Tag Archives: perfusion

Open letter in response to NYT article from July 31, 2010 “The Radiation Boom After Stroke Scans, Patients Face Serious Health Risks” By WALT BOGDANICH

posted by Michael H. Lev and Max Wintermark

Every year in the United States, more than three quarters of a million people have a stroke, and approximately every 3 minutes someone dies from a stroke. A significant portion of stroke victims are young, and left with a devastating handicap for the rest of their lives. The monetary and societal costs of stroke represent a major economic challenge to the healthcare system.  With stroke – as with heart attack – rapid treatment is essential to limit the extent of irreversible brain injury (“time-is-brain”), and rapid determination of the cause and degree … Continue reading >>

Posted in ASNR News, Brain, Imaging Protocols and Techniques, Letters to the Editor | Tagged , , | 1 Comment

Aunt Mickey (They Look the Same until You Undress Them). Meningioma or Something Else?

A young African American woman presented with progressive left vision loss.  Brain MRI with contrast and perfusion studies were obtained.  The studies showed a dural-based lesion involving the lateral aspect of the left cavernous sinus which extended superiorly and crossed the planum sphenoidale to insinuate itself around the contralateral anterior clinoid process. The lesion was isointense to gray matter on T1WI, dark on T2WI, showed homogeneous gadolinium enhancement and increased rCBV on the perfusion images (see below).  The provisional diagnosis of meningioma was made and the patient scheduled for surgical decompression of left optic canal.

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Before surgery, a chest radiograph … Continue reading >>

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Crossed Cerebellar Diaschisis

CCD1

CCD2

A 41-year-old female with history of migraine presented to the ED with acute onset of aphasia. In addition to the aphasia, there was numbness and tingling in the right arm and face. Patient demonstrated expressive aphasia and was not able to answer questions posed in the ED. Gadolinium MR perfusion images demonstrated decreased relative cerebral blood flow (top) in the left parietal/occipital lobes and increased time-to-peak (bottom) in the contralateral cerebellar hemisphere. Although crossed cerebellar diaschisis (CCD) is seen mostly on radiotracer studies (hypometabolism on PET studies), it was nicely demonstrated in our patient. CCD occurs more often after supratentorial … Continue reading >>

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Validation and Standardization of Stroke Perfusion Methods

CTP and MRP acquisition hardware, protocols,  post processing, and interpretation vary widely between centers.  If we are to use these techniques for rational triage of acute stroke patients to appropriate treatment, validation and standardization is required.  I encourage all who perform such imaging to participate in the “STIR” effort, being corrdinated by Max Wintermark et al at UCSF.… Continue reading >>

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