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DOI: 10.1148/rg.286085502
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RadioGraphics 2008;28:1673-1687
© RSNA, 2008

CT Protocol for Acute Stroke: Tips and Tricks for General Radiologists1

Enrique Marco de Lucas, MD, Elena Sánchez, MD, Agustín Gutiérrez, PhD, Andrés González Mandly, MD, Eva Ruiz, MD, Alejandro Fernández Flórez, MD, Javier Izquierdo, MD, Javier Arnáiz, MD, Tatiana Piedra, MD, Natalia Valle, MD, Itziar Bañales, MD, and Fernando Quintana, MD

1 From the Department of Diagnostic Radiology, Hospital Universitario Marqués de Valdecilla, Av Valdecilla s/n, 39008 Santander, Cantabria, Spain. Presented as an education exhibit at the 2007 RSNA Annual Meeting. Received January 29, 2008; revision requested March 13; final revision received April 18; accepted April 23. All authors have no financial relationships to disclose. Address correspondence to E.M.d.L. (e-mail: radmle{at}humv.es).

Acute stroke services have been installed in most hospitals in the industrialized world, and dealing with hyperacute stroke has become one of the most frequently performed tasks of the on-call radiologist. Imaging plays a key role in current guidelines for thrombolysis, and knowledge of classic early ischemic signs or depiction of hemorrhage at nonenhanced computed tomography (CT) is necessary (although not sufficient) for a satisfactory imaging study. A modern CT examination must also include perfusion CT and CT angiography. Perfusion CT delineates the ischemic tissue (penumbra) by showing increased mean transit time with decreased cerebral blood flow (CBF) and normal or increased cerebral blood volume (CBV), whereas infarcted tissue manifests with markedly decreased CBF and decreased CBV. CT angiography can depict the occlusion site, help grade collateral blood flow, and help characterize carotid atherosclerotic disease. A complete CT study (nonenhanced CT, perfusion CT, and CT angiography) may be performed and analyzed rapidly and easily by general radiologists using a simple standardized protocol and may even facilitate diagnosis by less experienced radiologists in affected patients.

© RSNA, 2008






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