Acute CT/MRI perfusion imaging in reperfusion therapy

Abstract

Evolution of reperfusion therapy in acute stroke has been accelerated after the evolution of the efficacy of endovascular therapy after/without recombinant tissue plasminogen activator (iv rt-PA). Reperfusion therapy has moved into a new era, although certain imaging criteria should have some favorable outcome which has not yet been established. Penumbral imaging has the potential to solve this issue both by CT and MRI scanning. Optimal mismatch ratio between MRI diffusion-weighted image/cerebral blood volume (DWI/CBF) (<30% of the contralateral hemisphere) and perfusion image (PWI) Tmax > 6 s area may predict the favorable outcome. On the other hand, certain large core threshold called malignant profile lead to poor outcomes despite any reperfusion therapies. Several criteria have been discussed but not met the consensus for optimal mismatch ratio and hazardous volume thresholds.