Computed Tomography-Based Evaluation of Cerebrovascular Disease

Computed tomography (CT) of the brain has been the mainstay of imaging in patients with cerebrovascular disease. When a patient presents with an acute neurologic deficit, the differential diagnosis includes ischemic stroke, hemorrhagic stroke, and transient ischemic attack (TIA) as well as mass lesions of traumatic, neoplastic, and infectious causes. Conventional CT has been revolutionary in the examination of brain parenchymal and extra-axial anatomy. Technologic advances have given us the ability to examine vascular anatomy through the use of CT angiography (CTA) and brain physiology through the investigation of cerebral blood flow (CBF) using the techniques of xenon-enhanced CT (XeCT) and dynamic CT perfusion (CTP). When these techniques are combined, CT-based imaging constitutes a powerful tool in both the diagnosis and the treatment of patients with cerebrovascular disease.