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Comment & Response
August 2016

Computed Tomography Perfusion and Diffusion-Weighted Imaging in Patients With Acute Stroke

Author Affiliations
  • 1Stroke Center, Department of Neurology, First Hospital of Jilin University, Chang Chun, China
JAMA Neurol. 2016;73(8):1032. doi:10.1001/jamaneurol.2016.1680

To the Editor In JAMA Neurology, Rudilosso and colleagues1 presented 2 cases using computed tomography perfusion (CTP) and diffusion-weighted imaging (DWI). They suggested that CTP was superior to DWI in the identification of ischemic changes in acute stroke. In most patients, DWI findings appear positive within several minutes to several hours of the onset of acute cerebral infarction.2 Positive DWI findings depend on cytotoxic edema. The morphology of the brain maintains intact when cerebral blood flow is decreased to 30% of its normal level. If perfusion is returned to normal, no abnormality will be detected by DWI. When cerebral blood flow is further decreased to 15% to 20% of its normal level, the function of membrane sodium-potassium ATPase would be impaired, leading to the development of cytotoxic edema.3

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