Neuro imaging Dr Teddy SpS

NEUROLOGIST VIEW

bull A brain CT or MRI scan is urgently recommended for all patients with suspected acute stroke or transient ischemic attack bull Noncontrast CT and gradient-recalled

echo MRI show similar accuracy in the diagnosis of acute intracerebral hemorrhage

bull Diffusion-weighted MRI is markedly more sensitive than noncontrast CT for distinguishing acute ischemic stroke from nonstroke conditions

bull Combined multimodal parenchymal perfusion and vascular imaging with CTor MRI could potentially identify patients with an ischemic penumbra that might be amenable to acute reperfusion therapies

bull MRI identifies a broad range of acute and chronic cerebrovascular pathologies that could aid decisions about acute intervention in-hospital management and secondary prevention

bull Overall MRI is diagnostically superior to CT for cerebrovascular indications but is contraindicated in asymp10 of patients has limited availability at many hospitals and can be costly and time-consuming

bull CT is more readily available than MRI for emergency use

bull Equipment costs and patient charges are lower for CT than for MRI

bull CT involves exposure to ionizing radiation no known biological risk exists for MRI

bull MRI is markedly more sensitive and accurate than CT in early imaging-based diagnosis of ischemic stroke

bull MRI is contraindicated in a subset of patients bull Patients personnel and equipment must be

screened to exclude unacceptable metal or electronics from the MRI scanning environment

bull In cases of severe renal failure intravenous contrast agent is contraindicated for both CT and MRI but noncontrast alternatives for vascular and perfusion imaging are available for MRI

bull Multimodal CT survey A 57 year-old male with a right MCA syndrome underwent CT a | The unenhanced CT scan ruled out a cerebral hemorrhage and showed effacement of the sulci and subtle loss of grayndashwhite matter differentiation in the inferior right MCA territory From the CTP raw data three parametric maps were extracted relating to b | mean transit time c | cerebral blood flow and d | cerebral blood volume e | Application of the concept of ischemic penumbra led to a prognostic map which depicted the infarct in red and the penumbra in green the latter being a potential target for acute reperfusion therapies f | CTA identified an occlusion at the distal right ICA just proximal to the MCA origin (arrow) as the origin of the hemodynamic disturbance demonstrated by CTP CTA also revealed a calcified atheromatous plaque at the right carotid bifurcation (arrowhead)

Key words umur infark

Hiperaut lt 6 jambull DWI brightbull ADC darkbull Flair normalbull karena flair baru ada

kelainan setelah 6 jam infark

lt 4 haribull DWI Brightbull ADC darkbull Flair bright

Umur infark 2

Infark gt 4 haribull DWI brightbull ADC brightbull Flair bright ADC bright setelah 4 hari

Infark kronik gt masa akutbull DWI darkbull ADC bright

Kebalikan infark akut

Axial unenhanced CT images in a proximal segment of the left MCA in a 53-year-old man (a) and a distal segment of the left MCA in a 62-year-old woman (b) obtained 2 hours after the onset of right hemiparesis and aphasia show areas of hyperattenuation (arrow) suggestive of intravas-

cular thrombi

Bila aspects score gt7 trombolyze

CT perfusi

bull Infark CBVbull Iskemi CBF dan MTT

Acute stroke in a 65-year-old man with left hemiparesis CT perfusion maps of cerebral blood vol- ume (a) cerebral blood flow (b) and mean transit time (c) show mismatched abnormalities (arrows) that imply the presence of a penumbra The area with decreased

blood volume represents the ischemic core and that with normal blood volume but decreased blood flow and increased mean transit time is the penumbra

Perdarahan pada MRI

bull T2 dan Flair intensitas meningkat tidak homogen

bull GRE hitam

Acute stroke in the left me- dial temporal lobe in a 44-year-old man (a b) Axial T2-weighted (a) and fluid- attenuated inversion recovery (b) images show areas with increased signal intensity (c) Gradient-echo image shows abnormal low signal intensity in the same areas These findings are

suggestive of hemor- rhage

Konfirmasi akut stroke

bull DWI putihbull ADC hitam

Acute stroke of the posterior circulation in a 77-year-old man (a) Diffusion- weighted MR image (b 1113089 1000 secmm2) shows bilateral areas of increased signal intensity (arrows) in the thalami and occipital lobes (b) ADC map shows decreased ADC values in the same areas (arrows) These findings are indicative of acute ischemia

Kronik infark

bull DWI hitambull ADC bright

Kebalikan dari infark akut

Chronic infarcts in a 71-year-old man with a remote history of multiple strokes (a) Diffusion- weighted MR image (b 1113089 1000 secmm2) shows areas of decreased signal intensity in the left frontal lobe (b) ADC map shows increased ADC values in the white matter of the right frontal

lobe These features are suggestive of chronic infarction

Acute stroke in a 67-year-old woman with acute left hemiplegia 2 hours after ca- rotid endarterectomy (a) Dif- fusion-weighted MR image

(b 1113089 1000 secmm2) shows an area of mildly increased signal intensity in the right parietal lobe (arrows) The ADC values in this region were decreased (b) Perfusion-weighted MR image shows

a larger area with increased time to peak en- hancement (arrows) in the right cerebral hemisphere The mis- match between the perfusion and diffusion images is indica- tive of a large

penumbra

Flow chart shows an acute stroke imaging protocolRadiographics october 2006

• Neuro imaging Dr Teddy SpS
• Slide 2
• Slide 3
• Slide 4
• Slide 5
• Slide 6
• Slide 7
• Slide 8
• Slide 9
• Slide 10
• Slide 11
• Slide 12
• Key words umur infark
• Umur infark 2
• Axial unenhanced CT images in a proximal segment of the left MC
• Slide 16
• Bila aspects score gt7 trombolyze
• Slide 18
• CT perfusi
• Acute stroke in a 65-year-old man with left hemiparesis CT per
• Perdarahan pada MRI
• Acute stroke in the left me- dial temporal lobe in a 44-year-ol
• Slide 23
• Konfirmasi akut stroke
• Acute stroke of the posterior circulation in a 77-year-old man
• Kronik infark
• Chronic infarcts in a 71-year-old man with a remote history of
• Acute stroke in a 67-year-old woman with acute left hemiplegia
• Flow chart shows an acute stroke imaging protocolRadiographic

bull A brain CT or MRI scan is urgently recommended for all patients with suspected acute stroke or transient ischemic attack bull Noncontrast CT and gradient-recalled

echo MRI show similar accuracy in the diagnosis of acute intracerebral hemorrhage

bull Diffusion-weighted MRI is markedly more sensitive than noncontrast CT for distinguishing acute ischemic stroke from nonstroke conditions

bull Combined multimodal parenchymal perfusion and vascular imaging with CTor MRI could potentially identify patients with an ischemic penumbra that might be amenable to acute reperfusion therapies

bull MRI identifies a broad range of acute and chronic cerebrovascular pathologies that could aid decisions about acute intervention in-hospital management and secondary prevention

bull Overall MRI is diagnostically superior to CT for cerebrovascular indications but is contraindicated in asymp10 of patients has limited availability at many hospitals and can be costly and time-consuming

bull CT is more readily available than MRI for emergency use

bull Equipment costs and patient charges are lower for CT than for MRI

bull CT involves exposure to ionizing radiation no known biological risk exists for MRI

bull MRI is markedly more sensitive and accurate than CT in early imaging-based diagnosis of ischemic stroke

bull MRI is contraindicated in a subset of patients bull Patients personnel and equipment must be

screened to exclude unacceptable metal or electronics from the MRI scanning environment

bull In cases of severe renal failure intravenous contrast agent is contraindicated for both CT and MRI but noncontrast alternatives for vascular and perfusion imaging are available for MRI

bull Multimodal CT survey A 57 year-old male with a right MCA syndrome underwent CT a | The unenhanced CT scan ruled out a cerebral hemorrhage and showed effacement of the sulci and subtle loss of grayndashwhite matter differentiation in the inferior right MCA territory From the CTP raw data three parametric maps were extracted relating to b | mean transit time c | cerebral blood flow and d | cerebral blood volume e | Application of the concept of ischemic penumbra led to a prognostic map which depicted the infarct in red and the penumbra in green the latter being a potential target for acute reperfusion therapies f | CTA identified an occlusion at the distal right ICA just proximal to the MCA origin (arrow) as the origin of the hemodynamic disturbance demonstrated by CTP CTA also revealed a calcified atheromatous plaque at the right carotid bifurcation (arrowhead)

Key words umur infark

Hiperaut lt 6 jambull DWI brightbull ADC darkbull Flair normalbull karena flair baru ada

kelainan setelah 6 jam infark

lt 4 haribull DWI Brightbull ADC darkbull Flair bright

Umur infark 2

Infark gt 4 haribull DWI brightbull ADC brightbull Flair bright ADC bright setelah 4 hari

Infark kronik gt masa akutbull DWI darkbull ADC bright

Kebalikan infark akut

Axial unenhanced CT images in a proximal segment of the left MCA in a 53-year-old man (a) and a distal segment of the left MCA in a 62-year-old woman (b) obtained 2 hours after the onset of right hemiparesis and aphasia show areas of hyperattenuation (arrow) suggestive of intravas-

cular thrombi

Bila aspects score gt7 trombolyze

CT perfusi

bull Infark CBVbull Iskemi CBF dan MTT

Acute stroke in a 65-year-old man with left hemiparesis CT perfusion maps of cerebral blood vol- ume (a) cerebral blood flow (b) and mean transit time (c) show mismatched abnormalities (arrows) that imply the presence of a penumbra The area with decreased

blood volume represents the ischemic core and that with normal blood volume but decreased blood flow and increased mean transit time is the penumbra

