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    CT Brain Perfusion: BY Arief Oesmanto, Dipl - Rad, S.Si Application Specialist Philips Indonesia Commercial

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    rin
    The document discusses CT brain perfusion for evaluating strokes. It notes that stroke is a leading cause of death and disability worldwide. It describes the types of strokes as hemorrhagic or ischemic and lists current treatment options such as aspirin, IV thrombolysis with tPA within 4.5 hours, and IA thrombolysis. The optimal treatment goal is to determine if a patient has a large salvageable brain tissue region based on their physiological status. The document then explains the steps for performing CT brain perfusion including pre-contrast scans, IV contrast injection, and multi-cycle perfusion scans to evaluate blood flow and volume.

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    CT Brain Perfusion: BY Arief Oesmanto, Dipl - Rad, S.Si Application Specialist Philips Indonesia Commercial

    Uploaded by

    rin
    60 views22 pages
    The document discusses CT brain perfusion for evaluating strokes. It notes that stroke is a leading cause of death and disability worldwide. It describes the types of strokes as hemorrhagic or ischemic and lists current treatment options such as aspirin, IV thrombolysis with tPA within 4.5 hours, and IA thrombolysis. The optimal treatment goal is to determine if a patient has a large salvageable brain tissue region based on their physiological status. The document then explains the steps for performing CT brain perfusion including pre-contrast scans, IV contrast injection, and multi-cycle perfusion scans to evaluate blood flow and volume.

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    CT Perfusi

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    The document discusses CT brain perfusion for evaluating strokes. It notes that stroke is a leading cause of death and disability worldwide. It describes the types of strokes as hemorrhagic or ischemic and lists current treatment options such as aspirin, IV thrombolysis with tPA within 4.5 hours, and IA thrombolysis. The optimal treatment goal is to determine if a patient has a large salvageable brain tissue region based on their physiological status. The document then explains the steps for performing CT brain perfusion including pre-contrast scans, IV contrast injection, and multi-cycle perfusion scans to evaluate blood flow and volume.

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    60 views22 pages

    CT Brain Perfusion: BY Arief Oesmanto, Dipl - Rad, S.Si Application Specialist Philips Indonesia Commercial

    Uploaded by

    rin
    The document discusses CT brain perfusion for evaluating strokes. It notes that stroke is a leading cause of death and disability worldwide. It describes the types of strokes as hemorrhagic or ischemic and lists current treatment options such as aspirin, IV thrombolysis with tPA within 4.5 hours, and IA thrombolysis. The optimal treatment goal is to determine if a patient has a large salvageable brain tissue region based on their physiological status. The document then explains the steps for performing CT brain perfusion including pre-contrast scans, IV contrast injection, and multi-cycle perfusion scans to evaluate blood flow and volume.

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    CT BRAIN PERFUSION

    BY
    Arief Oesmanto,Dipl.Rad,S.Si
    Application Specialist
    Philips Indonesia Commercial

    Workshop for Radiografer Neuro Update January 2015


    by Arief Oesmanto Imaging System Application PT Philips Indonesia Commercial
    STROKE
    Penyebab utama ke-2 kematian di negara-negara industri

    Salah satu penyebab utama kecacatan di seluruh dunia

    Sekitar 25% pasien stroke meninggal dalam waktu satu bulan.

    Lebih dari 1/3 dari pasien meninggal dalam waktu satu tahun.

    Komplikasi dari stroke memiliki pengaruh besar pada hasil klinis.

    Deteksi dan prediksi komplikasi memainkan peran penting


    dalam peningkatan penyelamatan.

    Workshop for Radiografer Neuro Update January 2015


    by Arief Oesmanto Imaging System Application PT Philips Indonesia Commercial
    PENYEBAB
    Pendarahan Iskemik Stroke
    Stroke

    Pembuluh darah pecah di otak 87%Pembuluh darah tersumbat di


    karena: otak
    • Pembuluh lemah • Emboli Jantung yaitu embolus
    • tekanan darah tinggi dari plak aterosklerotik
    • aneurisma

    Workshop for Radiografer Neuro Update January 2015


    by Arief Oesmanto Imaging System Application PT Philips Indonesia Commercial
    Stroke
    Treatment

    • ASA (acetyl salicyl acid) – aspirin


    (antikoagulan)
    • IV trombolisis
    – Risiko pendarahan (hemorrhage!)
    – Batasa waktu ±4.5 jam stelah
    terserang stroke
    – Umur < 80th
    • IA trombolisis / metode lain
    When do treat or NOT
    If stroke is embolic
    – < 3 hours from onset = IV tPA
    – 3 – 6 hours from onset = IA tPA
    – > 6 hours = No Treatment

    Limitations to current treatment


    These time based cutoffs are based on population averages (not ideal)
    Many patients > 6 hrs have little salvageable tissue
    Many patients < 6 hrs have much salvageable tissue

    Ultimate goal is to determine patient appropriate treatment based on physiological status


    of tissue
    Large penumbra, small infarct = treat
    Large infarct, small penumbra = do not treat
    Tehnik Pemeriksaan

    Workshop for Radiografer Neuro Update January 2015


    by Arief Oesmanto Imaging System Application PT Philips Indonesia Commercial
    Alat dan Bahan
    1. Injector
    Alat 2. Syringe Tube Injector
    3. Conector Tube
    4. Tree Way
    5. Spuit 10 cc
    6. Spuit 1 cc
    7. IV Canule/vasovix

