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.
CA0392-CT Perfusion
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CA0392-CT Perfusion
Case ReportExam
Prior Study
Changes consistent with hyperacute stroke in the Lt. lateral lenticulostriate and the Lt. superior division MCA regions. This makes the likely level of occlusion in the Lt. M1/2 superior division MCA segment.
No intracranial hemorrhage nor hyperdense (acute) thrombotic arterial segments are evident.
Findings
CT perfusion
There is prolonged TTP and reduced CBV & CBF in the Lt. lateral lenticulostriate (branches off the lateral M1 and M2 segments), in the Lt orbitofrontal artery (branch off the M2 segment), and in left M3 anterior insular perfusion zones; sites of reduced CBV are consistent with ischemic injury.
Prolonged TTP but increased CBF/CBV are evident in the Lt. anterior temporal polar area (M1 branch) and distal M4 territories are consistent with physiologic hyperemia in collateral perfusion zone surrounding the stroke-zone.
There may be stroke changes in the superior temporal gyrus, which would suggest involvement of the inferior MCA division as well. However, not all the inferior division is abnormal which means there is PCA (P3 trunk).
The hyperemic regions account for the loss of sulci on the CT head in this area.
There is prolonged TTP with minimal CVF reduction in the right posterior sylvian (M3) area likely from prior ischemic event at less depth and duration as seen anteriorly.
There is some TTP prolongation in the right cerebellar but the CBV/CBF/MTT are within NL limits; correlate for Rt. vertebral artery stenosis.
Impression
2. Compensatory hyperemia is evident surrounding the stroke-zone.
3. Minimally prolonged TTP is evident in the Rt. cerebellar hemisphere, but with normal CBV/CBF/MTT