Perdarahan pada MRI

bull T2 dan Flair intensitas meningkat tidak homogen

bull GRE hitam

Acute stroke in the left me- dial temporal lobe in a 44-year-old man (a b) Axial T2-weighted (a) and fluid- attenuated inversion recovery (b) images show areas with increased signal intensity (c) Gradient-echo image shows abnormal low signal intensity in the same areas These findings are

suggestive of hemor- rhage

Konfirmasi akut stroke

bull DWI putihbull ADC hitam

Acute stroke of the posterior circulation in a 77-year-old man (a) Diffusion- weighted MR image (b 1113089 1000 secmm2) shows bilateral areas of increased signal intensity (arrows) in the thalami and occipital lobes (b) ADC map shows decreased ADC values in the same areas (arrows) These findings are indicative of acute ischemia

Kronik infark

bull DWI hitambull ADC bright

Kebalikan dari infark akut

Chronic infarcts in a 71-year-old man with a remote history of multiple strokes (a) Diffusion- weighted MR image (b 1113089 1000 secmm2) shows areas of decreased signal intensity in the left frontal lobe (b) ADC map shows increased ADC values in the white matter of the right frontal

lobe These features are suggestive of chronic infarction

Acute stroke in a 67-year-old woman with acute left hemiplegia 2 hours after ca- rotid endarterectomy (a) Dif- fusion-weighted MR image

(b 1113089 1000 secmm2) shows an area of mildly increased signal intensity in the right parietal lobe (arrows) The ADC values in this region were decreased (b) Perfusion-weighted MR image shows

a larger area with increased time to peak en- hancement (arrows) in the right cerebral hemisphere The mis- match between the perfusion and diffusion images is indica- tive of a large

penumbra

Flow chart shows an acute stroke imaging protocolRadiographics october 2006

• Neuro imaging Dr Teddy SpS
• Slide 2
• Slide 3
• Slide 4
• Slide 5
• Slide 6
• Slide 7
• Slide 8
• Slide 9
• Slide 10
• Slide 11
• Slide 12
• Key words umur infark
• Umur infark 2
• Axial unenhanced CT images in a proximal segment of the left MC
• Slide 16
• Bila aspects score gt7 trombolyze
• Slide 18
• CT perfusi
• Acute stroke in a 65-year-old man with left hemiparesis CT per
• Perdarahan pada MRI
• Acute stroke in the left me- dial temporal lobe in a 44-year-ol
• Slide 23
• Konfirmasi akut stroke
• Acute stroke of the posterior circulation in a 77-year-old man
• Kronik infark
• Chronic infarcts in a 71-year-old man with a remote history of
• Acute stroke in a 67-year-old woman with acute left hemiplegia
• Flow chart shows an acute stroke imaging protocolRadiographic

bull Diffusion-weighted MRI is markedly more sensitive than noncontrast CT for distinguishing acute ischemic stroke from nonstroke conditions

bull Combined multimodal parenchymal perfusion and vascular imaging with CTor MRI could potentially identify patients with an ischemic penumbra that might be amenable to acute reperfusion therapies

bull MRI identifies a broad range of acute and chronic cerebrovascular pathologies that could aid decisions about acute intervention in-hospital management and secondary prevention

bull Overall MRI is diagnostically superior to CT for cerebrovascular indications but is contraindicated in asymp10 of patients has limited availability at many hospitals and can be costly and time-consuming

bull CT is more readily available than MRI for emergency use

bull Equipment costs and patient charges are lower for CT than for MRI

bull CT involves exposure to ionizing radiation no known biological risk exists for MRI

bull MRI is markedly more sensitive and accurate than CT in early imaging-based diagnosis of ischemic stroke

bull MRI is contraindicated in a subset of patients bull Patients personnel and equipment must be

screened to exclude unacceptable metal or electronics from the MRI scanning environment

bull In cases of severe renal failure intravenous contrast agent is contraindicated for both CT and MRI but noncontrast alternatives for vascular and perfusion imaging are available for MRI

bull Multimodal CT survey A 57 year-old male with a right MCA syndrome underwent CT a | The unenhanced CT scan ruled out a cerebral hemorrhage and showed effacement of the sulci and subtle loss of grayndashwhite matter differentiation in the inferior right MCA territory From the CTP raw data three parametric maps were extracted relating to b | mean transit time c | cerebral blood flow and d | cerebral blood volume e | Application of the concept of ischemic penumbra led to a prognostic map which depicted the infarct in red and the penumbra in green the latter being a potential target for acute reperfusion therapies f | CTA identified an occlusion at the distal right ICA just proximal to the MCA origin (arrow) as the origin of the hemodynamic disturbance demonstrated by CTP CTA also revealed a calcified atheromatous plaque at the right carotid bifurcation (arrowhead)

Key words umur infark

Hiperaut lt 6 jambull DWI brightbull ADC darkbull Flair normalbull karena flair baru ada

kelainan setelah 6 jam infark

lt 4 haribull DWI Brightbull ADC darkbull Flair bright

Umur infark 2

Infark gt 4 haribull DWI brightbull ADC brightbull Flair bright ADC bright setelah 4 hari

Infark kronik gt masa akutbull DWI darkbull ADC bright

Kebalikan infark akut

Axial unenhanced CT images in a proximal segment of the left MCA in a 53-year-old man (a) and a distal segment of the left MCA in a 62-year-old woman (b) obtained 2 hours after the onset of right hemiparesis and aphasia show areas of hyperattenuation (arrow) suggestive of intravas-

cular thrombi

Bila aspects score gt7 trombolyze

CT perfusi

bull Infark CBVbull Iskemi CBF dan MTT

Acute stroke in a 65-year-old man with left hemiparesis CT perfusion maps of cerebral blood vol- ume (a) cerebral blood flow (b) and mean transit time (c) show mismatched abnormalities (arrows) that imply the presence of a penumbra The area with decreased

blood volume represents the ischemic core and that with normal blood volume but decreased blood flow and increased mean transit time is the penumbra

Perdarahan pada MRI

bull T2 dan Flair intensitas meningkat tidak homogen

bull GRE hitam

Acute stroke in the left me- dial temporal lobe in a 44-year-old man (a b) Axial T2-weighted (a) and fluid- attenuated inversion recovery (b) images show areas with increased signal intensity (c) Gradient-echo image shows abnormal low signal intensity in the same areas These findings are

suggestive of hemor- rhage

Konfirmasi akut stroke

bull DWI putihbull ADC hitam

Acute stroke of the posterior circulation in a 77-year-old man (a) Diffusion- weighted MR image (b 1113089 1000 secmm2) shows bilateral areas of increased signal intensity (arrows) in the thalami and occipital lobes (b) ADC map shows decreased ADC values in the same areas (arrows) These findings are indicative of acute ischemia

Kronik infark

bull DWI hitambull ADC bright

Kebalikan dari infark akut

Chronic infarcts in a 71-year-old man with a remote history of multiple strokes (a) Diffusion- weighted MR image (b 1113089 1000 secmm2) shows areas of decreased signal intensity in the left frontal lobe (b) ADC map shows increased ADC values in the white matter of the right frontal

lobe These features are suggestive of chronic infarction

Acute stroke in a 67-year-old woman with acute left hemiplegia 2 hours after ca- rotid endarterectomy (a) Dif- fusion-weighted MR image

(b 1113089 1000 secmm2) shows an area of mildly increased signal intensity in the right parietal lobe (arrows) The ADC values in this region were decreased (b) Perfusion-weighted MR image shows

a larger area with increased time to peak en- hancement (arrows) in the right cerebral hemisphere The mis- match between the perfusion and diffusion images is indica- tive of a large

penumbra

Flow chart shows an acute stroke imaging protocolRadiographics october 2006

• Neuro imaging Dr Teddy SpS
• Slide 2
• Slide 3
• Slide 4
• Slide 5
• Slide 6
• Slide 7
• Slide 8
• Slide 9
• Slide 10
• Slide 11
• Slide 12
• Key words umur infark
• Umur infark 2
• Axial unenhanced CT images in a proximal segment of the left MC
• Slide 16
• Bila aspects score gt7 trombolyze
• Slide 18
• CT perfusi
• Acute stroke in a 65-year-old man with left hemiparesis CT per
• Perdarahan pada MRI
• Acute stroke in the left me- dial temporal lobe in a 44-year-ol
• Slide 23
• Konfirmasi akut stroke
• Acute stroke of the posterior circulation in a 77-year-old man
• Kronik infark
• Chronic infarcts in a 71-year-old man with a remote history of
• Acute stroke in a 67-year-old woman with acute left hemiplegia
• Flow chart shows an acute stroke imaging protocolRadiographic

bull MRI identifies a broad range of acute and chronic cerebrovascular pathologies that could aid decisions about acute intervention in-hospital management and secondary prevention

bull Overall MRI is diagnostically superior to CT for cerebrovascular indications but is contraindicated in asymp10 of patients has limited availability at many hospitals and can be costly and time-consuming

bull CT is more readily available than MRI for emergency use

bull Equipment costs and patient charges are lower for CT than for MRI

bull CT involves exposure to ionizing radiation no known biological risk exists for MRI

bull MRI is markedly more sensitive and accurate than CT in early imaging-based diagnosis of ischemic stroke

bull MRI is contraindicated in a subset of patients bull Patients personnel and equipment must be

screened to exclude unacceptable metal or electronics from the MRI scanning environment

bull In cases of severe renal failure intravenous contrast agent is contraindicated for both CT and MRI but noncontrast alternatives for vascular and perfusion imaging are available for MRI

bull Multimodal CT survey A 57 year-old male with a right MCA syndrome underwent CT a | The unenhanced CT scan ruled out a cerebral hemorrhage and showed effacement of the sulci and subtle loss of grayndashwhite matter differentiation in the inferior right MCA territory From the CTP raw data three parametric maps were extracted relating to b | mean transit time c | cerebral blood flow and d | cerebral blood volume e | Application of the concept of ischemic penumbra led to a prognostic map which depicted the infarct in red and the penumbra in green the latter being a potential target for acute reperfusion therapies f | CTA identified an occlusion at the distal right ICA just proximal to the MCA origin (arrow) as the origin of the hemodynamic disturbance demonstrated by CTP CTA also revealed a calcified atheromatous plaque at the right carotid bifurcation (arrowhead)

