C T Imaging Of Acute Stroke
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This document discusses CT imaging techniques for evaluating acute stroke. It describes CT perfusion imaging which uses a contrast agent bolus to evaluate cerebral blood flow, cerebral blood volume, and mean transit time. These perfusion values can identify the ischemic core with very low blood flow as well as the penumbra of salvageable tissue at risk for infarction. CT angiography is also discussed for evaluating vessel occlusion in thromboembolic stroke.
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This document discusses imaging techniques for diagnosing strokes. It notes that CT scans are the initial test but can miss acute infarcts in up to 40% of cases within 24 hours. Diffusion-weighted MRI can detect strokes within 30 minutes and is more sensitive than CT for early detection. Perfusion imaging provides information on tissue at risk. The document reviews signs of acute infarction on CT and MRI appearances of different stroke types and hemorrhages. It emphasizes the importance of rapidly diagnosing strokes to determine treatment.
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1) The document discusses imaging protocols for acute ischemic stroke, including non-contrast CT (NCCT), CT angiography (CTA), MRI, and thrombectomy procedures.
2) NCCT can help identify hemorrhage as a contraindication to thrombolysis and detect early ischemia. CTA can demonstrate thrombi to guide thrombolysis or thrombectomy and assess vessel occlusion, core infarction, and collaterals.
3) MRI is more sensitive than CT for acute stroke, detecting most infarcts by 24 hours. Diffusion-weighted imaging (DWI) is most sensitive in the first few hours. Perfusion imaging assesses penumbra.
4) For severe strokes,
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This document discusses various imaging modalities for stroke, focusing on their ability to assess the 4 P's: parenchyma, pipes, perfusion, and penumbra. CT techniques like non-contrast CT, CTA, and CTP can quickly detect hemorrhage, visualize vessels for clots, and assess perfusion/penumbra. MRI techniques like DWI, PWI, MRA provide highly sensitive visualization of acute ischemia and perfusion abnormalities to identify the ischemic core and penumbra. Imaging plays a crucial role in the early diagnosis and management of stroke by establishing the diagnosis, guiding therapy decisions, and identifying salvageable brain tissue.
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This document discusses the use of various imaging modalities such as CT, MRI, CTA, and CTP in evaluating patients presenting with acute stroke. It outlines the goals of acute stroke imaging as establishing the diagnosis, obtaining information on vasculature, and guiding appropriate therapy. CT is described as the initial test to rule out hemorrhage and identify early signs of infarction. MRI sequences such as DWI, T2WI, and FLAIR are also summarized. The roles of CTA in evaluating vessels and CTP in identifying tissue at risk of infarction are covered. Imaging findings of ischemic and hemorrhagic stroke subtypes are presented.
Imaging in acute stroke
This document discusses imaging for stroke. It begins by introducing the types and pathophysiology of stroke, including ischemic and hemorrhagic strokes. It then covers the anatomy of arterial circulation and goals of imaging in acute stroke. Key imaging modalities are computed tomography (CT) and magnetic resonance imaging (MRI). CT is useful for quickly ruling out hemorrhage. Early signs of infarction on CT include hypoattenuating brain tissue and obscuration of the lentiform nucleus. MRI is more sensitive for detecting acute infarction and can identify the ischemic penumbra. Imaging aims to assess the brain parenchyma, vessels, perfusion, and potentially salvageable penumbra tissue.
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1) The document discusses imaging in stroke, focusing on various modalities including CT, CT angiography, CT perfusion, MRI, diffusion weighted imaging, and perfusion weighted imaging.
2) These modalities are used to assess the brain parenchyma, vasculature, perfusion, and penumbra (area of reversible ischemia surrounding the irreversibly damaged core).
3) Identification of the penumbra is especially important as this region may be salvageable with early reperfusion and helps guide treatment decisions.
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1) The document discusses imaging protocols for acute ischemic stroke, including non-contrast CT (NCCT), CT angiography (CTA), MRI, and thrombectomy procedures.
2) NCCT can help identify hemorrhage as a contraindication to thrombolysis and detect early ischemia. CTA can demonstrate thrombi to guide thrombolysis or thrombectomy and assess vessel occlusion, core infarction, and collaterals.
