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.
CA0567-CT Perfusion
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CA0567-CT Perfusion
Case ReportHistory
Exam
Prior Study
Focal left retrosylvian vasogenic edema matching the vein of Labbe' venous egress territory. Whether there is cytogenic edema in this area representing venous stroke remains indeterminate.
There is acute thrombus in multiple branches of the left vein of Labbe' without apparent concurrent left transverse sinus thrombosis.
There is no hemorrhagic conversion.
Findings
CT Perfusion
There is evidence of prolonged TTP (slow flow) in the left retrosylvian area with minimal reduction of CBV; this pattern in consistent with a vein of Labbe' thrombosis. The CBV in the focal retrosylvian area of oligemia is reduced but not absent making it difficult to confirm venous stroke on CT perfusion imaging.
There is increase CBV surrounding the site of oligemia consistent with physiologic hyperemia (expected pial venous collateral). Re routing of venous egress from the vein of Labbe' egress zone is evident in two ways. There is increased CBV plus shortened TTP (high flow rate in the venous egress collateral) within the left superior sylvian vein complex draining into the left sphenoparietal sinus and into the cavernous sinus. Additionally, there is increased CBV in the left transverse sinus, especially at the lateral tentorial venous confluence.
The included CTA demonstrates both physiologic arterial hyperemia and unexpected serpiginous vessels (probably collateral pial veins) in the collateral zone surrounding the area of left retrosylvian edema. There is increase blood flow throught the left lateral venous confluence (venous egress re-routing).
Impression
2. There is both collateral zone physiologic hyperemia in the collateral zone surrounding the retrosylvian oligemic area plus evidence of re-routing of venous egress into the left superior sylvian vein complex and left lateral tentorial venous confluence. This accounts for the increased blood volumn (increased CBV) in the cavernous sinus and left transverse sinus.
