Angiographic reconstructions from whole-brain perfusion CT for the detection of large vessel occlusion in acute stroke.
OBJECTIVE
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.
University Medicine Göttingen, Department of Neuroradiology, Robert-Koch-Str 40, 37075 Göttingen, Germany. andreas.froelich@med.uni-goettingen.de
Andreas M J
AM
Frölich
Marios N
MN
Psychogios
Ernst
E
Klotz
Ramona
R
Schramm
Michael
M
Knauth
Peter
P
Schramm
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001921:Brain / Q000000981:diagnostic imaging; D002533:Cerebral Angiography / Q000379:methods*; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000379:methods*; D020767:Intracranial Thrombosis / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D020521:Stroke / Q000000981:diagnostic imaging*; D014057:Tomography, X-Ray Computed / Q000379:methods*