Key words umur infark

Hiperaut lt 6 jambull DWI brightbull ADC darkbull Flair normalbull karena flair baru ada

kelainan setelah 6 jam infark

lt 4 haribull DWI Brightbull ADC darkbull Flair bright

Umur infark 2

Infark gt 4 haribull DWI brightbull ADC brightbull Flair bright ADC bright setelah 4 hari

Infark kronik gt masa akutbull DWI darkbull ADC bright

Kebalikan infark akut

Axial unenhanced CT images in a proximal segment of the left MCA in a 53-year-old man (a) and a distal segment of the left MCA in a 62-year-old woman (b) obtained 2 hours after the onset of right hemiparesis and aphasia show areas of hyperattenuation (arrow) suggestive of intravas-

cular thrombi

Bila aspects score gt7 trombolyze

CT perfusi

bull Infark CBVbull Iskemi CBF dan MTT

Acute stroke in a 65-year-old man with left hemiparesis CT perfusion maps of cerebral blood vol- ume (a) cerebral blood flow (b) and mean transit time (c) show mismatched abnormalities (arrows) that imply the presence of a penumbra The area with decreased

blood volume represents the ischemic core and that with normal blood volume but decreased blood flow and increased mean transit time is the penumbra

Perdarahan pada MRI

bull T2 dan Flair intensitas meningkat tidak homogen

bull GRE hitam

Acute stroke in the left me- dial temporal lobe in a 44-year-old man (a b) Axial T2-weighted (a) and fluid- attenuated inversion recovery (b) images show areas with increased signal intensity (c) Gradient-echo image shows abnormal low signal intensity in the same areas These findings are

suggestive of hemor- rhage

Konfirmasi akut stroke

bull DWI putihbull ADC hitam

Acute stroke of the posterior circulation in a 77-year-old man (a) Diffusion- weighted MR image (b 1113089 1000 secmm2) shows bilateral areas of increased signal intensity (arrows) in the thalami and occipital lobes (b) ADC map shows decreased ADC values in the same areas (arrows) These findings are indicative of acute ischemia

Kronik infark

bull DWI hitambull ADC bright

Kebalikan dari infark akut

Chronic infarcts in a 71-year-old man with a remote history of multiple strokes (a) Diffusion- weighted MR image (b 1113089 1000 secmm2) shows areas of decreased signal intensity in the left frontal lobe (b) ADC map shows increased ADC values in the white matter of the right frontal

lobe These features are suggestive of chronic infarction

Acute stroke in a 67-year-old woman with acute left hemiplegia 2 hours after ca- rotid endarterectomy (a) Dif- fusion-weighted MR image

(b 1113089 1000 secmm2) shows an area of mildly increased signal intensity in the right parietal lobe (arrows) The ADC values in this region were decreased (b) Perfusion-weighted MR image shows

a larger area with increased time to peak en- hancement (arrows) in the right cerebral hemisphere The mis- match between the perfusion and diffusion images is indica- tive of a large

penumbra

Flow chart shows an acute stroke imaging protocolRadiographics october 2006

• Neuro imaging Dr Teddy SpS
• Slide 2
• Slide 3
• Slide 4
• Slide 5
• Slide 6
• Slide 7
• Slide 8
• Slide 9
• Slide 10
• Slide 11
• Slide 12
• Key words umur infark
• Umur infark 2
• Axial unenhanced CT images in a proximal segment of the left MC
• Slide 16
• Bila aspects score gt7 trombolyze
• Slide 18
• CT perfusi
• Acute stroke in a 65-year-old man with left hemiparesis CT per
• Perdarahan pada MRI
• Acute stroke in the left me- dial temporal lobe in a 44-year-ol
• Slide 23
• Konfirmasi akut stroke
• Acute stroke of the posterior circulation in a 77-year-old man
• Kronik infark
• Chronic infarcts in a 71-year-old man with a remote history of
• Acute stroke in a 67-year-old woman with acute left hemiplegia
• Flow chart shows an acute stroke imaging protocolRadiographic

bull CT is more readily available than MRI for emergency use

bull Equipment costs and patient charges are lower for CT than for MRI

bull CT involves exposure to ionizing radiation no known biological risk exists for MRI

bull MRI is markedly more sensitive and accurate than CT in early imaging-based diagnosis of ischemic stroke

bull MRI is contraindicated in a subset of patients bull Patients personnel and equipment must be

screened to exclude unacceptable metal or electronics from the MRI scanning environment

bull In cases of severe renal failure intravenous contrast agent is contraindicated for both CT and MRI but noncontrast alternatives for vascular and perfusion imaging are available for MRI

bull Multimodal CT survey A 57 year-old male with a right MCA syndrome underwent CT a | The unenhanced CT scan ruled out a cerebral hemorrhage and showed effacement of the sulci and subtle loss of grayndashwhite matter differentiation in the inferior right MCA territory From the CTP raw data three parametric maps were extracted relating to b | mean transit time c | cerebral blood flow and d | cerebral blood volume e | Application of the concept of ischemic penumbra led to a prognostic map which depicted the infarct in red and the penumbra in green the latter being a potential target for acute reperfusion therapies f | CTA identified an occlusion at the distal right ICA just proximal to the MCA origin (arrow) as the origin of the hemodynamic disturbance demonstrated by CTP CTA also revealed a calcified atheromatous plaque at the right carotid bifurcation (arrowhead)

Key words umur infark

Hiperaut lt 6 jambull DWI brightbull ADC darkbull Flair normalbull karena flair baru ada

kelainan setelah 6 jam infark

lt 4 haribull DWI Brightbull ADC darkbull Flair bright

Umur infark 2

Infark gt 4 haribull DWI brightbull ADC brightbull Flair bright ADC bright setelah 4 hari

Infark kronik gt masa akutbull DWI darkbull ADC bright

Kebalikan infark akut

Axial unenhanced CT images in a proximal segment of the left MCA in a 53-year-old man (a) and a distal segment of the left MCA in a 62-year-old woman (b) obtained 2 hours after the onset of right hemiparesis and aphasia show areas of hyperattenuation (arrow) suggestive of intravas-

cular thrombi

Bila aspects score gt7 trombolyze

CT perfusi

bull Infark CBVbull Iskemi CBF dan MTT

Acute stroke in a 65-year-old man with left hemiparesis CT perfusion maps of cerebral blood vol- ume (a) cerebral blood flow (b) and mean transit time (c) show mismatched abnormalities (arrows) that imply the presence of a penumbra The area with decreased

blood volume represents the ischemic core and that with normal blood volume but decreased blood flow and increased mean transit time is the penumbra

Perdarahan pada MRI

bull T2 dan Flair intensitas meningkat tidak homogen

bull GRE hitam

Acute stroke in the left me- dial temporal lobe in a 44-year-old man (a b) Axial T2-weighted (a) and fluid- attenuated inversion recovery (b) images show areas with increased signal intensity (c) Gradient-echo image shows abnormal low signal intensity in the same areas These findings are

suggestive of hemor- rhage

Konfirmasi akut stroke

bull DWI putihbull ADC hitam

Acute stroke of the posterior circulation in a 77-year-old man (a) Diffusion- weighted MR image (b 1113089 1000 secmm2) shows bilateral areas of increased signal intensity (arrows) in the thalami and occipital lobes (b) ADC map shows decreased ADC values in the same areas (arrows) These findings are indicative of acute ischemia

Kronik infark

bull DWI hitambull ADC bright

Kebalikan dari infark akut

Chronic infarcts in a 71-year-old man with a remote history of multiple strokes (a) Diffusion- weighted MR image (b 1113089 1000 secmm2) shows areas of decreased signal intensity in the left frontal lobe (b) ADC map shows increased ADC values in the white matter of the right frontal

lobe These features are suggestive of chronic infarction

Acute stroke in a 67-year-old woman with acute left hemiplegia 2 hours after ca- rotid endarterectomy (a) Dif- fusion-weighted MR image

