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.
CA0383-CT Perfusion
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CA0383-CT Perfusion
Case ReportExam
Prior Study
Hyperacute very focal intraluminal thrombus in a single mid insular M3 branch off the superior division Lt. MCA; stroke-age would likely be hyperacute.
Findings
CT perfusion
There is prolonged TTP and MTT in posterior insula & adjacent opercular and retrosylvian areas. This matches the posterior three branches of the M3 segment and their distal M4 perfusion zones. This is a wider territory of slowed filling time than can be accounted for by a single branch acute thrombus as evident on the noncontrast CT head. The anterior group of M3 intrasylvian artery perfusion zones are normal as is the ipsilateral P4 PCA perfusion zone.
CBV and CBF are minimally increased in the area of the prolonged TTP, which is likely related to the physiologic hyperemia witihin the collateral zone. No focally reduced CBV is evident in the area suspected as a stroke zone in the mid insular region to confirm completed stroke.
The initial post contrast CTA (included in our CT perfusion protocol) demonstrates a focal area of significantly reduced CT density within the venocapillary pool in the mid insula consistent with a potential stroke zone that is certainly less obvious on the CBV and CBF, but is evident in retrospect.
Impression
2. The wider area of both prolonged TTP/MTT (compared to the CT) suggests that there is additional thrombus in the more proximal M3 trunk that is not currently hyperdense on CT.
