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CT ANGIOGRAPHY BRAIN PERFUSION

*This code should only be ordered after consultation with the stroke neurologist. This code is used if a Non Contrast Brain and a CT Arch to COW angio has already been performed.

CT Perfusion indications

INDICATIONS (1-5)

*This code should only be ordered after consultation with the stroke neurologist. This code is for if a Non Contrast Brain and a CT Arch to COW angio has already been performed.
IF WANTING NON CONTRAST BRAIN + PERFUSION + ARCH TO COW ANGIO-- PLEASE SEE ORDER "CT ANGIOGRAPHY ACUTE STROKE"

Potential neurological symptoms in the presence of an Acute Stroke

  • Muscular: difficulty walking, paralysis with weak muscles, problems with coordination, or paralysis of one side of the body

  • Visual: blurred vision, double vision, sudden visual loss, or temporary loss of vision in one eye

  • Speech: difficulty speaking, slurred speech, or speech loss

  • Whole body: fatigue, light-headedness, or vertigo

  • Limbs: numbness or weakness

  • Facial: muscle weakness or numbness

  • Also common: balance disorder, difficulty swallowing, headache, inability to understand, mental confusion, pins and needles or reduced sensation of touch

 

These symptoms should be assessed for onset and clinical correlation with a neurologists recommendation.

 

  • Assess whether a stroke is haemorrhage or ischaemic in nature to enact the appropriate treatment in a timely manner (e.g. endovascular clot retrieval or intravenous thrombolysis)

PATHOLOGY DEMONSTRATED (6)

Perfusion study

  • Calculation of perfusion parameters (cerebral blood flow, cerebral blood volume, time-to-peak, mean transit time)

  • Identification of penumbra vs infarct core

 

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PATIENT PREPARATION

ct perfuson patient prep
  • Patient able to lie still for 15 minutes

  • Not claustrophobic (sedation may be given)

  • Cognitively capable of following basic instructions

  • Metal artefacts removed from the region of interest

  • No respiratory distress when lying supine

  • Not allergic to Iodine based Contrast

  • Patient to have 18G cannula in anterior cubital fossa to allow a 7ml/s flow rate (20G cannula acceptable if flushing to 5ml/s)

  • Preferably patient fasted for 4 hours

  • Neurology to be present for scan.

ct perfusion anatomy

ANATOMY INCLUDED

axial.gif
CT 4D Perfusion (Axial)
coronal.gif
CT 4D Perfusion (Coronal)

REFERENCES

  1. Radiopaedia. CT Head. [Internet]. 2010 [updated 01 Dec 2021, cited 23 Nov 2021]. Available from https://radiopaedia.org/articles/ct-head

  2. American College of Radiology (ACR). Appropriateness Criteria. [Internet]. 2022 [Updated 2021, cited 23 Nov 2021]. Available from https://www.acr.org/Clinical-Resources/ACR-Appropriateness-Criteria

  3. Radiopaedia. Ischaemic Stroke. [Internet]. 2011. [updated 25 Nov 2021, accessed 25 Nov 2021]. Available from https://radiopaedia.org/articles/ischaemic-stroke

  4. Radiopaedia. Stroke. [Internet]. 2009. [updated 19 Apr 2021, accessed 23 Nov 2021]. Available from https://radiopaedia.org/articles/stroke?lang=gb

  5. Birenbaum D, Bancroft LW, Felsberg GJ. Imaging in Acute Stroke. 2011. Western Journal of Emergency Medicine. 12 (1). 67-76.

  6. Eisenberg RL., Johnson NM. Comprehensive Radiographic Pathology. 5th Edition. Elsevier Mosby, 2012

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