A growing number of health organizations are making computed tomographic perfusion (CTP) a critical part of their stroke intervention protocols.
Research, like the DAWN trials, supports stroke diagnosis and emergency interventional treatment (thrombectomy) up to 24 hours after symptom onset, extending the timeline during which an initial head CT report provides critical information. Further, it allows more time to augment CT results with CTP studies, adding meaningful perspective for clinicians to use in prescribing treatment.
Non-contrast CT is still the critical first step
When stroke is suspected, “time is brain.” Every second that passes threatens further damage. A standard, non-contrast head CT remains the fastest, most accurate way to provide clinicians what is needed to initiate appropriate emergency interventional treatment.
Previously, it was widely believed that any treatment not initiated within 6 hours of symptom onset would promise little benefit to acute stroke patients. However, recent trials support positive results for stroke patients who first receive treatment up to 24 hours after symptom onset. (See my earlier blog entry highlighting the DAWN Trials, DAWN of a New Age for Stroke Imaging.)
CTs are still the critical first step in imaging protocols for acute stroke diagnosis, providing critical diagnostic insight through what is now a much wider window of time. This means more head CTs will be ordered, resulting in lives saved and reduced long-term disability for many stroke victims. It also opens the opportunity for clinicians to employ additional diagnostic tools to more precisely assess potential damage, and to implement more informed treatment and recovery programs.
CT perfusion adds dimension
With a much larger window of opportunity through which to properly diagnose and treat stroke victims, it becomes beneficial to supplement the initial head CT with more detailed imaging to precisely assess areas affected and the extent of damage. CTP has emerged as a valuable tool, providing physicians with the data to identify patients who are likely to benefit from reperfusion therapy.
MR is similarly employed by many in the diagnosis of ischemic stroke. Studies have demonstrated comparable results for CTP and MR imaging.
Stroke protocols must change
It is imperative that radiology practitioners prepare for significant increases in the volume of studies requested for stroke victims.
Extending the diagnosis window to 24 hours means clinicians may request imaging for the estimated 200,000 stroke victims who previously fell outside the 6-hour-symptom-onset guidelines. This represents a potential increase of 33% in the number of standard head CTA orders annually. In addition, requests for more detailed studies, like CTP, will increase among all 800,000 stroke cases across the country (Source: Centers for Disease Control), as clinicians recognize their value in developing effective, individualized long-term treatment plans.
Requests for CT perfusion studies are on pace to double this year at vRad, with continued exponential growth expected for the foreseeable future.
Every radiology practice should prepare for a significant increase in non-contrast head CT orders, keeping in mind that the turnaround time for results is no less critical than it has always been – every second still counts. We can leverage our technology platform and honed protocols to deliver critical test calls in as few as 1 to 2 minutes, while delivering reports, on average, in under 7 minutes.
About the Author
Jean-Paul Dym, MD, Director of Stroke Imaging, vRad. ABR certified, Diagnostic Radiology, Neuroradiology. An early passion for photography, combined with his fascination in human anatomy propelled J.P. toward a radiology career and fellowship at Yale University. He leads the vRad team exploring advanced imaging techniques that enable unprecedented insights into diagnosing neurological diseases.