(b 1113089 1000 secmm2) shows an area of mildly increased signal intensity in the right parietal lobe (arrows) The ADC values in this region were decreased (b) Perfusion-weighted MR image shows

a larger area with increased time to peak en- hancement (arrows) in the right cerebral hemisphere The mis- match between the perfusion and diffusion images is indica- tive of a large

penumbra

Flow chart shows an acute stroke imaging protocolRadiographics october 2006

• Neuro imaging Dr Teddy SpS
• Slide 2
• Slide 3
• Slide 4
• Slide 5
• Slide 6
• Slide 7
• Slide 8
• Slide 9
• Slide 10
• Slide 11
• Slide 12
• Key words umur infark
• Umur infark 2
• Axial unenhanced CT images in a proximal segment of the left MC
• Slide 16
• Bila aspects score gt7 trombolyze
• Slide 18
• CT perfusi
• Acute stroke in a 65-year-old man with left hemiparesis CT per
• Perdarahan pada MRI
• Acute stroke in the left me- dial temporal lobe in a 44-year-ol
• Slide 23
• Konfirmasi akut stroke
• Acute stroke of the posterior circulation in a 77-year-old man
• Kronik infark
• Chronic infarcts in a 71-year-old man with a remote history of
• Acute stroke in a 67-year-old woman with acute left hemiplegia
• Flow chart shows an acute stroke imaging protocolRadiographic

bull MRI is contraindicated in a subset of patients bull Patients personnel and equipment must be

screened to exclude unacceptable metal or electronics from the MRI scanning environment

bull In cases of severe renal failure intravenous contrast agent is contraindicated for both CT and MRI but noncontrast alternatives for vascular and perfusion imaging are available for MRI

bull Multimodal CT survey A 57 year-old male with a right MCA syndrome underwent CT a | The unenhanced CT scan ruled out a cerebral hemorrhage and showed effacement of the sulci and subtle loss of grayndashwhite matter differentiation in the inferior right MCA territory From the CTP raw data three parametric maps were extracted relating to b | mean transit time c | cerebral blood flow and d | cerebral blood volume e | Application of the concept of ischemic penumbra led to a prognostic map which depicted the infarct in red and the penumbra in green the latter being a potential target for acute reperfusion therapies f | CTA identified an occlusion at the distal right ICA just proximal to the MCA origin (arrow) as the origin of the hemodynamic disturbance demonstrated by CTP CTA also revealed a calcified atheromatous plaque at the right carotid bifurcation (arrowhead)

Key words umur infark

Hiperaut lt 6 jambull DWI brightbull ADC darkbull Flair normalbull karena flair baru ada

kelainan setelah 6 jam infark

lt 4 haribull DWI Brightbull ADC darkbull Flair bright

Umur infark 2

Infark gt 4 haribull DWI brightbull ADC brightbull Flair bright ADC bright setelah 4 hari

Infark kronik gt masa akutbull DWI darkbull ADC bright

Kebalikan infark akut

Axial unenhanced CT images in a proximal segment of the left MCA in a 53-year-old man (a) and a distal segment of the left MCA in a 62-year-old woman (b) obtained 2 hours after the onset of right hemiparesis and aphasia show areas of hyperattenuation (arrow) suggestive of intravas-

cular thrombi

Bila aspects score gt7 trombolyze

CT perfusi

bull Infark CBVbull Iskemi CBF dan MTT

Acute stroke in a 65-year-old man with left hemiparesis CT perfusion maps of cerebral blood vol- ume (a) cerebral blood flow (b) and mean transit time (c) show mismatched abnormalities (arrows) that imply the presence of a penumbra The area with decreased

blood volume represents the ischemic core and that with normal blood volume but decreased blood flow and increased mean transit time is the penumbra

Perdarahan pada MRI

bull T2 dan Flair intensitas meningkat tidak homogen

bull GRE hitam

Acute stroke in the left me- dial temporal lobe in a 44-year-old man (a b) Axial T2-weighted (a) and fluid- attenuated inversion recovery (b) images show areas with increased signal intensity (c) Gradient-echo image shows abnormal low signal intensity in the same areas These findings are

suggestive of hemor- rhage

Konfirmasi akut stroke

bull DWI putihbull ADC hitam

Acute stroke of the posterior circulation in a 77-year-old man (a) Diffusion- weighted MR image (b 1113089 1000 secmm2) shows bilateral areas of increased signal intensity (arrows) in the thalami and occipital lobes (b) ADC map shows decreased ADC values in the same areas (arrows) These findings are indicative of acute ischemia

Kronik infark

bull DWI hitambull ADC bright

Kebalikan dari infark akut

Chronic infarcts in a 71-year-old man with a remote history of multiple strokes (a) Diffusion- weighted MR image (b 1113089 1000 secmm2) shows areas of decreased signal intensity in the left frontal lobe (b) ADC map shows increased ADC values in the white matter of the right frontal

lobe These features are suggestive of chronic infarction

Acute stroke in a 67-year-old woman with acute left hemiplegia 2 hours after ca- rotid endarterectomy (a) Dif- fusion-weighted MR image

(b 1113089 1000 secmm2) shows an area of mildly increased signal intensity in the right parietal lobe (arrows) The ADC values in this region were decreased (b) Perfusion-weighted MR image shows

a larger area with increased time to peak en- hancement (arrows) in the right cerebral hemisphere The mis- match between the perfusion and diffusion images is indica- tive of a large

penumbra

Flow chart shows an acute stroke imaging protocolRadiographics october 2006

• Neuro imaging Dr Teddy SpS
• Slide 2
• Slide 3
• Slide 4
• Slide 5
• Slide 6
• Slide 7
• Slide 8
• Slide 9
• Slide 10
• Slide 11
• Slide 12
• Key words umur infark
• Umur infark 2
• Axial unenhanced CT images in a proximal segment of the left MC
• Slide 16
• Bila aspects score gt7 trombolyze
• Slide 18
• CT perfusi
• Acute stroke in a 65-year-old man with left hemiparesis CT per
• Perdarahan pada MRI
• Acute stroke in the left me- dial temporal lobe in a 44-year-ol
• Slide 23
• Konfirmasi akut stroke
• Acute stroke of the posterior circulation in a 77-year-old man
• Kronik infark
• Chronic infarcts in a 71-year-old man with a remote history of
• Acute stroke in a 67-year-old woman with acute left hemiplegia
• Flow chart shows an acute stroke imaging protocolRadiographic

bull Multimodal CT survey A 57 year-old male with a right MCA syndrome underwent CT a | The unenhanced CT scan ruled out a cerebral hemorrhage and showed effacement of the sulci and subtle loss of grayndashwhite matter differentiation in the inferior right MCA territory From the CTP raw data three parametric maps were extracted relating to b | mean transit time c | cerebral blood flow and d | cerebral blood volume e | Application of the concept of ischemic penumbra led to a prognostic map which depicted the infarct in red and the penumbra in green the latter being a potential target for acute reperfusion therapies f | CTA identified an occlusion at the distal right ICA just proximal to the MCA origin (arrow) as the origin of the hemodynamic disturbance demonstrated by CTP CTA also revealed a calcified atheromatous plaque at the right carotid bifurcation (arrowhead)

Key words umur infark

Hiperaut lt 6 jambull DWI brightbull ADC darkbull Flair normalbull karena flair baru ada

kelainan setelah 6 jam infark

lt 4 haribull DWI Brightbull ADC darkbull Flair bright

Umur infark 2

Infark gt 4 haribull DWI brightbull ADC brightbull Flair bright ADC bright setelah 4 hari

Infark kronik gt masa akutbull DWI darkbull ADC bright

Kebalikan infark akut

Axial unenhanced CT images in a proximal segment of the left MCA in a 53-year-old man (a) and a distal segment of the left MCA in a 62-year-old woman (b) obtained 2 hours after the onset of right hemiparesis and aphasia show areas of hyperattenuation (arrow) suggestive of intravas-

cular thrombi

Bila aspects score gt7 trombolyze

CT perfusi

bull Infark CBVbull Iskemi CBF dan MTT

Acute stroke in a 65-year-old man with left hemiparesis CT perfusion maps of cerebral blood vol- ume (a) cerebral blood flow (b) and mean transit time (c) show mismatched abnormalities (arrows) that imply the presence of a penumbra The area with decreased

blood volume represents the ischemic core and that with normal blood volume but decreased blood flow and increased mean transit time is the penumbra

Perdarahan pada MRI

bull T2 dan Flair intensitas meningkat tidak homogen

bull GRE hitam

Acute stroke in the left me- dial temporal lobe in a 44-year-old man (a b) Axial T2-weighted (a) and fluid- attenuated inversion recovery (b) images show areas with increased signal intensity (c) Gradient-echo image shows abnormal low signal intensity in the same areas These findings are

suggestive of hemor- rhage

Konfirmasi akut stroke

bull DWI putihbull ADC hitam

Acute stroke of the posterior circulation in a 77-year-old man (a) Diffusion- weighted MR image (b 1113089 1000 secmm2) shows bilateral areas of increased signal intensity (arrows) in the thalami and occipital lobes (b) ADC map shows decreased ADC values in the same areas (arrows) These findings are indicative of acute ischemia

Kronik infark

bull DWI hitambull ADC bright

Kebalikan dari infark akut

Chronic infarcts in a 71-year-old man with a remote history of multiple strokes (a) Diffusion- weighted MR image (b 1113089 1000 secmm2) shows areas of decreased signal intensity in the left frontal lobe (b) ADC map shows increased ADC values in the white matter of the right frontal

lobe These features are suggestive of chronic infarction

Acute stroke in a 67-year-old woman with acute left hemiplegia 2 hours after ca- rotid endarterectomy (a) Dif- fusion-weighted MR image

