Automated Brain Perfusion Imaging in Acute Ischemic Stroke Interpretation Pearls and Pitfalls

Recent advancements in computed tomography technology, including improved brain coverage and automated processing of the perfusion data, have reinforced the use of perfusion computed tomography imaging in the routine evaluation of patients with acute ischemic stroke. The DAWN (Diffusion Weighted Imaging or Computerized Tomography Perfusion Assessment With Clinical Mismatch in the Triage of Wake Up and Late Presenting Strokes Undergoing Neurointervention) and DEFUSE 3 (Endovascular Therapy Following Imaging Evaluation for Ischemic Stroke 3) trials have established the benefit of endovascular thrombectomy in patients with acute ischemic stroke with anterior circulation large vessel occlusion up to 24 hours of last seen normal, using perfusion imaging-based patient selection. The compelling data has prompted stroke centers to increasingly introduce automated perfusion computed tomography imaging in the routine evaluation of patients with acute ischemic stroke. We present a comprehensive overview of the acquisition and interpretation of automated perfusion imaging in patients with acute ischemic stroke with a special emphasis on the interpretation pearls, pitfalls, and stroke mimicking conditions.

Automated summary

Recent advancements in computed tomography technology have reinforced the importance of perfusion computed tomography imaging in evaluating patients with acute ischemic stroke, especially in selecting patients for endovascular thrombectomy. Studies have shown the benefits of perfusion imaging in diagnosing patients with anterior circulation large vessel occlusion within 24 hours. This compelling data has led to an increased introduction of automated perfusion computed tomography imaging in routine evaluation of stroke patients.