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Neuroimaging applications of multislice CT perfusion

¹ Neuroradiology Department, Sir Charles Gairdner Hospital, Perth, Western Australia 6009, Australia, ² Department of Neuroradiology, Clarendon Wing, Leeds General Infirmary, Great George Street, Leeds LS1 3EX, Uk

• In acute stroke, very early cranial CT may be normal. Perfusion CT shows great promise in refining the selection of patients suitable for thrombolysis, as it can accurately determine infarct core from potentially salvageable ischaemic penumbra.
  
• In patients with acute subarachnoid haemorrhage, perfusion abnormalities are evident early on and can predict subsequent vasospasm. These can be detected by CT perfusion, which may enable more aggressive medical management of vasospasm.
  
• Some cerebral tumours are associated with angiogenesis and a breakdown of the blood-brain barrier. Angiogenesis can be detected as an increase in flow and volume parameters, and blood-brain barrier breakdown can be quantified as contrast accumulates in the interstitial space. Such aggressive features can distinguish malignant from benign tumours when standard imaging may not.
  
• CT perfusion is a very promising tool, and new advances in the technique are overcoming some of the initial shortcomings, leading to increased coverage, reduced processing time, and reduced volume and rate of contrast utilized.
  

CT perfusion is an evolving technology that assesses the behaviour of intravenous contrast in cerebral tissue and provides quantitative information on cerebral blood flow parameters. It has been validated in many clinical situations against established techniques and is being increasingly applied in clinical situations to provide physiological information to direct medical therapies. This article reviews the evolution of perfusion measurements by CT, the principles of CT perfusion calculation and, with illustrated case histories, examines the clinical utility of this technique.