(b 1113089 1000 secmm2) shows an area of mildly increased signal intensity in the right parietal lobe (arrows) The ADC values in this region were decreased (b) Perfusion-weighted MR image shows

a larger area with increased time to peak en- hancement (arrows) in the right cerebral hemisphere The mis- match between the perfusion and diffusion images is indica- tive of a large

penumbra

Flow chart shows an acute stroke imaging protocolRadiographics october 2006

• Neuro imaging Dr Teddy SpS
• Slide 2
• Slide 3
• Slide 4
• Slide 5
• Slide 6
• Slide 7
• Slide 8
• Slide 9
• Slide 10
• Slide 11
• Slide 12
• Key words umur infark
• Umur infark 2
• Axial unenhanced CT images in a proximal segment of the left MC
• Slide 16
• Bila aspects score gt7 trombolyze
• Slide 18
• CT perfusi
• Acute stroke in a 65-year-old man with left hemiparesis CT per
• Perdarahan pada MRI
• Acute stroke in the left me- dial temporal lobe in a 44-year-ol
• Slide 23
• Konfirmasi akut stroke
• Acute stroke of the posterior circulation in a 77-year-old man
• Kronik infark
• Chronic infarcts in a 71-year-old man with a remote history of
• Acute stroke in a 67-year-old woman with acute left hemiplegia
• Flow chart shows an acute stroke imaging protocolRadiographic

Key words umur infark

Hiperaut lt 6 jambull DWI brightbull ADC darkbull Flair normalbull karena flair baru ada

kelainan setelah 6 jam infark

lt 4 haribull DWI Brightbull ADC darkbull Flair bright

Umur infark 2

Infark gt 4 haribull DWI brightbull ADC brightbull Flair bright ADC bright setelah 4 hari

Infark kronik gt masa akutbull DWI darkbull ADC bright

Kebalikan infark akut

Axial unenhanced CT images in a proximal segment of the left MCA in a 53-year-old man (a) and a distal segment of the left MCA in a 62-year-old woman (b) obtained 2 hours after the onset of right hemiparesis and aphasia show areas of hyperattenuation (arrow) suggestive of intravas-

cular thrombi

Bila aspects score gt7 trombolyze

CT perfusi

bull Infark CBVbull Iskemi CBF dan MTT

Acute stroke in a 65-year-old man with left hemiparesis CT perfusion maps of cerebral blood vol- ume (a) cerebral blood flow (b) and mean transit time (c) show mismatched abnormalities (arrows) that imply the presence of a penumbra The area with decreased

blood volume represents the ischemic core and that with normal blood volume but decreased blood flow and increased mean transit time is the penumbra

Perdarahan pada MRI

bull T2 dan Flair intensitas meningkat tidak homogen

bull GRE hitam

Acute stroke in the left me- dial temporal lobe in a 44-year-old man (a b) Axial T2-weighted (a) and fluid- attenuated inversion recovery (b) images show areas with increased signal intensity (c) Gradient-echo image shows abnormal low signal intensity in the same areas These findings are

suggestive of hemor- rhage

Konfirmasi akut stroke

bull DWI putihbull ADC hitam

Acute stroke of the posterior circulation in a 77-year-old man (a) Diffusion- weighted MR image (b 1113089 1000 secmm2) shows bilateral areas of increased signal intensity (arrows) in the thalami and occipital lobes (b) ADC map shows decreased ADC values in the same areas (arrows) These findings are indicative of acute ischemia

Kronik infark

bull DWI hitambull ADC bright

Kebalikan dari infark akut

Chronic infarcts in a 71-year-old man with a remote history of multiple strokes (a) Diffusion- weighted MR image (b 1113089 1000 secmm2) shows areas of decreased signal intensity in the left frontal lobe (b) ADC map shows increased ADC values in the white matter of the right frontal

lobe These features are suggestive of chronic infarction

Acute stroke in a 67-year-old woman with acute left hemiplegia 2 hours after ca- rotid endarterectomy (a) Dif- fusion-weighted MR image

(b 1113089 1000 secmm2) shows an area of mildly increased signal intensity in the right parietal lobe (arrows) The ADC values in this region were decreased (b) Perfusion-weighted MR image shows

a larger area with increased time to peak en- hancement (arrows) in the right cerebral hemisphere The mis- match between the perfusion and diffusion images is indica- tive of a large

penumbra

Flow chart shows an acute stroke imaging protocolRadiographics october 2006

• Neuro imaging Dr Teddy SpS
• Slide 2
• Slide 3
• Slide 4
• Slide 5
• Slide 6
• Slide 7
• Slide 8
• Slide 9
• Slide 10
• Slide 11
• Slide 12
• Key words umur infark
• Umur infark 2
• Axial unenhanced CT images in a proximal segment of the left MC
• Slide 16
• Bila aspects score gt7 trombolyze
• Slide 18
• CT perfusi
• Acute stroke in a 65-year-old man with left hemiparesis CT per
• Perdarahan pada MRI
• Acute stroke in the left me- dial temporal lobe in a 44-year-ol
• Slide 23
• Konfirmasi akut stroke
• Acute stroke of the posterior circulation in a 77-year-old man
• Kronik infark
• Chronic infarcts in a 71-year-old man with a remote history of
• Acute stroke in a 67-year-old woman with acute left hemiplegia
• Flow chart shows an acute stroke imaging protocolRadiographic

Umur infark 2

Infark gt 4 haribull DWI brightbull ADC brightbull Flair bright ADC bright setelah 4 hari

Infark kronik gt masa akutbull DWI darkbull ADC bright

Kebalikan infark akut

Axial unenhanced CT images in a proximal segment of the left MCA in a 53-year-old man (a) and a distal segment of the left MCA in a 62-year-old woman (b) obtained 2 hours after the onset of right hemiparesis and aphasia show areas of hyperattenuation (arrow) suggestive of intravas-

cular thrombi

Bila aspects score gt7 trombolyze

CT perfusi

bull Infark CBVbull Iskemi CBF dan MTT

Acute stroke in a 65-year-old man with left hemiparesis CT perfusion maps of cerebral blood vol- ume (a) cerebral blood flow (b) and mean transit time (c) show mismatched abnormalities (arrows) that imply the presence of a penumbra The area with decreased

blood volume represents the ischemic core and that with normal blood volume but decreased blood flow and increased mean transit time is the penumbra

Perdarahan pada MRI

bull T2 dan Flair intensitas meningkat tidak homogen

bull GRE hitam

Acute stroke in the left me- dial temporal lobe in a 44-year-old man (a b) Axial T2-weighted (a) and fluid- attenuated inversion recovery (b) images show areas with increased signal intensity (c) Gradient-echo image shows abnormal low signal intensity in the same areas These findings are

suggestive of hemor- rhage

Konfirmasi akut stroke

bull DWI putihbull ADC hitam

Acute stroke of the posterior circulation in a 77-year-old man (a) Diffusion- weighted MR image (b 1113089 1000 secmm2) shows bilateral areas of increased signal intensity (arrows) in the thalami and occipital lobes (b) ADC map shows decreased ADC values in the same areas (arrows) These findings are indicative of acute ischemia

Kronik infark

bull DWI hitambull ADC bright

Kebalikan dari infark akut

Chronic infarcts in a 71-year-old man with a remote history of multiple strokes (a) Diffusion- weighted MR image (b 1113089 1000 secmm2) shows areas of decreased signal intensity in the left frontal lobe (b) ADC map shows increased ADC values in the white matter of the right frontal

lobe These features are suggestive of chronic infarction

Acute stroke in a 67-year-old woman with acute left hemiplegia 2 hours after ca- rotid endarterectomy (a) Dif- fusion-weighted MR image

(b 1113089 1000 secmm2) shows an area of mildly increased signal intensity in the right parietal lobe (arrows) The ADC values in this region were decreased (b) Perfusion-weighted MR image shows

a larger area with increased time to peak en- hancement (arrows) in the right cerebral hemisphere The mis- match between the perfusion and diffusion images is indica- tive of a large

penumbra

Flow chart shows an acute stroke imaging protocolRadiographics october 2006

• Neuro imaging Dr Teddy SpS
• Slide 2
• Slide 3
• Slide 4
• Slide 5
• Slide 6
• Slide 7
• Slide 8
• Slide 9
• Slide 10
• Slide 11
• Slide 12
• Key words umur infark
• Umur infark 2
• Axial unenhanced CT images in a proximal segment of the left MC
• Slide 16
• Bila aspects score gt7 trombolyze
• Slide 18
• CT perfusi
• Acute stroke in a 65-year-old man with left hemiparesis CT per
• Perdarahan pada MRI
• Acute stroke in the left me- dial temporal lobe in a 44-year-ol
• Slide 23
• Konfirmasi akut stroke
• Acute stroke of the posterior circulation in a 77-year-old man
• Kronik infark
• Chronic infarcts in a 71-year-old man with a remote history of
• Acute stroke in a 67-year-old woman with acute left hemiplegia
• Flow chart shows an acute stroke imaging protocolRadiographic

Axial unenhanced CT images in a proximal segment of the left MCA in a 53-year-old man (a) and a distal segment of the left MCA in a 62-year-old woman (b) obtained 2 hours after the onset of right hemiparesis and aphasia show areas of hyperattenuation (arrow) suggestive of intravas-

cular thrombi

Bila aspects score gt7 trombolyze

CT perfusi

bull Infark CBVbull Iskemi CBF dan MTT

Acute stroke in a 65-year-old man with left hemiparesis CT perfusion maps of cerebral blood vol- ume (a) cerebral blood flow (b) and mean transit time (c) show mismatched abnormalities (arrows) that imply the presence of a penumbra The area with decreased

blood volume represents the ischemic core and that with normal blood volume but decreased blood flow and increased mean transit time is the penumbra

