CTP enables the differentiation of salvageable ischaemic brain tissue (the penumbra) from the irrevocably damaged brain tissue (the infarct core). This is useful when assessing a patient for treatment (thrombolysis or clot retrieval).
(1)
A CTP uses helical imaging across the brain over time to image contrast entering and leaving the brain tissue. Our scanners uses a mode called Adaptive 4D Spiral to perform the CTP (see video across). The table will shuttle back and forth while imaging.
As this technique uses serial brain CT's, the dose is high so it is important that the following occur:
is only used when justified by radiology and neurology consultants
The patients head is tilted so the orbits are outside the scan FOV (see across)
The patient is capable of holding still throughout entire scan (approx. 45 seconds)
The patients also require good PIVC access as high flow rates are used for the contrast injection.
These images are sent to RAPID where the following measurements and maps are made automatically.
In the case of RAPID not working we can also create these maps on Syngo Via.
Cerebral blood volume (CBV)
volume of flowing blood within a given volume of the brain.
Cerebral blood flow (CBF)
volume of the blood moving through a given volume of the brain.
Mean transit time (MTT)
Time it takes the blood to transit through the given volume of the brain.
T-max or Time to Peak (TTP)
Time it takes to get to peak concentration in the brain.
(1)
Decreased CBV (<40%)
Decreased CBF (<30%)
Increase MTT
= Infarct Core
Normal CBV
Decreased CBF (mildly)
Increase MTT
= Infarct Penumbra
Mismatch ratio
Shows the difference in volume between the infarct core and penumbra. Helps to dictate treatment options in many cases.
In this image the CBF maps show tissue in pink that is decreased 30% (infarct core). The T-max/MTT map below shows the area with increased 6.0s transit time (infarct penumbra) (2)