PPTS Portal Home
Revised 2022 (Resolution 22)
Document Navigator
All
PREAMBLE
I. INTRODUCTION
II. INDICATIONS AND CONTRAINDICATIONS
III. QUALIFICATIONS AND RESPONSIBILITIES OF PERSONNEL
IV. SPECIFICATIONS OF THE EXAMINATION
V. DOCUMENTATION
VI. EQUIPMENT SPECIFICATIONS
VII. EQUIPMENT SPECIFICATIONS
VIII. RADIATION SAFETY IN IMAGING
IX. QUALITY CONTROL AND IMPROVEMENT, SAFETY, INFECTION CONTROL, AND PATIENT EDUCATION
ACKNOWLEDGEMENTS
REFERENCES
Document Navigator
ACR–ASNR–SPR PRACTICE PARAMETER FOR THE PERFORMANCE OF COMPUTED TOMOGRAPHY (CT) PERFUSION IN NEURORADIOLOGIC IMAGING
PREAMBLE
I. INTRODUCTION
II. INDICATIONS AND CONTRAINDICATIONS
III. QUALIFICATIONS AND RESPONSIBILITIES OF PERSONNEL
IV. SPECIFICATIONS OF THE EXAMINATION
V. DOCUMENTATION
VI. EQUIPMENT SPECIFICATIONS
VII. EQUIPMENT SPECIFICATIONS
VIII. RADIATION SAFETY IN IMAGING
IX. QUALITY CONTROL AND IMPROVEMENT, SAFETY, INFECTION CONTROL, AND PATIENT EDUCATION
ACKNOWLEDGEMENTS
REFERENCES
1. [30346227]
Christensen SS, Lansberg MM. CT perfusion in acute stroke: Practical guidance for implementation in clinical practice. J Cereb Blood Flow Metab 39:1664-1668, .
2. [31636160]
Vagal AA, Wintermark MM, Nael KK, et al. Automated CT perfusion imaging for acute ischemic stroke: Pearls and pitfalls for real-world use. Neurology 93:888-898, .
3. [25796424]
Yeung TT, Bauman GG, Yartsev SS, Fainardi EE, Macdonald DD, Lee TT. Dynamic perfusion CT in brain tumors. Eur J Radiol 84:2386-92, .
4. [30319112]
Zerna C, Thomalla G, Campbell BCV, Rha JH, Hill MD. Current practice and future directions in the diagnosis and acute treatment of ischaemic stroke. [Review]. Lancet. 392(10154):1247-1256, 2018 10 06.
5. [21178348]
Bivard AA, McElduff PP, Spratt NN, Levi CC, Parsons MM. Defining the extent of irreversible brain ischemia using perfusion computed tomography. Cerebrovasc Dis 31:238-45, .
6. [20308452]
Hopyan JJ, Ciarallo AA, Dowlatshahi DD, et al. Certainty of stroke diagnosis: incremental benefit with CT perfusion over noncontrast CT and CT angiography. Radiology 255:142-53, .
7. [16240339]
Parsons MM, Pepper EE, Chan VV, et al. Perfusion computed tomography: prediction of final infarct extent and stroke outcome. Ann Neurol 58:672-9, .
8. [16514093]
Wintermark MM, Flanders AA, Velthuis BB, et al. Perfusion-CT assessment of infarct core and penumbra: receiver operating characteristic curve analysis in 130 patients suspected of acute hemispheric stroke. Stroke 37:979-85, .
9. [22194372]
Kamalian SS, Kamalian SS, Konstas AA, et al. CT perfusion mean transit time maps optimally distinguish benign oligemia from true "at-risk" ischemic penumbra, but thresholds vary by postprocessing technique. AJNR Am J Neuroradiol 33:545-9, .
10. [29364767]
Albers GW, Marks MP, Kemp S, et al. Thrombectomy for Stroke at 6 to 16 Hours with Selection by Perfusion Imaging. N Engl J Med. 378(8):708-718, 2018 02 22.
11. [30413385]
Campbell BCV, Majoie CBLM, Albers GW, et al. Penumbral imaging and functional outcome in patients with anterior circulation ischaemic stroke treated with endovascular thrombectomy versus medical therapy: a meta-analysis of individual patient-level data. Lancet neurol.. 18(1):46-55, 2019 01.
12. [15569863]
Hacke W, Albers G, Al-Rawi Y, et al. The Desmoteplase in Acute Ischemic Stroke Trial (DIAS): a phase II MRI-based 9-hour window acute stroke thrombolysis trial with intravenous desmoteplase. Stroke. 2005;36(1):66-73.
13. [25726502]
Huang X, Cheripelli BK, Lloyd SM, et al. Alteplase versus tenecteplase for thrombolysis after ischaemic stroke (ATTEST): a phase 2, randomised, open-label, blinded endpoint study. Lancet neurol.. 14(4):368-76, 2015 Apr.