Perdarahan pada MRI

bull T2 dan Flair intensitas meningkat tidak homogen

bull GRE hitam

Acute stroke in the left me- dial temporal lobe in a 44-year-old man (a b) Axial T2-weighted (a) and fluid- attenuated inversion recovery (b) images show areas with increased signal intensity (c) Gradient-echo image shows abnormal low signal intensity in the same areas These findings are

suggestive of hemor- rhage

Konfirmasi akut stroke

bull DWI putihbull ADC hitam

Acute stroke of the posterior circulation in a 77-year-old man (a) Diffusion- weighted MR image (b 1113089 1000 secmm2) shows bilateral areas of increased signal intensity (arrows) in the thalami and occipital lobes (b) ADC map shows decreased ADC values in the same areas (arrows) These findings are indicative of acute ischemia

Kronik infark

bull DWI hitambull ADC bright

Kebalikan dari infark akut

Chronic infarcts in a 71-year-old man with a remote history of multiple strokes (a) Diffusion- weighted MR image (b 1113089 1000 secmm2) shows areas of decreased signal intensity in the left frontal lobe (b) ADC map shows increased ADC values in the white matter of the right frontal

lobe These features are suggestive of chronic infarction

Acute stroke in a 67-year-old woman with acute left hemiplegia 2 hours after ca- rotid endarterectomy (a) Dif- fusion-weighted MR image

(b 1113089 1000 secmm2) shows an area of mildly increased signal intensity in the right parietal lobe (arrows) The ADC values in this region were decreased (b) Perfusion-weighted MR image shows

a larger area with increased time to peak en- hancement (arrows) in the right cerebral hemisphere The mis- match between the perfusion and diffusion images is indica- tive of a large

penumbra

Flow chart shows an acute stroke imaging protocolRadiographics october 2006

• Neuro imaging Dr Teddy SpS
• Slide 2
• Slide 3
• Slide 4
• Slide 5
• Slide 6
• Slide 7
• Slide 8
• Slide 9
• Slide 10
• Slide 11
• Slide 12
• Key words umur infark
• Umur infark 2
• Axial unenhanced CT images in a proximal segment of the left MC
• Slide 16
• Bila aspects score gt7 trombolyze
• Slide 18
• CT perfusi
• Acute stroke in a 65-year-old man with left hemiparesis CT per
• Perdarahan pada MRI
• Acute stroke in the left me- dial temporal lobe in a 44-year-ol
• Slide 23
• Konfirmasi akut stroke
• Acute stroke of the posterior circulation in a 77-year-old man
• Kronik infark
• Chronic infarcts in a 71-year-old man with a remote history of
• Acute stroke in a 67-year-old woman with acute left hemiplegia
• Flow chart shows an acute stroke imaging protocolRadiographic

Bila aspects score gt7 trombolyze

CT perfusi

bull Infark CBVbull Iskemi CBF dan MTT

Acute stroke in a 65-year-old man with left hemiparesis CT perfusion maps of cerebral blood vol- ume (a) cerebral blood flow (b) and mean transit time (c) show mismatched abnormalities (arrows) that imply the presence of a penumbra The area with decreased

blood volume represents the ischemic core and that with normal blood volume but decreased blood flow and increased mean transit time is the penumbra

Perdarahan pada MRI

bull T2 dan Flair intensitas meningkat tidak homogen

bull GRE hitam

Acute stroke in the left me- dial temporal lobe in a 44-year-old man (a b) Axial T2-weighted (a) and fluid- attenuated inversion recovery (b) images show areas with increased signal intensity (c) Gradient-echo image shows abnormal low signal intensity in the same areas These findings are

suggestive of hemor- rhage

Konfirmasi akut stroke

bull DWI putihbull ADC hitam

Acute stroke of the posterior circulation in a 77-year-old man (a) Diffusion- weighted MR image (b 1113089 1000 secmm2) shows bilateral areas of increased signal intensity (arrows) in the thalami and occipital lobes (b) ADC map shows decreased ADC values in the same areas (arrows) These findings are indicative of acute ischemia

Kronik infark

bull DWI hitambull ADC bright

Kebalikan dari infark akut

Chronic infarcts in a 71-year-old man with a remote history of multiple strokes (a) Diffusion- weighted MR image (b 1113089 1000 secmm2) shows areas of decreased signal intensity in the left frontal lobe (b) ADC map shows increased ADC values in the white matter of the right frontal

lobe These features are suggestive of chronic infarction

Acute stroke in a 67-year-old woman with acute left hemiplegia 2 hours after ca- rotid endarterectomy (a) Dif- fusion-weighted MR image

(b 1113089 1000 secmm2) shows an area of mildly increased signal intensity in the right parietal lobe (arrows) The ADC values in this region were decreased (b) Perfusion-weighted MR image shows

a larger area with increased time to peak en- hancement (arrows) in the right cerebral hemisphere The mis- match between the perfusion and diffusion images is indica- tive of a large

penumbra

Flow chart shows an acute stroke imaging protocolRadiographics october 2006

• Neuro imaging Dr Teddy SpS
• Slide 2
• Slide 3
• Slide 4
• Slide 5
• Slide 6
• Slide 7
• Slide 8
• Slide 9
• Slide 10
• Slide 11
• Slide 12
• Key words umur infark
• Umur infark 2
• Axial unenhanced CT images in a proximal segment of the left MC
• Slide 16
• Bila aspects score gt7 trombolyze
• Slide 18
• CT perfusi
• Acute stroke in a 65-year-old man with left hemiparesis CT per
• Perdarahan pada MRI
• Acute stroke in the left me- dial temporal lobe in a 44-year-ol
• Slide 23
• Konfirmasi akut stroke
• Acute stroke of the posterior circulation in a 77-year-old man
• Kronik infark
• Chronic infarcts in a 71-year-old man with a remote history of
• Acute stroke in a 67-year-old woman with acute left hemiplegia
• Flow chart shows an acute stroke imaging protocolRadiographic

CT perfusi

bull Infark CBVbull Iskemi CBF dan MTT

Acute stroke in a 65-year-old man with left hemiparesis CT perfusion maps of cerebral blood vol- ume (a) cerebral blood flow (b) and mean transit time (c) show mismatched abnormalities (arrows) that imply the presence of a penumbra The area with decreased

blood volume represents the ischemic core and that with normal blood volume but decreased blood flow and increased mean transit time is the penumbra

Perdarahan pada MRI

bull T2 dan Flair intensitas meningkat tidak homogen

bull GRE hitam

Acute stroke in the left me- dial temporal lobe in a 44-year-old man (a b) Axial T2-weighted (a) and fluid- attenuated inversion recovery (b) images show areas with increased signal intensity (c) Gradient-echo image shows abnormal low signal intensity in the same areas These findings are

suggestive of hemor- rhage

Konfirmasi akut stroke

bull DWI putihbull ADC hitam

Acute stroke of the posterior circulation in a 77-year-old man (a) Diffusion- weighted MR image (b 1113089 1000 secmm2) shows bilateral areas of increased signal intensity (arrows) in the thalami and occipital lobes (b) ADC map shows decreased ADC values in the same areas (arrows) These findings are indicative of acute ischemia

Kronik infark

bull DWI hitambull ADC bright

Kebalikan dari infark akut

Chronic infarcts in a 71-year-old man with a remote history of multiple strokes (a) Diffusion- weighted MR image (b 1113089 1000 secmm2) shows areas of decreased signal intensity in the left frontal lobe (b) ADC map shows increased ADC values in the white matter of the right frontal

lobe These features are suggestive of chronic infarction

Acute stroke in a 67-year-old woman with acute left hemiplegia 2 hours after ca- rotid endarterectomy (a) Dif- fusion-weighted MR image

(b 1113089 1000 secmm2) shows an area of mildly increased signal intensity in the right parietal lobe (arrows) The ADC values in this region were decreased (b) Perfusion-weighted MR image shows

a larger area with increased time to peak en- hancement (arrows) in the right cerebral hemisphere The mis- match between the perfusion and diffusion images is indica- tive of a large

penumbra

Flow chart shows an acute stroke imaging protocolRadiographics october 2006

• Neuro imaging Dr Teddy SpS
• Slide 2
• Slide 3
• Slide 4
• Slide 5
• Slide 6
• Slide 7
• Slide 8
• Slide 9
• Slide 10
• Slide 11
• Slide 12
• Key words umur infark
• Umur infark 2
• Axial unenhanced CT images in a proximal segment of the left MC
• Slide 16
• Bila aspects score gt7 trombolyze
• Slide 18
• CT perfusi
• Acute stroke in a 65-year-old man with left hemiparesis CT per
• Perdarahan pada MRI
• Acute stroke in the left me- dial temporal lobe in a 44-year-ol
• Slide 23
• Konfirmasi akut stroke
• Acute stroke of the posterior circulation in a 77-year-old man
• Kronik infark
• Chronic infarcts in a 71-year-old man with a remote history of
• Acute stroke in a 67-year-old woman with acute left hemiplegia
• Flow chart shows an acute stroke imaging protocolRadiographic

Acute stroke in a 65-year-old man with left hemiparesis CT perfusion maps of cerebral blood vol- ume (a) cerebral blood flow (b) and mean transit time (c) show mismatched abnormalities (arrows) that imply the presence of a penumbra The area with decreased

blood volume represents the ischemic core and that with normal blood volume but decreased blood flow and increased mean transit time is the penumbra

