Objective:

To evaluate the appropriateness of CT perfusion (CTP) as a screening tool for acute stroke patients, particularly considering radiation exposure and the potential of alternative imaging techniques.

Key Findings:

• CTP is frequently used despite higher radiation doses compared to other imaging techniques.
• AI models show promise in enhancing non-contrast CT accuracy for early stroke detection.
• mCTA can provide valuable information with less complexity and radiation exposure.
• CTP's complexity requires trained personnel for accurate interpretation.

Interpretation:

While CTP is widely used, its radiation burden and potential inaccuracies necessitate a reevaluation in favor of safer imaging alternatives like non-contrast CT and mCTA, while acknowledging CTP's role in certain contexts.

Limitations:

• CTP's complexity requires trained personnel for accurate interpretation.
• Current guidelines may not reflect the practical use of imaging in acute stroke cases.
• Lack of standardization in post-processing algorithms for CTP.

Conclusion:

CTP may not be the optimal screening tool for acute stroke patients due to radiation concerns and the availability of more accurate and safer alternatives.