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Comprehensive Imaging of Ischemic Stroke with Multisection CT¹

¹ From the Division of Neuroradiology, Department of Neurosurgery (B.F.T., W.J.H., K.E.E.) and the Departments of Neurology (R.H., B.S., F.R.) and Internal Medicine II (S.F.M.), University of Erlangen-Nuremberg, Schwabachanlage 6, D-91054 Erlangen, Germany; and Siemens Medical Solutions, Forchheim, Germany (E.K.). Recipient of a Magna Cum Laude award for an education exhibit at the 2001 RSNA scientific assembly. Received February 26, 2002; revision requested April 24; final revision received November 14; accepted November 15. Address correspondence to B.F.T. (e-mail: tomandl@neuroradiologie-erlangen.de).

Computed tomography (CT) is an established tool for the diagnosis of ischemic or hemorrhagic stroke. Nonenhanced CT can help exclude hemorrhage and detect "early signs" of infarction but cannot reliably demonstrate irreversibly damaged brain tissue in the hyperacute stage of ischemic stroke. Further evaluation of patients with ischemic stroke should include differentiation between reversible and irreversible brain damage, which is essential for choosing an appropriate therapy. Perfusion CT provides information about brain perfusion, which permits differentiation of irreversibly damaged brain tissue from reversibly impaired "tissue at risk." CT angiography can help detect stenosis or occlusion of extra- and intracranial arteries. Multisection CT allows the combined use of all three imaging modalities—nonenhanced CT, perfusion CT, and CT angiography—to rapidly obtain comprehensive information regarding the extent of ischemic damage in acute stroke patients. Specific patterns of findings are typically seen in ischemic stroke and can be analyzed more accurately with the combined use of multisection CT and MR imaging. Nevertheless, prospective studies involving a large number of patients will be needed to ascertain the treatment of choice for patients with each of these patterns of findings.

© RSNA, 2003

Index Terms: Brain, CT, 10.1211 • Brain, infarction, 10.781 • Brain, ischemia, 10.781

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