Preoperative brain computed tomographic perfusion for quantitative evaluation of cerebral malperfusion caused by acute type A aortic dissection

Figures

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  Preoperative CTP imaging in patients with type A dissection and cerebral malperfusion.

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  Video 1. Explanation of CTP data and surgical strategy for patients with acute type A aortic dissection. Video available at: https://www.jtcvs.org/article/S2666-2507(21)00662-3/fulltext.

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  Figure 1. Illustration summarizing case 1. A, Preoperative CT angiography focusing on CCA stenosis. Yellow circle points out right CCA with decompression of true lumen. Red circle points out left CCA with decompression of true lumen. B, Preoperative CT perfusion imaging automated by software (RAPID). Left side implies no ischemic core, and green lesion (right side) implies occupied area of penumbra. C, Postoperative CT perfusion imaging automated by software (RAPID). Left side implies no ischemic core and green penumbra lesion (right side) dramatically decreased. CCA, Common carotid artery; CBF, cerebral blood flow; RAPID, RApid processing of Perfusion and Diffusion.

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  Figure 2. Illustration summarizing case 2. A, Preoperative CT angiography focusing on CCA stenosis. Yellow circle points out right CCA with static obstruction. B, Preoperative CT perfusion imaging automated by software (RAPID). Left side implies ischemic core was 57 mL and green lesion (right side) implies occupied area of penumbra as much as 353 mL. C, Preoperative CT perfusion imaging automated by software (RAPID). Tmax >10 seconds volume was detected as 228 mL with greater hypoperfusion intensity ratio as 0.6. D, Postoperative CT of the head revealed massive intracranial hemorrhage requiring craniotomy. CCA, Common carotid artery; CBF, cerebral blood flow; RAPID, RApid processing of Perfusion and Diffusion.

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  Figure E1. An example of ischemic core penumbra mismatch map automatically computed by RAPID software. CBF, Cerebral blood flow; RAPID, RApid processing of Perfusion and Diffusion.