Newsletter - July / August, 2013   send this newsletter to a colleague
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Dear MDCT.net users,

This month, the MDCT.net newsletter is dedicated to the topic of stroke and cerebrovascular disorders and to the imaging techniques – in particular, perfusion CT and CT angiography – that allow the immediate and rigorous diagnosis of these conditions. The newsletter presents new content on MDCT.net regarding stroke and cerebrovascular diseases, and also highlights previously published material on the topic.

Stroke is a medical emergency of increasing relevance due to its global burden, being the second leading cause of death in the world. The early detection of its signs and a prompt recognition of its cause represent life-saving actions, as “time is brain” in this context. Advanced imaging techniques such as cerebral perfusion imaging are essential not only for locating the site of the disturbance or the blockage, but also for revealing the corresponding loss of neurologic function and for identifying potentially salvageable brain tissue. Furthermore, they provide information that is useful in choosing the optimal intervention to be undertaken.

To explore the application of neuroimaging in the assessment of stroke, MDCT.net has now published a new review and a new clinical case on the subject. In addition, the website offers access to the full text of several recent articles on the topic from Springer journals such as Neuroradiology, European Radiology and Emergency Radiology and to a relevant chapter from the recently published book Cardiovascular CT and MR Imaging. From technique to clinical interpretation. Finally, for your reference, we have included here in this newsletter a listing of clinical cases, hot topics, imaging protocols and e-Lectures about stroke and cerebrovascular diseases that were published on MDCT.net in the previous years.
We hope you find this newsletter helpful. If you would like to suggest topics to be covered in future issues, please write to us at editorial@mdct.net.

Your MDCT.net team
MDCT diagnosis of acute ischemic stroke: considerations on image quality and clinical value
V. Matarese

The diagnostic workup for acute ischemic stroke increasingly involves advanced neuroimaging methods such as CT angiography and perfusion CT. Some studies suggest that better imaging results, supporting better clinical decisions, can be obtained when the contrast medium used has a high iodine concentration. This paper looks at the evidence for the use of such contrast media and also at the current debate as to whether these advanced imaging protocols can really improve medical decision-making and clinical outcomes.
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Handbook af Headache

Cardiovascular CT and MR Imaging.
From Technique to Clinical Interpretation

C. Catalano, M. Anzidei, A. Napoli

“Intracranial Circulation”

This chapter reviews the anatomy of the intracranial vascular district and discusses the main related pathological conditions. 
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Brain, head and neck / Perfusion CT
The technical aspects of studying brain perfusion were the focus of two studies published in the journal European Radiology in 2011.
In one study, a 256-slice MDCT scanner with an 8-cm detector was proposed to improve brain coverage and to detect more ischemic lesions than scanners with detectors of standard width.

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Another study proposed that the cerebral blood volume, one of the parameters studied with perfusion CT, can also be accurately measured using flat detector CT systems meant for angiography.

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Further titles
Morhard D, Wirth CD, Reiser MF, Schulte-Altedorneburg G, Ertl-Wagner B. Optimal sequence timing of CT angiography and perfusion CT in patients with stroke. Eur J Radiol. 2013 Jun;82(6):e286-e289
Niesten JM, van der Schaaf IC et al.  Optimisation of vascular input and output functions in CT-perfusion imaging using 256(or more)-slice multidetector CT. Eur Radiol. 2013 May;23(5):1242-9
Leiva-Salinas C, Provenzale JM, Kudo K et al. The alphabet soup of perfusion CT and MR imaging: terminology revisited and clarified in five questions. Neuroradiology. 2012 Sep;54(9):907-18
Dorn F., Muenzel D., Meier R. et al.  Brain perfusion CT for acute stroke using a 256-slice CT: improvement of diagnostic information by large volume coverage. Eur Radiol. 2011 Sep;21(9):1803-10
Struffert T., Deuerling-Zheng Y., Kloska S. et al. Cerebral blood volume imaging by flat detector computed tomography in comparison to conventional multislice perfusion CT. Eur Radiol. 2011 Apr;21(4):882-9
Leiva-Salinas C., Wintermark M., Kidwell CS.  Neuroimaging of cerebral ischemia and infarction. Neurotherapeutics. 2011 Jan;8(1):19-27
Bonatti G., Ferro F., Haglmüller T. et al. Basilar artery thrombosis: imaging and endovascular therapy. Radiol Med. 2010 Dec;115(8):1219-33
Harris AD, Coutts SB, Frayne R. Diffusion and perfusion MR imaging of acute ischemic stroke. Magn Reson Imaging Clin N Am. 2009 May;17(2):291-313
Provenzale JM, Wintermark M. Optimization of perfusion imaging for acute cerebral ischemia: review of recent clinical trials and recommendations for future studies. AJR Am J Roentgenol. 2008 Oct;191(4):1263-1270
Lell MM, Anders K., Uder M., Klotz E., Ditt H., Vega-Higuera F., Boskamp T., Bautz WA, Tomandl BF. New techniques in CT angiography. Radiographics. 2006 Oct;26[Suppl 1]:S45-S62


Acute-onset left-sided hemiparesis

Woman, 62 years old
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Acute onset of right-sided hemiparesis
Woman, 84 years old
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Left sided hemiparesis
Woman, 73 years old
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New onset, left-sided hemiplegia
Woman, 66 years old
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Acute reduction of consciousness, then coma
Man, 62 years old
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Comatose state
Male, 89 years old
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Unexplained deep coma
Woman, 58 years old
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Coma after an accident
Man, 69 years old
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• The diagnostic accuracy of CT perfusion compared to MRI view »

Novel perfusion CT techniques in neurovascular imaging view »

Methods of CT perfusion of the brain view »

Basilar artery occlusion: limited diagnostic performance of unenhanced CT view »

Comprehensive imaging of acute ischemic stroke using multidetector CT view »
Browse by...
Body region, Pathology, Scanner type and Manufacturer to identify the appropriate protocol

MDCT in neuro-vascular imaging
B. Ertl-Wagner

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Perfusion imaging with CT: brain and beyond
K. Miles

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MDCT angiography of the carotid arteries and intracranial vessels
B. Ertl-Wagner

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