BACKGROUND AND PURPOSE: Multimodal CT imaging consisting of nonenhanced CT, CT angiography (CTA), and whole-brain volume perfusion CT is increasingly used for acute stroke imaging. In these patients, presence of vessel occlusion is an important factor governing treatment decisions and possible endovascular therapy. The goal of this study was to assess the value and diagnostic accuracy of angiographic thin-slice volume perfusion CT reconstructions for the detection of intracranial large vessel occlusion in patients with stroke. METHODS: Fifty-eight patients with acute stroke received nonenhanced CT, CTA, and volume perfusion CT. All images were obtained on a 128-slice multidetector CT scanner. CT angiographic axial and coronal maximum-intensity projections of the head were reconstructed from conventional CTA and from the peak arterial scan of the volume perfusion CT data set (4-dimensional CTA). Images were assessed for the presence of intracranial vessel occlusion. The distribution of ischemic lesions was analyzed on perfusion parameter maps. RESULTS: On CTA, 30 patients (52%) had a total of 33 occluded intracranial artery segments. Twenty-eight occlusions were identified on 4-dimensional CTA, resulting in an 85% sensitivity with a positive predictive value of 97%. When combined with an analysis of the perfusion parameter maps, sensitivity of 4-dimensional CTA increased to 94% with a positive predictive value of 100%. CONCLUSIONS: In acute stroke, angiographic volume perfusion CT reconstructions may be a feasible option to detect intracranial arterial occlusion and evaluate patients for endovascular therapy. Sensitivity for detection of intracranial arterial occlusion can be increased by simultaneous assessment of perfusion parameter maps. Future studies should assess whether time-resolved 4-dimensional CTA may offer additional diagnostically relevant information compared with single-phase CTA.
BACKGROUND AND PURPOSE: Multimodal CT imaging consisting of nonenhanced CT, CT angiography (CTA), and whole-brain volume perfusion CT is increasingly used for acute stroke imaging. In these patients, presence of vessel occlusion is an important factor governing treatment decisions and possible endovascular therapy. The goal of this study was to assess the value and diagnostic accuracy of angiographic thin-slice volume perfusion CT reconstructions for the detection of intracranial large vessel occlusion in patients with stroke. METHODS: Fifty-eight patients with acute stroke received nonenhanced CT, CTA, and volume perfusion CT. All images were obtained on a 128-slice multidetector CT scanner. CT angiographic axial and coronal maximum-intensity projections of the head were reconstructed from conventional CTA and from the peak arterial scan of the volume perfusion CT data set (4-dimensional CTA). Images were assessed for the presence of intracranial vessel occlusion. The distribution of ischemic lesions was analyzed on perfusion parameter maps. RESULTS: On CTA, 30 patients (52%) had a total of 33 occluded intracranial artery segments. Twenty-eight occlusions were identified on 4-dimensional CTA, resulting in an 85% sensitivity with a positive predictive value of 97%. When combined with an analysis of the perfusion parameter maps, sensitivity of 4-dimensional CTA increased to 94% with a positive predictive value of 100%. CONCLUSIONS: In acute stroke, angiographic volume perfusion CT reconstructions may be a feasible option to detect intracranial arterial occlusion and evaluate patients for endovascular therapy. Sensitivity for detection of intracranial arterial occlusion can be increased by simultaneous assessment of perfusion parameter maps. Future studies should assess whether time-resolved 4-dimensional CTA may offer additional diagnostically relevant information compared with single-phase CTA.
Authors: Xiao Kun Fang; Qian Qian Ni; U Joseph Schoepf; Chang Sheng Zhou; Guo Zhong Chen; Song Luo; Stephen R Fuller; Carlo N De Cecco; Long Jiang Zhang; Guang Ming Lu Journal: Eur Radiol Date: 2016-02-06 Impact factor: 5.315
Authors: Wolfgang G Kunz; Wieland H Sommer; Lukas Havla; Franziska Dorn; Felix G Meinel; Olaf Dietrich; Grete Buchholz; Birgit Ertl-Wagner; Kolja M Thierfelder Journal: Eur Radiol Date: 2016-10-08 Impact factor: 5.315
Authors: M Saake; P Goelitz; T Struffert; L Breuer; B Volbers; A Doerfler; S Kloska Journal: AJNR Am J Neuroradiol Date: 2012-06-28 Impact factor: 3.825
Authors: A M J Frölich; D Schrader; E Klotz; R Schramm; K Wasser; M Knauth; P Schramm Journal: AJNR Am J Neuroradiol Date: 2013-04-25 Impact factor: 3.825
Authors: Andreas M J Frölich; Sarah Lena Wolff; Marios N Psychogios; Ernst Klotz; Ramona Schramm; Katrin Wasser; Michael Knauth; Peter Schramm Journal: Eur Radiol Date: 2014-02 Impact factor: 5.315
Authors: Claude A Beaty; George J Arnaoutakis; Maura A Grega; Chase W Robinson; Timothy J George; William A Baumgartner; Rebecca F Gottesman; Guy M McKhann; Duke E Cameron; Glenn J Whitman Journal: Ann Thorac Surg Date: 2012-12-06 Impact factor: 4.330