title: Detection of single-phase CTA occult vessel occlusions in acute ischemic stroke using CT perfusion-based wavelet-transformed angiography.
abstract: OBJECTIVE
  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.
  
  
  CONCLUSIONS
  • 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.
authors.affiliation: Institute for Clinical Radiology, Ludwig-Maximilian-University Hospital Munich, Marchioninistr. 15, 81377, Munich, Germany.
authors.forename: Wolfgang G
authors.initials: WG
authors.lastname: Kunz
authors.affiliation: Institute for Clinical Radiology, Ludwig-Maximilian-University Hospital Munich, Marchioninistr. 15, 81377, Munich, Germany.
authors.forename: Wieland H
authors.initials: WH
authors.lastname: Sommer
authors.affiliation: Josef Lissner Laboratory for Biomedical Imaging of the Institute for Clinical Radiology, Ludwig-Maximilian-University Hospital Munich, Munich, Germany.
authors.forename: Lukas
authors.initials: L
authors.lastname: Havla
authors.affiliation: Department of Neuroradiology, Ludwig-Maximilian-University Hospital Munich, Munich, Germany.
authors.forename: Franziska
authors.initials: F
authors.lastname: Dorn
authors.affiliation: Institute for Clinical Radiology, Ludwig-Maximilian-University Hospital Munich, Marchioninistr. 15, 81377, Munich, Germany.
authors.forename: Felix G
authors.initials: FG
authors.lastname: Meinel
authors.affiliation: Josef Lissner Laboratory for Biomedical Imaging of the Institute for Clinical Radiology, Ludwig-Maximilian-University Hospital Munich, Munich, Germany.
authors.forename: Olaf
authors.initials: O
authors.lastname: Dietrich
authors.affiliation: Department of Neurology, Ludwig-Maximilian-University Hospital Munich, Munich, Germany.
authors.forename: Grete
authors.initials: G
authors.lastname: Buchholz
authors.affiliation: Institute for Clinical Radiology, Ludwig-Maximilian-University Hospital Munich, Marchioninistr. 15, 81377, Munich, Germany.
authors.forename: Birgit
authors.initials: B
authors.lastname: Ertl-Wagner
authors.affiliation: Institute for Clinical Radiology, Ludwig-Maximilian-University Hospital Munich, Marchioninistr. 15, 81377, Munich, Germany. kolja.thierfelder@med.lmu.de.
authors.forename: Kolja M
authors.initials: KM
authors.lastname: Thierfelder
mesh_terms: D000368:Aged; D001921:Brain / Q000098:blood supply; D002545:Brain Ischemia / Q000000981:diagnostic imaging / Q000209:etiology; D002533:Cerebral Angiography / Q000379:methods; D002560:Cerebrovascular Circulation / Q000502:physiology; D015331:Cohort Studies; D000072226:Computed Tomography Angiography / Q000379:methods; D003287:Contrast Media; D005260:Female; D006801:Humans; D020244:Infarction, Middle Cerebral Artery / Q000150:complications / Q000175:diagnosis* / Q000532:radiotherapy*; D008297:Male; D008875:Middle Aged; D020521:Stroke / Q000000981:diagnostic imaging / Q000209:etiology*
chemical_list: D003287:Contrast Media
keywords: Angiography; Stroke; Thrombectomy; Thrombolysis; Wavelet transform