Perdarahan pada MRI

bull T2 dan Flair intensitas meningkat tidak homogen

bull GRE hitam

Acute stroke in the left me- dial temporal lobe in a 44-year-old man (a b) Axial T2-weighted (a) and fluid- attenuated inversion recovery (b) images show areas with increased signal intensity (c) Gradient-echo image shows abnormal low signal intensity in the same areas These findings are

suggestive of hemor- rhage

Konfirmasi akut stroke

bull DWI putihbull ADC hitam

Acute stroke of the posterior circulation in a 77-year-old man (a) Diffusion- weighted MR image (b 1113089 1000 secmm2) shows bilateral areas of increased signal intensity (arrows) in the thalami and occipital lobes (b) ADC map shows decreased ADC values in the same areas (arrows) These findings are indicative of acute ischemia

Kronik infark

bull DWI hitambull ADC bright

Kebalikan dari infark akut

Chronic infarcts in a 71-year-old man with a remote history of multiple strokes (a) Diffusion- weighted MR image (b 1113089 1000 secmm2) shows areas of decreased signal intensity in the left frontal lobe (b) ADC map shows increased ADC values in the white matter of the right frontal

lobe These features are suggestive of chronic infarction

Acute stroke in a 67-year-old woman with acute left hemiplegia 2 hours after ca- rotid endarterectomy (a) Dif- fusion-weighted MR image

(b 1113089 1000 secmm2) shows an area of mildly increased signal intensity in the right parietal lobe (arrows) The ADC values in this region were decreased (b) Perfusion-weighted MR image shows

a larger area with increased time to peak en- hancement (arrows) in the right cerebral hemisphere The mis- match between the perfusion and diffusion images is indica- tive of a large

penumbra

Flow chart shows an acute stroke imaging protocolRadiographics october 2006

• Neuro imaging Dr Teddy SpS
• Slide 2
• Slide 3
• Slide 4
• Slide 5
• Slide 6
• Slide 7
• Slide 8
• Slide 9
• Slide 10
• Slide 11
• Slide 12
• Key words umur infark
• Umur infark 2
• Axial unenhanced CT images in a proximal segment of the left MC
• Slide 16
• Bila aspects score gt7 trombolyze
• Slide 18
• CT perfusi
• Acute stroke in a 65-year-old man with left hemiparesis CT per
• Perdarahan pada MRI
• Acute stroke in the left me- dial temporal lobe in a 44-year-ol
• Slide 23
• Konfirmasi akut stroke
• Acute stroke of the posterior circulation in a 77-year-old man
• Kronik infark
• Chronic infarcts in a 71-year-old man with a remote history of
• Acute stroke in a 67-year-old woman with acute left hemiplegia
• Flow chart shows an acute stroke imaging protocolRadiographic

Perdarahan pada MRI

bull T2 dan Flair intensitas meningkat tidak homogen

bull GRE hitam

Acute stroke in the left me- dial temporal lobe in a 44-year-old man (a b) Axial T2-weighted (a) and fluid- attenuated inversion recovery (b) images show areas with increased signal intensity (c) Gradient-echo image shows abnormal low signal intensity in the same areas These findings are

suggestive of hemor- rhage

Konfirmasi akut stroke

bull DWI putihbull ADC hitam

Acute stroke of the posterior circulation in a 77-year-old man (a) Diffusion- weighted MR image (b 1113089 1000 secmm2) shows bilateral areas of increased signal intensity (arrows) in the thalami and occipital lobes (b) ADC map shows decreased ADC values in the same areas (arrows) These findings are indicative of acute ischemia

Kronik infark

bull DWI hitambull ADC bright

Kebalikan dari infark akut

Chronic infarcts in a 71-year-old man with a remote history of multiple strokes (a) Diffusion- weighted MR image (b 1113089 1000 secmm2) shows areas of decreased signal intensity in the left frontal lobe (b) ADC map shows increased ADC values in the white matter of the right frontal

lobe These features are suggestive of chronic infarction

Acute stroke in a 67-year-old woman with acute left hemiplegia 2 hours after ca- rotid endarterectomy (a) Dif- fusion-weighted MR image

(b 1113089 1000 secmm2) shows an area of mildly increased signal intensity in the right parietal lobe (arrows) The ADC values in this region were decreased (b) Perfusion-weighted MR image shows

a larger area with increased time to peak en- hancement (arrows) in the right cerebral hemisphere The mis- match between the perfusion and diffusion images is indica- tive of a large

penumbra

Flow chart shows an acute stroke imaging protocolRadiographics october 2006

• Neuro imaging Dr Teddy SpS
• Slide 2
• Slide 3
• Slide 4
• Slide 5
• Slide 6
• Slide 7
• Slide 8
• Slide 9
• Slide 10
• Slide 11
• Slide 12
• Key words umur infark
• Umur infark 2
• Axial unenhanced CT images in a proximal segment of the left MC
• Slide 16
• Bila aspects score gt7 trombolyze
• Slide 18
• CT perfusi
• Acute stroke in a 65-year-old man with left hemiparesis CT per
• Perdarahan pada MRI
• Acute stroke in the left me- dial temporal lobe in a 44-year-ol
• Slide 23
• Konfirmasi akut stroke
• Acute stroke of the posterior circulation in a 77-year-old man
• Kronik infark
• Chronic infarcts in a 71-year-old man with a remote history of
• Acute stroke in a 67-year-old woman with acute left hemiplegia
• Flow chart shows an acute stroke imaging protocolRadiographic

Acute stroke in the left me- dial temporal lobe in a 44-year-old man (a b) Axial T2-weighted (a) and fluid- attenuated inversion recovery (b) images show areas with increased signal intensity (c) Gradient-echo image shows abnormal low signal intensity in the same areas These findings are

suggestive of hemor- rhage

Konfirmasi akut stroke

bull DWI putihbull ADC hitam

Acute stroke of the posterior circulation in a 77-year-old man (a) Diffusion- weighted MR image (b 1113089 1000 secmm2) shows bilateral areas of increased signal intensity (arrows) in the thalami and occipital lobes (b) ADC map shows decreased ADC values in the same areas (arrows) These findings are indicative of acute ischemia

Kronik infark

bull DWI hitambull ADC bright

Kebalikan dari infark akut

Chronic infarcts in a 71-year-old man with a remote history of multiple strokes (a) Diffusion- weighted MR image (b 1113089 1000 secmm2) shows areas of decreased signal intensity in the left frontal lobe (b) ADC map shows increased ADC values in the white matter of the right frontal

lobe These features are suggestive of chronic infarction

Acute stroke in a 67-year-old woman with acute left hemiplegia 2 hours after ca- rotid endarterectomy (a) Dif- fusion-weighted MR image

(b 1113089 1000 secmm2) shows an area of mildly increased signal intensity in the right parietal lobe (arrows) The ADC values in this region were decreased (b) Perfusion-weighted MR image shows

a larger area with increased time to peak en- hancement (arrows) in the right cerebral hemisphere The mis- match between the perfusion and diffusion images is indica- tive of a large

penumbra

Flow chart shows an acute stroke imaging protocolRadiographics october 2006

• Neuro imaging Dr Teddy SpS
• Slide 2
• Slide 3
• Slide 4
• Slide 5
• Slide 6
• Slide 7
• Slide 8
• Slide 9
• Slide 10
• Slide 11
• Slide 12
• Key words umur infark
• Umur infark 2
• Axial unenhanced CT images in a proximal segment of the left MC
• Slide 16
• Bila aspects score gt7 trombolyze
• Slide 18
• CT perfusi
• Acute stroke in a 65-year-old man with left hemiparesis CT per
• Perdarahan pada MRI
• Acute stroke in the left me- dial temporal lobe in a 44-year-ol
• Slide 23
• Konfirmasi akut stroke
• Acute stroke of the posterior circulation in a 77-year-old man
• Kronik infark
• Chronic infarcts in a 71-year-old man with a remote history of
• Acute stroke in a 67-year-old woman with acute left hemiplegia
• Flow chart shows an acute stroke imaging protocolRadiographic

Konfirmasi akut stroke

bull DWI putihbull ADC hitam

Acute stroke of the posterior circulation in a 77-year-old man (a) Diffusion- weighted MR image (b 1113089 1000 secmm2) shows bilateral areas of increased signal intensity (arrows) in the thalami and occipital lobes (b) ADC map shows decreased ADC values in the same areas (arrows) These findings are indicative of acute ischemia

Kronik infark

bull DWI hitambull ADC bright

Kebalikan dari infark akut

Chronic infarcts in a 71-year-old man with a remote history of multiple strokes (a) Diffusion- weighted MR image (b 1113089 1000 secmm2) shows areas of decreased signal intensity in the left frontal lobe (b) ADC map shows increased ADC values in the white matter of the right frontal

lobe These features are suggestive of chronic infarction

Acute stroke in a 67-year-old woman with acute left hemiplegia 2 hours after ca- rotid endarterectomy (a) Dif- fusion-weighted MR image

