Summary: A 66-year-old male was seen at an outside hospital presenting with left
hemiparesis and left-side neglect. At the outside hospital, the patient
was administered tissue plasminogen activator (TPA) before transfer to
our facility for possible intervention. Noncontrast computed tomography
(CT), CT angiography (CTA), and perfusion CT images were acquired.
Case Summary
A 66-year-old male was seen at an outside
hospital presenting with left hemiparesis and left-side neglect. At the
outside hospital, the patient was administered tissue plasminogen
activator (TPA) before transfer to our facility for possible
intervention. Noncontrast computed tomography (CT), CT angiography
(CTA), and perfusion CT images were acquired.
Image Findings
There
is a large area of infarct core seen in the posterior right middle
cerebral artery (MCA) distribution, the right posterior cerebral artery
(PCA) distribution and posterior right anterior cerebral artery (ACA)
distribution. There is a smaller area of ischemia in the anterior right
frontal lobe. (See Figures 1-4.)
Discussion
Accurate and
efficient postprocessing with the CT Advanced Brain Perfusion and
Advanced Vessel Analysis applications (IntelliSpace Portal, Philips
Healthcare, Cleveland, OH, USA), allow for quick decisions to be made by
the neurology team. The penumbra/infarct maps (summary maps) give the
brain perfusion application an advantage in facilitating these expedient
reviews.
We can use the summary maps to assess the likelihood of
success with an intra-arterial intervention. Patients with a large
infarct core and small amount of penumbra (brain at risk for infarction)
are thought to have a lower success following intra-arterial
intervention. On the other hand, in patients with a smaller infarct core
and a larger amount of brain at risk, an argument can be made for
intra-arterial intervention. In this case, due to the size of the
infarct core, the number of occlusions (2 ACA and 2 MCA branches), and a
relatively small area of brain at risk, it was elected to not proceed
with intra-arterial therapy. In today’s climate, it was a difficult
decision to not treat this patient; however, the advanced imaging made
possible with the Philips iCT and the ease of postprocessing the brain
perfusion and CTA data with the Philips IntelliSpace Portal made a hard
decision easier.
Key Benefits
• Summary maps
(penumbra/infarct maps), available in Philips’ CT Advanced Brain
Perfusion application, support expedient decision making by the
neurology team and offer an advantage.
• The iCT provides full
brain coverage and allows for quantitative analysis when paired with the
CT Advanced Brain Perfusion application.