320-multidetector row whole-head dynamic subtracted CT angiography and whole-brain CT perfusion before and after carotid artery stenting: technical note.
BACKGROUND
Multidetector CT (MDCT) is increasingly used for the investigation of neurovascular disorders, but restricted z-axis coverage (3.2 cm for 64-MDCT) currently limits perfusion to a small portion of the brain close to the circle of Willis, and precludes dynamic angiographic appreciation of the entire brain circulation. We illustrate the clinical potential of recently developed 320-MDCT extending the z-axis coverage to 16 cm in a patient with symptomatic carotid artery stenosis.


METHODS
In a 74-year-old patient presenting with critical symptomatic stenosis of the left CCA, pre- and post-carotid artery stenting whole-head subtracted dynamic MDCT angiography and perfusion were obtained in addition to CT angiography of the supra-aortic trunks. Both whole-head subtracted MDCT angiography and perfusion demonstrated delayed left ICA circulation, which normalized after carotid stenting.


CONCLUSIONS
320-MDCT offers unprecedented z-axis coverage allowing for whole-brain perfusion and subtracted dynamic angiography of the entire intracranial circulation. These innovations can consolidate the role of MDCT as a first intention imaging technique for cerebrovascular disorders, in particular for the acute management of stroke.
San Millán Ruíz
Diego
D
Division of Interventional Neuroradiology, Department of Radiology, The Johns Hopkins Hospital, 600 North Wolfe Street, B-100, Baltimore, MD 21287, USA. dsanmil1@jhmi.edu
Murphy
Kieran
K
Gailloud
Philippe
P
D000368:Aged; D015901:Angiography, Digital Subtraction / Q000379:methods*; D001807:Blood Vessel Prosthesis; D001921:Brain / Q000098:blood supply / Q000000981:diagnostic imaging*; D002339:Carotid Arteries / Q000000981:diagnostic imaging* / Q000601:surgery*; D002533:Cerebral Angiography / Q000379:methods; D006257:Head / Q000098:blood supply / Q000000981:diagnostic imaging; D006801:Humans; D008297:Male; D055420:Perfusion Imaging / Q000379:methods*; D011182:Postoperative Care; D011300:Preoperative Care / Q000379:methods; D015607:Stents; D014057:Tomography, X-Ray Computed / Q000379:methods*