14. [31067369]
Ma H, Campbell BCV, Parsons MW, et al. Thrombolysis Guided by Perfusion Imaging up to 9 Hours after Onset of Stroke. New England Journal of Medicine. 380(19):1795-1803, 2019 05 09.
15. [32232165]
Adebayo OO, Culpan GG. Diagnostic accuracy of computed tomography perfusion in the prediction of haemorrhagic transformation and patient outcome in acute ischaemic stroke: A systematic review and meta-analysis. Eur Stroke J 5:4-16, .
16. [22811464]
Inoue MM, Mlynash MM, Straka MM, et al. Patients with the malignant profile within 3 hours of symptom onset have very poor outcomes after intravenous tissue-type plasminogen activator therapy. Stroke 43:2494-6, .
17. [25572949]
Ivanidze JJ, Kesavabhotla KK, Kallas OO, et al. Evaluating blood-brain barrier permeability in delayed cerebral infarction after aneurysmal subarachnoid hemorrhage. AJNR Am J Neuroradiol 36:850-4, .
18. [30712134]
Malinova V, Tsogkas I, Behme D, Rohde V, Psychogios MN, Mielke D. Defining cutoff values for early prediction of delayed cerebral ischemia after subarachnoid hemorrhage by CT perfusion. Neurosurg Rev. 43(2):581-587, 2020 Apr.
19. [24309123]
Mir DD, Gupta AA, Dunning AA, et al. CT perfusion for detection of delayed cerebral ischemia in aneurysmal subarachnoid hemorrhage: a systematic review and meta-analysis. AJNR Am J Neuroradiol 35:866-71, .
20. [21367552]
Roach CC, Russell CC, Hanson EE, Bluett BB, Orrison WW. Appearance and impact of post-operative intracranial clips and coils on whole-brain CT angiography and perfusion. Eur J Radiol 81:960-7, .
21. [18504564]
Fainardi EE, Borrelli MM, Saletti AA, et al. CT perfusion mapping of hemodynamic disturbances associated to acute spontaneous intracerebral hemorrhage. Neuroradiology 50:729-40, .
22. [30864197]
Morotti AA, Busto GG, Bernardoni AA, Tamborino CC, Fainardi EE. Association between perihematomal cerebral blood volume and intracerebral hemorrhage expansion: A computed tomography perfusion study. Ann Neurol 85:943-947, .
23. [20140634]
Andaluz NN, Choutka OO, Vagal AA, Strunk RR, Zuccarello MM. Patient selection for revascularization procedures in adult Moyamoya disease based on dynamic perfusion computerized tomography with acetazolamide challenge (PCTA). Neurosurg Rev 33:225-32; discussion 232-3, .
24. [26631077]
Yoshie TT, Ueda TT, Takada TT, Nogoshi SS, Fukano TT, Hasegawa YY. Prediction of cerebral hyperperfusion syndrome after carotid artery stenting by CT perfusion imaging with acetazolamide challenge. Neuroradiology 58:253-9, .
25. [17848682]
Waaijer AA, van Leeuwen MM, van Osch MM, et al. Changes in cerebral perfusion after revascularization of symptomatic carotid artery stenosis: CT measurement. Radiology 245:541-8, .
26. [26661242]
Sommer WH, Bollwein C, Thierfelder KM, et al. Crossed cerebellar diaschisis in patients with acute middle cerebral artery infarction: Occurrence and perfusion characteristics. Journal of Cerebral Blood Flow & Metabolism. 36(4):743-54, 2016 Apr.
27. [33431503]
Amukotuwa SS, Wu AA, Zhou KK, Page II, Brotchie PP, Bammer RR. Time-to-Maximum of the Tissue Residue Function Improves Diagnostic Performance for Detecting Distal Vessel Occlusions on CT Angiography. AJNR Am J Neuroradiol 42:65-72, .
28. [22363062]
Keedy AA, Fischette WW, Soares BB, et al. Contrast delay on perfusion CT as a predictor of new, incident infarct: a retrospective cohort study. Stroke 43:1295-301, .
29. [31990213]
Shankar JJ, Green RR, Virani KK, Wong HH, Eddy KK, Vandorpe RR. Admission Perfusion CT for Classifying Early In-Hospital Mortality of Patients With Severe Traumatic Brain Injury: A Pilot Study. AJR Am J Roentgenol 214:872-876, .
30. [15220504]
Wintermark MM, van Melle GG, Schnyder PP, et al. Admission perfusion CT: prognostic value in patients with severe head trauma. Radiology 232:211-20, .
31. [33431502]
Lucas LL, Gariel FF, Menegon PP, et al. Acute Ischemic Stroke or Epileptic Seizure? Yield of CT Perfusion in a "Code Stroke" Situation. AJNR Am J Neuroradiol 42:49-56, .
