient selection for acute reperfusion therapy. For patients with aneurysmal SAH, PCT provides assessment of early brain injury, cerebral ischemia, and infarction, in addition to vasospasm. It may also be used to aid case selection for aggressive treatment of patients with poor SAH grade. In terms of oncological applications, PCT can be used as an imaging biomarker to assess angiogenesis and response to antiangiogenetic treatments, differentiate between glioma grades, and distinguish recurrent tumor from radiation necrosis. In the setting of traumatic brain injury, PCT can detect and delineate contusions at an early stage. In patients with mild head injury, PCT results have been shown to correlate with the severity and duration of postconcussion syndrome. In patients with moderate or severe head injury, PCT results have been shown to correlate with patients' functional outcome.
  
  
  CONCLUSIONS
  Perfusion CT provides quantitative and qualitative data that can add diagnostic and prognostic value in a number of neurosurgical disorders, and also help with clinical decision making. With emerging new technical developments in PCT, such as characterization of blood-brain barrier permeability and whole-brain PCT, this technique is expected to provide more and more insight into the pathophysiology of many neurosurgical conditions.
authors.affiliation: Division of Neurosurgery.
authors.forename: Abel Po-Hao
authors.initials: AP
authors.lastname: Huang
authors.forename: Jui-Chang
authors.initials: JC
authors.lastname: Tsai
authors.forename: Lu-Ting
authors.initials: LT
authors.lastname: Kuo
authors.forename: Chung-Wei
authors.initials: CW
authors.lastname: Lee
authors.forename: Hong-Shiee
authors.initials: HS
authors.lastname: Lai
authors.forename: Li-Kai
authors.initials: LK
authors.lastname: Tsai
authors.forename: Sheng-Jean
authors.initials: SJ
authors.lastname: Huang
authors.forename: Chien-Min
authors.initials: CM
authors.lastname: Chen
authors.forename: Yuan-Shen
authors.initials: YS
authors.lastname: Chen
authors.forename: Hao-Yu
authors.initials: HY
authors.lastname: Chuang
authors.forename: Max
authors.initials: M
authors.lastname: Wintermark
mesh_terms: D001930:Brain Injuries / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000601:surgery*; D002545:Brain Ischemia / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000601:surgery; D001932:Brain Neoplasms / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000601:surgery*; D002544:Cerebral Infarction / Q000175:diagnosis / Q000000981:diagnostic imaging; D002548:Cerebral Revascularization; D002561:Cerebrovascular Disorders / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000601:surgery*; D003399:Craniotomy; D018450:Disease Progression; D006439:Hemodynamics / Q000502:physiology; D006706:Homeostasis; D006801:Humans; D020300:Intracranial Hemorrhages / Q000175:diagnosis / Q000000981:diagnostic imaging; D009072:Moyamoya Disease / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000601:surgery; D009493:Neurosurgery / Q000379:methods*; D055420:Perfusion Imaging / Q000379:methods*; D011183:Postoperative Complications / Q000175:diagnosis / Q000000981:diagnostic imaging; D015607:Stents; D020521:Stroke / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000601:surgery; D013345:Subarachnoid Hemorrhage / Q000175:diagnosis / Q000000981:diagnostic imaging; D014057:Tomography, X-Ray Computed / Q000379:methods*