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Current advances in CT imaging of stroke

Jeremy L Rempel and Richard I Aviv

Stroke is the second most common cause of death in people over the age of 60. Imaging plays a pivotal role not only in stroke detection, but also in predicting infarct extent, hemorrhagic risk, tissue fate and clinical outcome. Noncontrast CT remains the modality of choice for investigation of acute stroke, with the use of the Alberta Stroke Program Early CT Score, CT angiography source images and CT perfusion significantly improving sensitivity. Hemorrhagic conversion risk may be predicted using permeability surface area product maps. The CT angiographic spot sign and postcontrast leakage visible on contrast CT can predict hematoma expansion in primary intracerebral hemorrhage. Clot burden and collateral blood-supply assessment can help identify patients who may benefit the most from more aggressive thrombolytic techniques. Physiological imaging of the ischemic penumbra may help identify selected patients that would benefit from thrombolysis beyond the current 4.5 h treatment window.