A trial of the use of perfusion computed tomography of the brain in combination with transcranial Doppler ultrasonography of blood vessels in patients with acute cerebrovascular accident

Abstract

Aim. Assessment of cerebral blood flow in various vascular beds in patients with an acute cerebrovascular accident in the acute period by perfusion computed tomography in combination with transcranial Doppler ultrasonography of cerebral vessels.

Methods. Data was analyzed from perfusion computed tomography of the brain and transcranial Doppler ultrasonography in 35 patients with an acute cerebrovascular accident, based at the vascular centre of the City Clinical Hospital No. 7 of Kazan. The study included 18 (51.4%) women and 17 (48.6%) men who had arrived in the first hours after a vascular accident. When analyzing the stroke subtype, atherothrombotic subtype was determined in 27 (77.1%) patients, cardioembolic subtype in 5 (14.3%) patients, and 3 (8.6%) patients had had a transient ischemic attack.

Results. Perfusion computed tomography is a method that allowed evaluation of the structure of the brain, and blood supply to the anterior cerebral (in 2.9% of the studied patients), middle cerebral (in 62.9% of the studied patients), posterior cerebral (in 11.4% of the studied patients) and vertebral (in 14.2% of the studied patients) arteries of patients with a stroke. The method revealed a zone of “critical” perfusion (ischemic penumbra) by quantitatively processing perfusion indicators in the anterior cerebral blood flow system (decrease in rate and increase in ave­rage volume of cerebral blood flow and average transit time) and in the posterior cerebral circulation system (decrease in blood flow and prolongation of transit time) in the bed of the right vertebral artery). The method also aided the construction of perfusion maps. Transcranial Doppler ultrasonography of cerebral vessels revealed breaches in the cerebral circulation: a decrease in the linear velocity of blood flow in the right middle cerebral arterial bed and in the posterior circulatory system of blood flow in the brain, and an increase in the pulsatility index in all the stu­died vascular beds.

Conclusion. Perfusion computed tomography of the brain in combination with transcranial Doppler ultrasonography is applicable to patients with stroke in various vascular beds, followed by determination of indications for thrombolytic therapy and thrombectomy.

Keywords

acute cerebrovascular accident / computed tomography of the brain / perfusion parameters / transcranial Doppler ultrasonography

References

[1] Gusev E.I., Skvortsova V.I., Stakhovskaya L.V. Epidemiology of stroke in Russia. Zhurnal nevrologii i psikhiatrii. (Prilozhenie «Insul't».) 2003; (8): 4–9. (In Russ.)

[2] Гусев Е.И., Скворцова В.И., Стаховская Л.В. Эпидемиология инсульта в России. Ж. неврол. и психиатр. (Приложение «Инсульт».) 2003; (8): 4–9.

[3] Collection of statistical materials on diseases of the circulatory system. Statistical reference. Moscow: Ministry Of Health Of Russia. 2017; 295 p. (In Russ.)

[4] Сборник статистических материалов по болезням системы кровообращения. Статистический справочник. М.: Минздрав России. 2017; 295 с.

[5] Levshakova A.V., Domashenko M.A. Acute cerebrovascular accident: diagnostic and organizational aspects (lecture). Radiologiya — praktika. 2014; (1): 48–57. (In Russ.)

[6] Левшакова А.В., Домашенко М.А. Острое нарушение мозгового кровообращения: диагностические и организационные аспекты (лекция). Радиология — практика. 2014; (1): 48–57.

[7] Morozov I.Yu., Nasnikova I.Yu., Shmyrev V.I. et al. Perfusion computed tomography in the diagnostics of acute cerebral bloodflow disorders. Kremlevskaya meditsina. Klini­cheskiy vestnik. 2011; (1): 14–18. (In Russ.)

[8] Морозов И.Ю., Насникова И.Ю., Шмырев В.И. и др. Перфузионная компьютерная томография в диагностике острого нарушения мозгового кровообращения. Ж. Кремлёвская мед. Клин. вестн. 2011; (1): 14–18.

[9] Sergeev D.V. Perfusion computed tomography in the diagnosis of acute ischemic stroke. RMZh. 2008; (26): 1758. (In Russ.)

[10] Сергеев Д.В. Перфузионная компьютерная томография в диагностике острого ишемического инсульта. РМЖ. 2008; (26): 1758.

[11] Shetty S.H., Lev M.H. CT perfusion. In: R.G. Gon­za­lez, J.A. Hirsch, W.J. Koroshetz et al. (eds.) Acute ischemic stroke. Imaging and intervention. Berlin — Heidelberg: Springer-­Verlag. 2006; 87–113. DOI: 10.1007/3-540-30810-5_5.

[12] Camerlingo M., Casto L., Censori B. et al. Transcranial Doppler in acute ischemic stroke of the middle cerebral artery territories. Acta. Neurol. Scand. 1993; 88: 108–111. DOI: 10.1111/j.1600-0404.1993.

[13] Ley-Pozo J., Ringelstein E.B. Noninvasive detection of occlusive disease of the carotid siphon and middle cerebral artery. Ann. Neurol. 1990; 28: 640–647. DOI: 10.1002/ana.410280507.

[14] Ringelstein E.B., von Kummer R., Baron J.-C. Ima­ging and the early evaluation of stroke. In: Stroke. Emergency management and critical care. T. Steiner, W. Hacke, D.F. Hanley eds. Springer. 1998; 43–60. DOI: 10.1002/ana.410280507.

[15] Miles K.A., Eastwood J.D., Konig M. Multidetector computed tomography in cerebrovascular disease. CT perfusion imaging. Informa, UK. 2007; 175 р.

RIGHTS & PERMISSIONS

Valeeva K.G., Perminova S.K., Nazipova A.Y., Kurochkin S.V., Yakupova A.A.