CT perfusion – an up-to-date element of the contemporary multimodal diagnostic approach to acute ischemic stroke

Acute ischemic stroke is of great clinical and societal importance due to its high incidence and mortality rates, as well as the fact that those who are affected suffer from permanent acquired disability. Modern trends explicitly state that the disease’s diagnostic plan should use a multidisciplinary approach. The therapeutic steps that ultimately determine the clinical outcome are defined by an accurate diagnosis of acute ischemic stroke. Highly specialized facilities for the diagnosis and treatment of acute ischemic stroke (Stroke Units) are in operation in countries that make significant investments in healthcare. Imaging the brain parenchyma at risk, or the so-called ischemic penumbra, in acute ischemic stroke is one of the main tasks of the multimodal computed tomography approach. The most rapid method for imaging the ischemic penumbra is computed tomography perfusion (CTP). This modality provides information about the anatomy and the physiologic state of the brain parenchyma. The current literature review offers a comprehensive overview of the various aspects of computed tomography perfusion in acute ischemic stroke and, more specifically, about the differential diagnosis of acute ischemic strokes and diseases that mimic strokes, predicting the risk of hemorrhagic transformation, the computed tomography perfusion used in intravenous thrombolysis (IVT) beyond the therapeutic window, wake-up strokes (WUS) and strokes of unknown onset (SUKO), and the reported predictive parameters of CTP in correlation with the clinical outcome in acute ischemic stroke.