Brain Stroke (CT) PRINT
Last updated: 5/21/2021.
What changed: N/A
History: Stroke, cerebrovascular accident, ischemia, large vessel occlusion
History should include presenting symptom and NIH stroke scale number
| Stroke | ||||||||
|---|---|---|---|---|---|---|---|---|
| Localizer | Frontal and Lateral | |||||||
| Scan | #1: non-con brain | #2: perfusion | #3: CTA Neck/Head | #4: Multiphase CTA (if requested at Swedish Hospital) | ||||
| Phase | non-contrast | Dynamic multiphase | Peak arterial | peak and late venous | ||||
| Instructions | none | none | Don’t swallow | |||||
| Coverage | foramen magnum to vertex | If using RAPID: whole brain; Otherwise basal ganglia | Top of aortic arch to vertex | foramen magnum to vertex | ||||
| Contrast agent | none | Isovue 370 | Isovue 370 | |||||
| Volume/ rate | - | 50 mL @ 5 mL / sec | 80 mL @ 4 mL/ sec | 80 mL @ 5 mL / sec | ||||
| Contrast Delay | - | simultaneous with start of scan | trigger at arch | #1 peak venous @ 10 sec; #2 late venous @ 18 sec | ||||
| Scan type | axial | axial, zero table movement | helical | - | ||||
| kVp | 140 | 80 | 120 | - | ||||
| Max mA | 510 | 300 | 580 | - | ||||
| Rotation time | 0.6 sec | 0.5 sec | 0.4 sec | - | ||||
| Target CTDIvol | < 35 mGy | 327.82 mGy | < 15 mGy | - | ||||
| Max CTDIvol | 75 mGy | 327.82 mGy | 25 mGy | - | ||||
| Max scan time | 24 sec | 75 sec (37 rotations) | 12 sec | 3.4 sec per phase | ||||
| Pitch / Noise index | n/a- 3.95 | - | 0.969:1/18.88 | - | ||||
| Table speed | - | - | 19.37mm/s | - | ||||
| Collimation | 5.0/4i | 5.0/8i | 0.625x64 | - | ||||
| Recon type | Soft | Soft | Standard | - | ||||
| SFOV/DFOV | Head / 25 cm | Head / 24 cm | Medium / 22-26 cm | - | ||||
| SEND TO PACS | ||||||||
| Ax 2 mm Soft | CBV, CBF, MTT, TTP or Tmax Color Maps | Ax 0.625 mm Std | Ax Color Summation | |||||
| Ax 2 mm Bone | Ax 5 mm Soft (perfusion series) | MIP Sag & Cor Neck 2 x 2 mm | SAG Color Summation | |||||
| Cor & Sag 3 mm Soft | MIP Ax & Cor & Sag Head 5 x 1 mm | COR Color Summation | ||||||
| 3D VRT COW & NECK | ||||||||
Key tips:
- Do not perform Perfusion scan at facilities where a stroke alert program and team does not exist.
- Run multiphase CT angiogram scan only if hospital has neurointerventional services.
- Following routine non-contrast head CT, start perfusion or angiogram immediately. Alert the radiologist of the non-contrast head CT images, but
- Radiologist “approval” is not needed to complete the perfusion or angiogram.
- Run CT perfusion for 60 second for patients < 65 yr old; 75 second for patients > 65 yr old or if cardiac output unknown.
- Mulitphase CT angiogram Color Maps Reconstructed with ColorViz module GE FastStroke software.