This is an education resource only. Ordering of all procedure codes on this website are subject to the Canberra Health Services guidelines for imaging orders.
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
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Muscular: difficulty walking, paralysis with weak muscles, problems with coordination, or paralysis of one side of the body
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Visual: blurred vision, double vision, sudden visual loss, or temporary loss of vision in one eye
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Speech: difficulty speaking, slurred speech, or speech loss
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Whole body: fatigue, light-headedness, or vertigo
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Limbs: numbness or weakness
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Facial: muscle weakness or numbness
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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.
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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
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Calculation of perfusion parameters (cerebral blood flow, cerebral blood volume, time-to-peak, mean transit time)
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Identification of penumbra vs infarct core
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PATIENT PREPARATION
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Patient able to lie still for 15 minutes
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Not claustrophobic (sedation may be given)
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Cognitively capable of following basic instructions
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Metal artefacts removed from the region of interest
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No respiratory distress when lying supine
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Not allergic to Iodine based Contrast
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Patient to have 18G cannula in anterior cubital fossa to allow a 7ml/s flow rate (20G cannula acceptable if flushing to 5ml/s)
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Preferably patient fasted for 4 hours
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Neurology to be present for scan.
ANATOMY INCLUDED
CT 4D Perfusion (Axial)
CT 4D Perfusion (Coronal)
REFERENCES
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Radiopaedia. CT Head. [Internet]. 2010 [updated 01 Dec 2021, cited 23 Nov 2021]. Available from https://radiopaedia.org/articles/ct-head
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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
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Radiopaedia. Ischaemic Stroke. [Internet]. 2011. [updated 25 Nov 2021, accessed 25 Nov 2021]. Available from https://radiopaedia.org/articles/ischaemic-stroke
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Radiopaedia. Stroke. [Internet]. 2009. [updated 19 Apr 2021, accessed 23 Nov 2021]. Available from https://radiopaedia.org/articles/stroke?lang=gb
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Birenbaum D, Bancroft LW, Felsberg GJ. Imaging in Acute Stroke. 2011. Western Journal of Emergency Medicine. 12 (1). 67-76.
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Eisenberg RL., Johnson NM. Comprehensive Radiographic Pathology. 5th Edition. Elsevier Mosby, 2012