Authors: By Jie Lu¹, MD, Miao Zhang¹, MD, Jiuhong Chen², Prof. Kuncheng Li, MD¹, 
¹Xuanwu Hospital, Capital Medical University Beijing, China 
²SIEMENS Ltd., China

History

A 59 year old male was delivered to our stroke unit in the Xuanwu hospital three hours after onset of right-sided extremity weakness and a right-sided hemiparesis. On examination in the emergency room, he was found to have profound right extremity paresis, an expressive aphasia and facial palsy on the left side. A complete stroke evaluation was scheduled. In order to meet the demand of fast hemodynamic imaging of the entire brain, CT Perfusion and whole brain perfused blood volume calculation using syngo Neuro PBV (Perfused Blood Volume)* were performed. This new approach allows for routine calculation of three-dimensional, color-coded whole brain images overcoming the limited scan coverage of Perfusion CT.

Diagnosis and comments

After exclusion of hemorrhage with a non-contrast CT scan, color maps of CT Perfusion demonstrated delayed Time to Peak (TTP) and reduced cerebral Blood Flow (CBF) and Cerebral Blood Volume (CBV) in the area of the arteria cerebri media. Using syngo Neuro Perfusion CT, oligemic tissue that is near the threshold for tissue at risk and regions of the core infarct were indicated [Fig. 1]. To overcome the limited scan coverage of Perfusion CT, the three-dimensional extend of the stroke area can now be defined using the new software syngo neuro PBV [Fig. 2] thus increasing the safety of treatment decision. Due to the perfusion parameters, an occlusion of the main cerebral artery was suspected which has been confirmed by a CT angiography in the concurrent stroke workflow [Fig. 3]. Based on the differential diagnoses obtained with CT Perfusion and 3D evaluation of perfused blood flow using syngo Neuro PBV and the right therapeutic window – 50 mg RTPA, anticoagulants and platelet anti-aggregates were administered. This led to a relief of the symptoms by the next day, for example partial words could be understood. The patient was released from the hospital in a stable condition one week later.

Fig. 1: CT Perfusion demonstrates a clear infarct of the left hemisphere with delayed TTP [marked areas, Fig. 1A] reduced cerebral blood volume [Fig. 1B] and reduced cerebral blood flow [Fig. 1C]. The “tissue at risk” assessment clearly indicated the core infarct [red areas, Fig. 1D] and with a large area of “tissue at risk” [yellow areas, Fig. 1D] which might be rescued after intervention.

Fig. 2: The three dimensional extent of the stroke area can be displayed using a color coded map of the perfused blood volume of the whole brain (arrows).
Fig. 3: CTA revealed a stenoses in the left internal carotid artery (arrow).

*available 04/2007 with syngo 2007C, 510(k) pending