Perfusion Imaging: Bolus truncation alters penumbral status of acute stroke patients. Using a vascular model reduces this effect

In acute stroke patients, the penumbra indicates tissue-at-risk. The corresponding imaging marker is the mismatch between abnormal regions on perfusion-weighted images (PWI) and diffusion-weighted images (DWI). The PWI-abnormality is affected, if imaging duration is too short to capture the entire passage of contrast agent through the tissue. We simulated bolus truncation in 73 patients, and found that penumbra would have been overlooked in 22 patients, had imaging duration been 15s after peak of the arterial curve. This number reduced with imaging duration, or if a vascular model for was used for perfusion-calculation. A BT indicator was suggested for quality assessment.

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