Time-Resolved C-Arm Computed Tomographic Angiography Derived From Computed Tomographic Perfusion Acquisition: New Capability for One-Stop-Shop Acute Ischemic Stroke Treatment in the Angiosuite.
OBJECTIVE
Multimodal imaging using cone beam C-arm computed tomography (CT) may shorten the delay from ictus to revascularization for acute ischemic stroke patients with a large vessel occlusion. Largely because of limited temporal resolution, reconstruction of time-resolved CT angiography (CTA) from these systems has not yielded satisfactory results. We evaluated the image quality and diagnostic value of time-resolved C-arm CTA reconstructed using novel image processing algorithms.


METHODS
Studies were done under an Institutional Review Board approved protocol. Postprocessing of data from 21 C-arm CT dynamic perfusion acquisitions from 17 patients with acute ischemic stroke were done to derive time-resolved C-arm CTA images. Two observers independently evaluated image quality and diagnostic content for each case. ICC and receiver-operating characteristic analysis were performed to evaluate interobserver agreement and diagnostic value of this novel imaging modality.


RESULTS
Time-resolved C-arm CTA images were successfully generated from 20 data sets (95.2%, 20/21). Two observers agreed well that the image quality for large cerebral arteries was good but was more limited for small cerebral arteries (distal to M1, A1, and P1). receiver-operating characteristic curves demonstrated excellent diagnostic value for detecting large vessel occlusions (area under the curve=0.987-1).


CONCLUSIONS
Time-resolved CTAs derived from C-arm CT perfusion acquisitions provide high quality images that allowed accurate diagnosis of large vessel occlusions. Although image quality of smaller arteries in this study was not optimal ongoing modifications of the postprocessing algorithm will likely remove this limitation. Adding time-resolved C-arm CTAs to the capabilities of the angiography suite further enhances its suitability as a one-stop shop for care for patients with acute ischemic stroke.
From the Department of Neurosurgery, Changhai Hospital, Second Military Medical University, Shanghai, China (P.Y.); Departments of Radiology (P.Y., C.S., G.-H.C.) and Medical Physics (K.N., Y.W., G.-H.C.), University of Wisconsin-Madison; Department of Neuroradiology, University of Erlangen-Nuremberg, Erlangen, Germany (T.S., A.D.); and Department of Research Collaboration, Siemens Medical Solutions, USA, Inc, Hoffman Estates, IL (S.S., K.R.). 15921196312@163.com gchen7@wisc.edu.
Pengfei
P
Yang
From the Department of Neurosurgery, Changhai Hospital, Second Military Medical University, Shanghai, China (P.Y.); Departments of Radiology (P.Y., C.S., G.-H.C.) and Medical Physics (K.N., Y.W., G.-H.C.), University of Wisconsin-Madison; Department of Neuroradiology, University of Erlangen-Nuremberg, Erlangen, Germany (T.S., A.D.); and Department of Research Collaboration, Siemens Medical Solutions, USA, Inc, Hoffman Estates, IL (S.S., K.R.).
Kai
K
Niu
From the Department of Neurosurgery, Changhai Hospital, Second Military Medical University, Shanghai, China (P.Y.); Departments of Radiology (P.Y., C.S., G.-H.C.) and Medical Physics (K.N., Y.W., G.-H.C.), University of Wisconsin-Madison; Department of Neuroradiology, University of Erlangen-Nuremberg, Erlangen, Germany (T.S., A.D.); and Department of Research Collaboration, Siemens Medical Solutions, USA, Inc, Hoffman Estates, IL (S.S., K.R.).
Yijing
Y
Wu
From the Department of Neurosurgery, Changhai Hospital, Second Military Medical University, Shanghai, China (P.Y.); Departments of Radiology (P.Y., C.S., G.-H.C.) and Medical Physics (K.N., Y.W., G.-H.C.), University of Wisconsin-Madison; Department of Neuroradiology, University of Erlangen-Nuremberg, Erlangen, Germany (T.S., A.D.); and Department of Research Collaboration, Siemens Medical Solutions, USA, Inc, Hoffman Estates, IL (S.S., K.R.).
Tobias
T
Struffert
From the Department of Neurosurgery, Changhai Hospital, Second Military Medical University, Shanghai, China (P.Y.); Departments of Radiology (P.Y., C.S., G.-H.C.) and Medical Physics (K.N., Y.W., G.-H.C.), University of Wisconsin-Madison; Department of Neuroradiology, University of Erlangen-Nuremberg, Erlangen, Germany (T.S., A.D.); and Department of Research Collaboration, Siemens Medical Solutions, USA, Inc, Hoffman Estates, IL (S.S., K.R.).
Arnd
A
Dorfler
From the Department of Neurosurgery, Changhai Hospital, Second Military Medical University, Shanghai, China (P.Y.); Departments of Radiology (P.Y., C.S., G.-H.C.) and Medical Physics (K.N., Y.W., G.-H.C.), University of Wisconsin-Madison; Department of Neuroradiology, University of Erlangen-Nuremberg, Erlangen, Germany (T.S., A.D.); and Department of Research Collaboration, Siemens Medical Solutions, USA, Inc, Hoffman Estates, IL (S.S., K.R.).
Sebastian
S
Schafer
From the Department of Neurosurgery, Changhai Hospital, Second Military Medical University, Shanghai, China (P.Y.); Departments of Radiology (P.Y., C.S., G.-H.C.) and Medical Physics (K.N., Y.W., G.-H.C.), University of Wisconsin-Madison; Department of Neuroradiology, University of Erlangen-Nuremberg, Erlangen, Germany (T.S., A.D.); and Department of Research Collaboration, Siemens Medical Solutions, USA, Inc, Hoffman Estates, IL (S.S., K.R.).
Kevin
K
Royalty
From the Department of Neurosurgery, Changhai Hospital, Second Military Medical University, Shanghai, China (P.Y.); Departments of Radiology (P.Y., C.S., G.-H.C.) and Medical Physics (K.N., Y.W., G.-H.C.), University of Wisconsin-Madison; Department of Neuroradiology, University of Erlangen-Nuremberg, Erlangen, Germany (T.S., A.D.); and Department of Research Collaboration, Siemens Medical Solutions, USA, Inc, Hoffman Estates, IL (S.S., K.R.).
Charles
C
Strother
From the Department of Neurosurgery, Changhai Hospital, Second Military Medical University, Shanghai, China (P.Y.); Departments of Radiology (P.Y., C.S., G.-H.C.) and Medical Physics (K.N., Y.W., G.-H.C.), University of Wisconsin-Madison; Department of Neuroradiology, University of Erlangen-Nuremberg, Erlangen, Germany (T.S., A.D.); and Department of Research Collaboration, Siemens Medical Solutions, USA, Inc, Hoffman Estates, IL (S.S., K.R.). 15921196312@163.com gchen7@wisc.edu.
Guang-Hong
GH
Chen
D015901:Angiography, Digital Subtraction / Q000379:methods* / Q000639:trends; D002545:Brain Ischemia / Q000000981:diagnostic imaging* / Q000628:therapy; D005260:Female; D006801:Humans; D008297:Male; D055420:Perfusion Imaging / Q000379:methods* / Q000639:trends; D020521:Stroke / Q000000981:diagnostic imaging* / Q000628:therapy; D013997:Time Factors; D014057:Tomography, X-Ray Computed / Q000379:methods* / Q000639:trends; D016896:Treatment Outcome
ROC curve; angiography; area under curve; cerebral arteries; stroke