    Bahan
    1. Kontras Media

    Workshop for Radiografer Neuro Update January 2015


    by Arief Oesmanto Imaging System Application PT Philips Indonesia Commercial
    Prosedure CT Brain Perfusi
     Scanogram/
    sureview/
    topogram
     Brain Non
    Kontras
     Axial/Helical
     Perfusion Scan
     Axial Multi
    cycles
     Parallel IV
    Contrast

    Workshop for Radiografer Neuro Update January 2015


    by Arief Oesmanto Imaging System Application PT Philips Indonesia Commercial
    Prosedur CT Brain Perfusi (Cont’d)
    START

    Pre Contrast
    Scan

    Haemoragic Non Haemoragic

    Calculation
    Injector+Contrast
    Start and End
    Preparation
    Table Position
    IV Line

    Thick Coverage

    Multi Cycle scan Injection Contrast


    1,5 Sec/Rot Volume=45cc
    40 Cycle Flow Rate=4,5 cc/sec

    END

    Workshop for Radiografer Neuro Update January 2015


    by Arief Oesmanto Imaging System Application PT Philips Indonesia Commercial
    Multi Cycles Perfusion Scan

    NON JOG Scan JOG Scan

    Detector Slices Coverage Detector Slices Coverage


    Wide (mm) (MSCT) (mm) Wide (mm) (MSCT) (mm)
    24 16 24 40 64 80
    40 64 40 40 128 (DFS) 80
    40 128 (DFS) 40 80 128 160
    80 128 80 80 256 (DFS) 160
    80 256 (DFS) 80

    Workshop for Radiografer Neuro Update January 2015


    by Arief Oesmanto Imaging System Application PT Philips Indonesia Commercial
    NON JOG Scan JOG Scan

    Workshop for Radiografer Neuro Update January 2015


    by Arief Oesmanto Imaging System Application PT Philips Indonesia Commercial
    Parameter
    CT Brain
    Perfusion

    Workshop for Radiografer Neuro Update January 2015


    by Arief Oesmanto Imaging System Application PT Philips Indonesia Commercial
    Traffic light

    Workshop for Radiografer Neuro Update January 2015


    by Arief Oesmanto Imaging System Application PT Philips Indonesia Commercial
    Field of view
    • Brain slice not fully imaged

    Improper scaling

    Workshop for Radiografer Neuro Update January 2015


    by Arief Oesmanto Imaging System Application PT Philips Indonesia Commercial
    9
    DHU Contrast agent injection
    • Late bolus arrival
    • Acquisition starts after bolus arrival
    6

    3
    V • Incomplete bolus

    t/s
    50
    DHU Disturbed first pass
    e.g. problems with catheter and injection
    TAC shape quality

    X
    t/s
    80 Workshop for Radiografer Neuro Update January 2015
    by Arief Oesmanto Imaging System Application PT Philips Indonesia Commercial
    Residual motion artifacts

    Workshop for Radiografer Neuro Update January 2015


    by Arief Oesmanto Imaging System Application PT Philips Indonesia Commercial
    Traffic light

    Workshop for Radiografer Neuro Update January 2015


    by Arief Oesmanto Imaging System Application PT Philips Indonesia Commercial
    CT Perfusion and MR Diffusion Weighted Imaging

    Perfusion-CT DWI-MR PWI-MR

    Wintermark et al. CHUV, Switzerland

    CT Perfusion MR DWI MR Perfusion DWI


    Workshop for Radiografer Neuro Update January 2015
    by Arief Oesmanto Imaging System Application PT Philips Indonesia Commercial
    Go to …………………ISP

    Workshop for Radiografer Neuro Update January 2015


    by Arief Oesmanto Imaging System Application PT Philips Indonesia Commercial
    Click :
    Directory/Neuro radiografer/B PERFUSION(Neuro)

    Workshop for Radiografer Neuro Update January 2015


    by Arief Oesmanto Imaging System Application PT Philips Indonesia Commercial
    tPA
    • merupakan protein yang bertanggung jawab
    pada pemecahan bekuan darah. Protein ini
    merupakan serine protease (EC 3.4.21.68)
    yang terdapat dalam sel endotel, sel yang
    mengelilingi pembuluh darah. Sebagai sebuah
    enzim, tPA mengkatalisis perubahan
    plasminogen menjadi plasmin, enzim yang
    memecah bekuan darah.

    Workshop for Radiografer Neuro Update January 2015


    by Arief Oesmanto Imaging System Application PT Philips Indonesia Commercial
    tPA
    • tPA digunakan pada pengobatan penyakit-
    penyakit yang terdapat penggumpalan darah,
    seperti emboli paru, infark myocard, dan stroke.
    • Agar penggunaannya efektif dalam pengobatan
    stroke iskemia, tPA harus digunakan sesegera
    mungkin setelah muncul gejala.
    • Menurut pedoman, tPA digunakan secara
    intravena pada 3 jam pertama setelah muncul
    gejala, karena lebih dari itu mungkin efek
    sampingnya lebih besar daripada manfaatnya.
    Workshop for Radiografer Neuro Update January 2015
    by Arief Oesmanto Imaging System Application PT Philips Indonesia Commercial

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