32. [21051510]
Jain RR. Perfusion CT imaging of brain tumors: an overview. AJNR Am J Neuroradiol 32:1570-7, .
33. [27693246]
Saito TT, Sugiyama KK, Ikawa FF, et al. Permeability Surface Area Product Using Perfusion Computed Tomography Is a Valuable Prognostic Factor in Glioblastomas Treated with Radiotherapy Plus Concomitant and Adjuvant Temozolomide. World Neurosurg 97:21-26, .
34. [20495977]
Schramm PP, Xyda AA, Klotz EE, Tronnier VV, Knauth MM, Hartmann MM. Dynamic CT perfusion imaging of intra-axial brain tumours: differentiation of high-grade gliomas from primary CNS lymphomas. Eur Radiol 20:2482-90, .
35. [15744192]
Wintermark MM, Cotting JJ, Roulet EE, et al. Acute brain perfusion disorders in children assessed by quantitative perfusion computed tomography in the emergency setting. Pediatr Emerg Care 21:149-60, .
36. [20028906]
Faggioni LL, Neri EE, Bartolozzi CC. CT perfusion of head and neck tumors: how we do it. AJR Am J Roentgenol 194:62-9, .
37. [29164573]
Ursino SS, Faggioni LL, Fiorica FF, et al. Role of perfusion CT in the evaluation of metastatic nodal tumor response after radiochemotherapy in head and neck cancer: preliminary findings. Eur Rev Med Pharmacol Sci 21:4882-4890, .
38. [27079367]
Proisy MM, Mitra SS, Uria-Avellana CC, et al. Brain Perfusion Imaging in Neonates: An Overview. AJNR Am J Neuroradiol 37:1766-1773, .
39. [22209434]
Zebedin D, Sorantin E, Riccabona M. Perfusion CT in childhood stroke--initial observations and review of the literature. Eur J Radiol. 2013;82(7):1059-1066.
40. [28583996]
Brinjikji W, Demchuk AM, Murad MH, et al. Neurons Over Nephrons: Systematic Review and Meta-Analysis of Contrast-Induced Nephropathy in Patients With Acute Stroke. [Review]. Stroke. 48(7):1862-1868, 2017 07.
41. [-3197748]
American College of Radiology. ACR–SPR Practice Parameter for the use of Intravascular Contrast Media. Available at https://gravitas.acr.org/PPTS/GetDocumentView?docId=142+&releaseId=2
42. [-3188535]
American College of Radiology. ACR Committee on Drugs and Contrast Media. Manual on Contrast Media. Available at: https://www.acr.org/Clinical-Resources/Clinical-Tools-and-Reference/Contrast-Manual.
43. [-3120926]
American College of Radiology. ACR-SPR Practice Parameter for Imaging Pregnant or Potentially Pregnant Patients with Ionizing Radiation. Available at: https://gravitas.acr.org/PPTS/GetDocumentView?docId=23+&releaseId=2.
44. [-3197742]
American College of Radiology. ACR–SPR Practice Parameter for Performing and Interpreting Diagnostic Computed Tomography (CT). Available at https://gravitas.acr.org/PPTS/GetDocumentView?docId=132+&releaseId=2
45. [-3197622]
American College of Radiology. ACR Practice Parameter for Continuing Medical Education. Available at https://gravitas.acr.org/PPTS/GetDocumentView?docId=130+&releaseId=2
46. [22596033]
Johnson MM. Stroke and CT Perfusion. Radiol Technol 83:467CT-486CT, .
47. [15547237]
Sanelli PP, Deshmukh MM, Ougorets II, Caiati RR, Heier LL. Safety and feasibility of using a central venous catheter for rapid contrast injection rates. AJR Am J Roentgenol 183:1829-34, .
48. [19270105]
Konstas AA, Goldmakher GG, Lee TT, Lev MM. Theoretic basis and technical implementations of CT perfusion in acute ischemic stroke, part 1: Theoretic basis. AJNR Am J Neuroradiol 30:662-8, .
49. [19299489]
Konstas AA, Goldmakher GV, Lee TY, Lev MH. Theoretic basis and technical implementations of CT perfusion in acute ischemic stroke, part 2: technical implementations. AJNR Am J Neuroradiol. 2009;30(5):885-892.
50. [18936029]
de Lucas EE, Sánchez EE, Gutiérrez AA, et al. CT protocol for acute stroke: tips and tricks for general radiologists. Radiographics 28:1673-87, .
51. [26965849]
Heit JJ, Wintermark MM. Perfusion Computed Tomography for the Evaluation of Acute Ischemic Stroke: Strengths and Pitfalls. Stroke 47:1153-8, .
52. [-3197778]
American Association of Physicists in Medicine. Adult routine head CT protocols. Available at: https://www.aapm.org/pubs/ctprotocols/documents/adultroutineheadct.pdf.
