CT Perfusion
Claim CME CreditPOINT OF CARE INFORMATION
This CME activity consists of the student reviewing the video of the professor reviewing the case as well as the associated DICOM image set related to the case in question.
Learning Objectives
As a result of participation in this activity, participants should be able to:
- Provide improved patient care.
- Greater knowledge of the imaging characteristics of the patient's disease.
- Understand a better approach to interpretation of studies.
Faculty Disclosure
Mehmet Albayram, MD, Ivan Davis, MD, Mariam Hanna, MD, Anthony Mancuso, MD, Ronald Quisling, MD, Dhanashree Rajderkar, MD, Priya Sharma, MD, Roberta Slater, MD and Joann Stamm, MBA have disclosed that they have no relevant financial relationships. No one else is a position to control content have any financial relationship to disclose.
CME Advisory Committee Disclosure:
Conflict of interest information for the CME Advisory Committee members can be found on the following website: https://cme.ufl.edu/disclosure/.
Continuing Medical Education Credit
Accreditation: The University of Florida College of Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.
Credit: The University of Florida College of Medicine designates this enduring material for a maximum of 0.5 AMA PRA Category 1 Credits. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
CA0362-CT Perfusion
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CA0362-CT Perfusion
Case ReportExam
Prior Study
1. Hyperdense thrombus is evident in the distal basilar artery extending into the left P1 PCA segment.
2. Multiple recent strokes (readily apparent cytogenic edema sites) involving Lt. PICA and both P4 segments of the PCA were evident on noncontrast CT placing these ischemic events outside the hyperacute treatment timeline on the right and within the timeline on the left. There is an evolving older left PICA stroke. There is parenchymal hypdensity in the deep cerebellar watershed zones, which could be recent ischemia or chronic age-related ischemic demyelination. It is likely there has been recent thrombus in the intradural vertebral artery initially occluding the left PICA, which has then undergone clot lysis with distal secondary embolization to downstream arteries.
Findings
CT Perfusion
There is an acute thrombus in distal basilar artery evident on the head CTA included in our CT perfusion protocol.
There is prolonged TTP and MTT in the PCA territories bilaterally, which is worse on the left. There is prolonged TTP & MTT in the mesial left cerebellar PICA territory and to a lesser extent in the cerebellar watershed regions bilaterally.
CBV & CBF are reduced in the Lt. PICA region and in the left P4-PCA mesial occipital areas. CBV & CBF are increased over the superior cerebellum and superior vermis consistent with physiologic hyperemia.
Impression
2. Focal completed stroke is evident in Lt. PICA perfusion zone with estimated age in the acute (not hyperacute) timeframe or older (subacute resorptive phase).
3. Focal, bilateral, mesial occipital strokes are evident corresponding to the P4 PCA perfusion zones with reasonably normal CBV on the right and lower than normal on the left. The ischemia is subcortical on the left and both cortical and subcortical on the right. They both likely affect the visual cortex, although visual loss was not given as a presenting symptom.