3) MRI is more sensitive than CT for acute stroke, detecting most infarcts by 24 hours. Diffusion-weighted imaging (DWI) is most sensitive in the first few hours. Perfusion imaging assesses penumbra.
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This document discusses various imaging modalities for stroke, focusing on their ability to assess the 4 P's: parenchyma, pipes, perfusion, and penumbra. CT techniques like non-contrast CT, CTA, and CTP can quickly detect hemorrhage, visualize vessels for clots, and assess perfusion/penumbra. MRI techniques like DWI, PWI, MRA provide highly sensitive visualization of acute ischemia and perfusion abnormalities to identify the ischemic core and penumbra. Imaging plays a crucial role in the early diagnosis and management of stroke by establishing the diagnosis, guiding therapy decisions, and identifying salvageable brain tissue.
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1) The document discusses imaging in stroke, focusing on various modalities including CT, CT angiography, CT perfusion, MRI, diffusion weighted imaging, and perfusion weighted imaging.
2) These modalities are used to assess the brain parenchyma, vasculature, perfusion, and penumbra (area of reversible ischemia surrounding the irreversibly damaged core).
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CT perfusion (CTP) provides important hemodynamic information about cerebral blood flow, blood volume, and mean transit time that complements CT angiography in the evaluation of acute stroke. CTP can help characterize acute ischemic stroke by identifying critically ischemic tissue in the stroke "core" and potentially salvageable tissue in the "penumbra", guiding treatment decisions about thrombolysis within time windows. A typical CTP exam involves an initial non-contrast CT followed by dynamic contrast-enhanced imaging over 40-60 seconds to generate perfusion maps and quantify key parameters.
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- How MRI works by applying a strong magnetic field to align hydrogen protons in water molecules and using radio waves to excite the protons and produce signals used to form images.
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- Computed tomography perfusion which uses contrast to generate maps of cerebral blood flow, volume, and transit time to identify ischemic tissue.
- Myelography which uses intrathecal contrast for spinal imaging.
- Magnetic resonance techniques like quantitative MRI, diffusion tensor imaging, and MR spectroscopy which provide microstructural data on tissues.
- Perfusion imaging uses ultrasound contrast to assess cerebral blood flow.
Imaging findings are discussed for conditions like multiple sclerosis, epilepsy, and stroke.
Cortical cerebral venous thrombosis (CVT) Management- Dr Ganesh.pptx
Cortical cerebral venous thrombosis (CVT) Management- Dr Ganesh.pptxDr Ganeshgouda Majigoudra Consultant Neurologist Nanjappa hospitals
"Navigating Cortical Cerebral Venous Thrombosis (CVT) Management with Dr. Ganesh"
🌟 Hello, everyone! Dr. Ganesh here, and today, we're delving into a critical topic in neurology: the management of Cortical Cerebral Venous Thrombosis (CVT). Whether you're a healthcare professional, a patient, or simply interested in understanding the complexities of cerebrovascular health, this discussion is crafted to provide valuable insights.Emergency CT: Updates
This talk includes 1) Pan-scan CT for trauma, 2) CTA for active bleeding and 3) multiphase CTA in acute stroke
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CT-SCAN provides concise summaries of medical documents. This document discusses the history and evolution of computed tomography (CT) scanning technology. It begins with definitions of CT scanning and diagrams of early CT scanner designs. It then summarizes the key developments, including the invention of CT scanning by Godfrey Hounsfield in 1971, the installation of the first CT prototype, and improvements in processing time. The document outlines the generations of CT scanners from first to fifth generation and describes advances in multi-slice and multi-detector array technologies. It concludes with examples of clinical applications and cases imaged with various CT techniques.
CT scan of the brain in stroke patients
This document discusses the use of CT scans for evaluating patients with strokes. It covers:
1) What a stroke is and the main types.
2) Why CT scans are commonly used for stroke patients due to advantages like cross-sectional imaging, visualization of small objects, and fast diagnosis.
3) The key components of a CT system and scanning techniques for stroke patients, including contrast administration and dual energy technology advances.