53. [-3197908]
American College of Radiology. ACR and american society of neuroradiology statement on ct protocols and radiation dose. Available at: https://www.acr.org/Advocacy-and-Economics/ACR-Position-Statements/CT-Protocols-and-Radiation-Dose.
54. [-3197907]
US Food and Drug Administration. Safety Investigation of CT Brain Perfusion Scans: Update 11/9/2010. Available at: http://www.fda.gov/medicaldevices/safety/alertsandnotices/ucm185898.htm.
55. [7304311]
Axel LL. A method of calculating brain blood flow with a CT dynamic scanner. Adv Neurol 30:67-71, .
56. [11415901]
Roberts HH, Roberts TT, Smith WW, Lee TT, Fischbein NN, Dillon WW. Multisection dynamic CT perfusion for acute cerebral ischemia: the "toggling-table" technique. AJNR Am J Neuroradiol 22:1077-80, .
57. [23598836]
Sanelli PC, Sykes JB, Ford AL, Lee JM, Vo KD, Hallam DK. Imaging and treatment of patients with acute stroke: an evidence-based review. AJNR Am J Neuroradiol. 2014;35(6):1045-1051.
58. [16418350]
Schaefer PP, Roccatagliata LL, Ledezma CC, et al. First-pass quantitative CT perfusion identifies thresholds for salvageable penumbra in acute stroke patients treated with intra-arterial therapy. AJNR Am J Neuroradiol 27:20-5, .
59. [18716079]
Youn SS, Kim JJ, Weon YY, Kim SS, Han MM, Bae HH. Perfusion CT of the brain using 40-mm-wide detector and toggling table technique for initial imaging of acute stroke. AJR Am J Roentgenol 191:W120-6, .
60. [15173485]
Wintermark MM, Lepori DD, Cotting JJ, et al. Brain perfusion in children: evolution with age assessed by quantitative perfusion computed tomography. Pediatrics 113:1642-52, .
61. [24691387]
Fahmi FF, Marquering HH, Streekstra GG, et al. Automatic detection of CT perfusion datasets unsuitable for analysis due to head movement of acute ischemic stroke patients. J Healthc Eng 5:67-78, .
62. [17179367]
Sanelli PP, Nicola GG, Tsiouris AA, et al. Reproducibility of postprocessing of quantitative CT perfusion maps. AJR Am J Roentgenol 188:213-8, .
63. [20410422]
Ferreira RR, Lev MM, Goldmakher GG, et al. Arterial input function placement for accurate CT perfusion map construction in acute stroke. AJR Am J Roentgenol 194:1330-6, .
64. [19274457]
Soares BB, Dankbaar JJ, Bredno JJ, et al. Automated versus manual post-processing of perfusion-CT data in patients with acute cerebral ischemia: influence on interobserver variability. Neuroradiology 51:445-51, .
65. [21371698]
Orrison WW, Snyder KK, Hopkins LL, et al. Whole-brain dynamic CT angiography and perfusion imaging. Clin Radiol 66:566-74, .
66. [31296523]
Brehm AA, Tsogkas II, Maier II, et al. One-Stop Management with Perfusion for Transfer Patients with Stroke due to a Large-Vessel Occlusion: Feasibility and Effects on In-Hospital Times. AJNR Am J Neuroradiol 40:1330-1334, .
67. [18029901]
Huang BB, Castillo MM. Radiological reasoning: extracranial causes of unilateral decreased brain perfusion. AJR Am J Roentgenol 189:S49-54, .
68. [22985169]
Keedy AA, Soares BB, Wintermark MM. A pictorial essay of brain perfusion-CT: not every abnormality is a stroke!. J Neuroimaging 22:e20-33, .
69. [20190208]
Lui YY, Tang EE, Allmendinger AA, Spektor VV. Evaluation of CT perfusion in the setting of cerebral ischemia: patterns and pitfalls. AJNR Am J Neuroradiol 31:1552-63, .
70. [17646976]
Turk AA, Grayev AA, Rowley HH, et al. Variability of clinical CT perfusion measurements in patients with carotid stenosis. Neuroradiology 49:955-61, .
71. [-3197621]
American College of Radiology. ACR Practice Parameter for Communication of Diagnostic Imaging Findings. Available at https://gravitas.acr.org/PPTS/GetDocumentView?docId=74+&releaseId=2
72. [-3197634]
American College of Radiology. ACR–AAPM Technical Standard for Diagnostic Medical Physics Performance Monitoring of Computed Tomography (CT) Equipment. Available at https://gravitas.acr.org/PPTS/GetDocumentView?docId=131+&releaseId=2
73. [19892810]
Wintermark MM, Lev MM. FDA investigates the safety of brain perfusion CT. AJNR Am J Neuroradiol 31:2-3, .