(b 1113089 1000 secmm2) shows an area of mildly increased signal intensity in the right parietal lobe (arrows) The ADC values in this region were decreased (b) Perfusion-weighted MR image shows

a larger area with increased time to peak en- hancement (arrows) in the right cerebral hemisphere The mis- match between the perfusion and diffusion images is indica- tive of a large

penumbra

Flow chart shows an acute stroke imaging protocolRadiographics october 2006

• Neuro imaging Dr Teddy SpS
• Slide 2
• Slide 3
• Slide 4
• Slide 5
• Slide 6
• Slide 7
• Slide 8
• Slide 9
• Slide 10
• Slide 11
• Slide 12
• Key words umur infark
• Umur infark 2
• Axial unenhanced CT images in a proximal segment of the left MC
• Slide 16
• Bila aspects score gt7 trombolyze
• Slide 18
• CT perfusi
• Acute stroke in a 65-year-old man with left hemiparesis CT per
• Perdarahan pada MRI
• Acute stroke in the left me- dial temporal lobe in a 44-year-ol
• Slide 23
• Konfirmasi akut stroke
• Acute stroke of the posterior circulation in a 77-year-old man
• Kronik infark
• Chronic infarcts in a 71-year-old man with a remote history of
• Acute stroke in a 67-year-old woman with acute left hemiplegia
• Flow chart shows an acute stroke imaging protocolRadiographic

Acute stroke of the posterior circulation in a 77-year-old man (a) Diffusion- weighted MR image (b 1113089 1000 secmm2) shows bilateral areas of increased signal intensity (arrows) in the thalami and occipital lobes (b) ADC map shows decreased ADC values in the same areas (arrows) These findings are indicative of acute ischemia

Kronik infark

bull DWI hitambull ADC bright

Kebalikan dari infark akut

Chronic infarcts in a 71-year-old man with a remote history of multiple strokes (a) Diffusion- weighted MR image (b 1113089 1000 secmm2) shows areas of decreased signal intensity in the left frontal lobe (b) ADC map shows increased ADC values in the white matter of the right frontal

lobe These features are suggestive of chronic infarction

Acute stroke in a 67-year-old woman with acute left hemiplegia 2 hours after ca- rotid endarterectomy (a) Dif- fusion-weighted MR image

(b 1113089 1000 secmm2) shows an area of mildly increased signal intensity in the right parietal lobe (arrows) The ADC values in this region were decreased (b) Perfusion-weighted MR image shows

a larger area with increased time to peak en- hancement (arrows) in the right cerebral hemisphere The mis- match between the perfusion and diffusion images is indica- tive of a large

penumbra

Flow chart shows an acute stroke imaging protocolRadiographics october 2006

• Neuro imaging Dr Teddy SpS
• Slide 2
• Slide 3
• Slide 4
• Slide 5
• Slide 6
• Slide 7
• Slide 8
• Slide 9
• Slide 10
• Slide 11
• Slide 12
• Key words umur infark
• Umur infark 2
• Axial unenhanced CT images in a proximal segment of the left MC
• Slide 16
• Bila aspects score gt7 trombolyze
• Slide 18
• CT perfusi
• Acute stroke in a 65-year-old man with left hemiparesis CT per
• Perdarahan pada MRI
• Acute stroke in the left me- dial temporal lobe in a 44-year-ol
• Slide 23
• Konfirmasi akut stroke
• Acute stroke of the posterior circulation in a 77-year-old man
• Kronik infark
• Chronic infarcts in a 71-year-old man with a remote history of
• Acute stroke in a 67-year-old woman with acute left hemiplegia
• Flow chart shows an acute stroke imaging protocolRadiographic

Kronik infark

bull DWI hitambull ADC bright

Kebalikan dari infark akut

Chronic infarcts in a 71-year-old man with a remote history of multiple strokes (a) Diffusion- weighted MR image (b 1113089 1000 secmm2) shows areas of decreased signal intensity in the left frontal lobe (b) ADC map shows increased ADC values in the white matter of the right frontal

lobe These features are suggestive of chronic infarction

Acute stroke in a 67-year-old woman with acute left hemiplegia 2 hours after ca- rotid endarterectomy (a) Dif- fusion-weighted MR image

(b 1113089 1000 secmm2) shows an area of mildly increased signal intensity in the right parietal lobe (arrows) The ADC values in this region were decreased (b) Perfusion-weighted MR image shows

a larger area with increased time to peak en- hancement (arrows) in the right cerebral hemisphere The mis- match between the perfusion and diffusion images is indica- tive of a large

penumbra

Flow chart shows an acute stroke imaging protocolRadiographics october 2006

• Neuro imaging Dr Teddy SpS
• Slide 2
• Slide 3
• Slide 4
• Slide 5
• Slide 6
• Slide 7
• Slide 8
• Slide 9
• Slide 10
• Slide 11
• Slide 12
• Key words umur infark
• Umur infark 2
• Axial unenhanced CT images in a proximal segment of the left MC
• Slide 16
• Bila aspects score gt7 trombolyze
• Slide 18
• CT perfusi
• Acute stroke in a 65-year-old man with left hemiparesis CT per
• Perdarahan pada MRI
• Acute stroke in the left me- dial temporal lobe in a 44-year-ol
• Slide 23
• Konfirmasi akut stroke
• Acute stroke of the posterior circulation in a 77-year-old man
• Kronik infark
• Chronic infarcts in a 71-year-old man with a remote history of
• Acute stroke in a 67-year-old woman with acute left hemiplegia
• Flow chart shows an acute stroke imaging protocolRadiographic

Chronic infarcts in a 71-year-old man with a remote history of multiple strokes (a) Diffusion- weighted MR image (b 1113089 1000 secmm2) shows areas of decreased signal intensity in the left frontal lobe (b) ADC map shows increased ADC values in the white matter of the right frontal

lobe These features are suggestive of chronic infarction

Acute stroke in a 67-year-old woman with acute left hemiplegia 2 hours after ca- rotid endarterectomy (a) Dif- fusion-weighted MR image

(b 1113089 1000 secmm2) shows an area of mildly increased signal intensity in the right parietal lobe (arrows) The ADC values in this region were decreased (b) Perfusion-weighted MR image shows

a larger area with increased time to peak en- hancement (arrows) in the right cerebral hemisphere The mis- match between the perfusion and diffusion images is indica- tive of a large

penumbra

Flow chart shows an acute stroke imaging protocolRadiographics october 2006

• Neuro imaging Dr Teddy SpS
• Slide 2
• Slide 3
• Slide 4
• Slide 5
• Slide 6
• Slide 7
• Slide 8
• Slide 9
• Slide 10
• Slide 11
• Slide 12
• Key words umur infark
• Umur infark 2
• Axial unenhanced CT images in a proximal segment of the left MC
• Slide 16
• Bila aspects score gt7 trombolyze
• Slide 18
• CT perfusi
• Acute stroke in a 65-year-old man with left hemiparesis CT per
• Perdarahan pada MRI
• Acute stroke in the left me- dial temporal lobe in a 44-year-ol
• Slide 23
• Konfirmasi akut stroke
• Acute stroke of the posterior circulation in a 77-year-old man
• Kronik infark
• Chronic infarcts in a 71-year-old man with a remote history of
• Acute stroke in a 67-year-old woman with acute left hemiplegia
• Flow chart shows an acute stroke imaging protocolRadiographic

Acute stroke in a 67-year-old woman with acute left hemiplegia 2 hours after ca- rotid endarterectomy (a) Dif- fusion-weighted MR image

(b 1113089 1000 secmm2) shows an area of mildly increased signal intensity in the right parietal lobe (arrows) The ADC values in this region were decreased (b) Perfusion-weighted MR image shows

a larger area with increased time to peak en- hancement (arrows) in the right cerebral hemisphere The mis- match between the perfusion and diffusion images is indica- tive of a large

penumbra

Flow chart shows an acute stroke imaging protocolRadiographics october 2006

• Neuro imaging Dr Teddy SpS
• Slide 2
• Slide 3
• Slide 4
• Slide 5
• Slide 6
• Slide 7
• Slide 8
• Slide 9
• Slide 10
• Slide 11
• Slide 12
• Key words umur infark
• Umur infark 2
• Axial unenhanced CT images in a proximal segment of the left MC
• Slide 16
• Bila aspects score gt7 trombolyze
• Slide 18
• CT perfusi
• Acute stroke in a 65-year-old man with left hemiparesis CT per
• Perdarahan pada MRI
• Acute stroke in the left me- dial temporal lobe in a 44-year-ol
• Slide 23
• Konfirmasi akut stroke
• Acute stroke of the posterior circulation in a 77-year-old man
• Kronik infark
• Chronic infarcts in a 71-year-old man with a remote history of
• Acute stroke in a 67-year-old woman with acute left hemiplegia
• Flow chart shows an acute stroke imaging protocolRadiographic

Flow chart shows an acute stroke imaging protocolRadiographics october 2006

• Neuro imaging Dr Teddy SpS
• Slide 2
• Slide 3
• Slide 4
• Slide 5
• Slide 6
• Slide 7
• Slide 8
• Slide 9
• Slide 10
• Slide 11
• Slide 12
• Key words umur infark
• Umur infark 2
• Axial unenhanced CT images in a proximal segment of the left MC
• Slide 16
• Bila aspects score gt7 trombolyze
• Slide 18
• CT perfusi
• Acute stroke in a 65-year-old man with left hemiparesis CT per
• Perdarahan pada MRI
• Acute stroke in the left me- dial temporal lobe in a 44-year-ol
• Slide 23
• Konfirmasi akut stroke
• Acute stroke of the posterior circulation in a 77-year-old man
• Kronik infark
• Chronic infarcts in a 71-year-old man with a remote history of
• Acute stroke in a 67-year-old woman with acute left hemiplegia
• Flow chart shows an acute stroke imaging protocolRadiographic