Meyer_Keystone_USAISR_FV
An ex-vivo study found that extracorporeal circulation in an ECLS circuit led to increased pro-thrombotic platelet-derived microparticles (PMPs) over time compared to static controls. While platelet counts and standard coagulation tests did not change, clotting time decreased in the circuit samples. Thrombin generation increased over time in the circuit plasma compared to controls. These results suggest PMPs may enhance thrombosis during ECLS and be a potential therapeutic target to reduce complications.
Cardiac ct ccta
Cardiac CT provides a noninvasive way to evaluate the coronary arteries and cardiac structure. It has largely replaced invasive coronary angiography due to improvements in temporal and spatial resolution allowing for clear images of the heart. Cardiac CT is indicated to rule out coronary artery disease in low-moderate risk patients, assess anomalies, evaluate grafts and stents, and aid in surgical planning. It has limitations including irregular heart rates over 80 bpm, high calcium scores, small vessels, and radiation exposure. Proper patient selection and preparation are important to optimize results.
Tcd sandeep.ppt.oct 2009.ppt
Transcranial Doppler (TCD) uses ultrasound to evaluate blood flow velocity in the brain's intracranial arteries. It is a noninvasive technique that uses probes placed on the head to transmit ultrasound pulses through thin parts of the skull and detect the Doppler shift of reflected signals from moving blood. TCD allows evaluation of conditions like stenosis, occlusion, vasospasm, and collateral flow. It can be used to monitor blood flow during surgery or in intracranial hemorrhage. Interpretation requires identifying vessels based on depth, direction of flow, and spatial relationships to other vessels. The vertebrobasilar system can be more difficult to evaluate due to anatomical variability.
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This document outlines the pathophysiology, clinical presentation, diagnosis, and treatment of ischemic stroke with intravenous tissue plasminogen activator (tPA). It discusses that ischemic stroke is caused by decreased blood flow to the brain and can lead to neuronal cell death. Clinical features and differential diagnosis are provided. It recommends administering intravenous tPA within 3 hours of symptom onset based on evidence from randomized controlled trials showing improved outcomes. Extended time windows up to 4.5 hours may also be considered based on additional trials. Contraindications, management, and local stroke treatment protocols are reviewed.
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The document discusses the benefits of a procedure compared to Kyphon. It can often be done unilaterally rather than bilaterally as with Kyphon. It has high viscosity cement and extended working time, allowing for relaxed two-level vertebral treatment with a single kit or bilateral sacroplasty. This reduces the risk of cement extravasation. The procedure also reduces operator radiation exposure by using physician-controlled hydraulic cement delivery and facilitating sacroplasty through intermittent CT fluoro visualization without moving the patient in and out of the gantry.
Current applications of interventional radiology 97
Interventional radiologists are physicians who specialize in minimally invasive targeted treatments using image guidance. They undergo 4 years of undergraduate education, 4 years of medical school, 5 years of residency training, and 1 year of fellowship training. Interventional radiology pioneered modern medicine by inventing angioplasty and stenting to treat blocked arteries. Some key milestones include the first angioplasty in 1964, development of embolization therapy in the 1960s, and invention of the catheter-delivered stent in the late 1960s and early 1970s. Interventional radiologists now perform a variety of minimally invasive procedures to treat cancer, vascular diseases, trauma, and other conditions.
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Visit our web site at www.radclinic.com!
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C T Imaging Of Acute Stroke
- 1. CT Imaging of acute strokeArun JagannathanVascular and Interventional Radiology
- 3. Thromboembolic Stroke CT Perfusion Rapid qualitative/quantitative evaluation of cerebral perfusion CBF = Cerebral Blood Flow CBV = Cerebral Blood Volume MTT = Mean Transit Time CBF = CBV/MTT www.radclinic.com
- 5. CT Perfusion (CTP) Obtained by monitoring first pass of contrast agent bolus through cerebral vasculature Linear relationship between contrast agent concentration and attenuation (density) ROI = Region of Interest www.radclinic.com
- 7. CTP Ischemic Thresholds CBF 0-10 ml/100 g/min CBV 0-1.5 ml/100 g MTT > 6 seconds Penumbra Threshold 2.5 ml/ 100 g www.radclinic.com
- 8. Large Infarcted Core www.radclinic.com CBF CBV
- 9. Penumbra of Salvageable Tissue www.radclinic.com