Wolfgang G Kunz1, Wieland H Sommer1, Lukas Havla2, Franziska Dorn3, Felix G Meinel1, Olaf Dietrich2, Grete Buchholz4, Birgit Ertl-Wagner1, Kolja M Thierfelder5. 1. Institute for Clinical Radiology, Ludwig-Maximilian-University Hospital Munich, Marchioninistr. 15, 81377, Munich, Germany. 2. Josef Lissner Laboratory for Biomedical Imaging of the Institute for Clinical Radiology, Ludwig-Maximilian-University Hospital Munich, Munich, Germany. 3. Department of Neuroradiology, Ludwig-Maximilian-University Hospital Munich, Munich, Germany. 4. Department of Neurology, Ludwig-Maximilian-University Hospital Munich, Munich, Germany. 5. Institute for Clinical Radiology, Ludwig-Maximilian-University Hospital Munich, Marchioninistr. 15, 81377, Munich, Germany. kolja.thierfelder@med.lmu.de.
Abstract
OBJECTIVES: To determine the detection rate of intracranial vessel occlusions using CT perfusion-based wavelet-transformed angiography (waveletCTA) in acute ischemic stroke patients, in whom single-phase CTA (spCTA) failed to detect an occlusion. METHODS: Subjects were selected from a cohort of 791 consecutive patients who underwent multiparametric CT including whole-brain CT perfusion. Inclusion criteria were (1) significant cerebral blood flow (CBF) deficit, (2) no evidence of vessel occlusion on spCTA and (3) follow-up-confirmed acute ischemic infarction. waveletCTA was independently analysed by two readers regarding presence and location of vessel occlusions. Logistic regression analysis was performed to identify predictors of waveletCTA-detected occlusions. RESULTS: Fifty-nine patients fulfilled the inclusion criteria. Overall, an occlusion was identified using waveletCTA in 31 (52.5 %) patients with negative spCTA. Out of 47 patients with middle cerebral artery infarction, 27 occlusions (57.4 %) were detected by waveletCTA, mainly located in the M2 (15) and M3 segments (8). The presence of waveletCTA-detected occlusions was associated with larger CBF deficit volumes (odds ratio (OR) = 1.335, p = 0.010) and shorter times from symptom onset (OR = 0.306, p = 0.041). CONCLUSIONS: waveletCTA is able to detect spCTA occult vessel occlusions in about half of acute ischemic stroke patients and may potentially identify more patients eligible for endovascular therapy. KEY POINTS: • waveletCTA is able to detect spCTA occult vessel occlusions in stroke patients. • waveletCTA-detected occlusions are associated with larger cerebral blood flow deficits. • waveletCTA has the potential to identify more patients eligible for endovascular therapy. • waveletCTA implies neither additional radiation exposure nor extra contrast agent.
OBJECTIVES: To determine the detection rate of intracranial vessel occlusions using CT perfusion-based wavelet-transformed angiography (waveletCTA) in acute ischemic strokepatients, in whom single-phase CTA (spCTA) failed to detect an occlusion. METHODS: Subjects were selected from a cohort of 791 consecutive patients who underwent multiparametric CT including whole-brain CT perfusion. Inclusion criteria were (1) significant cerebral blood flow (CBF) deficit, (2) no evidence of vessel occlusion on spCTA and (3) follow-up-confirmed acute ischemic infarction. waveletCTA was independently analysed by two readers regarding presence and location of vessel occlusions. Logistic regression analysis was performed to identify predictors of waveletCTA-detected occlusions. RESULTS: Fifty-nine patients fulfilled the inclusion criteria. Overall, an occlusion was identified using waveletCTA in 31 (52.5 %) patients with negative spCTA. Out of 47 patients with middle cerebral artery infarction, 27 occlusions (57.4 %) were detected by waveletCTA, mainly located in the M2 (15) and M3 segments (8). The presence of waveletCTA-detected occlusions was associated with larger CBF deficit volumes (odds ratio (OR) = 1.335, p = 0.010) and shorter times from symptom onset (OR = 0.306, p = 0.041). CONCLUSIONS: waveletCTA is able to detect spCTA occult vessel occlusions in about half of acute ischemic strokepatients and may potentially identify more patients eligible for endovascular therapy. KEY POINTS: • waveletCTA is able to detect spCTA occult vessel occlusions in strokepatients. • waveletCTA-detected occlusions are associated with larger cerebral blood flow deficits. • waveletCTA has the potential to identify more patients eligible for endovascular therapy. • waveletCTA implies neither additional radiation exposure nor extra contrast agent.
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