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Dual-phase 16 slice CT angiography in stroke imaging: a poor man’s multiphase study?

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Abstract

Multiphase CT angiography (CTA) in collateral assessment provides time-resolved cerebral angiograms of the intracranial vasculature, requiring a high-speed multidetector CT (MDCT) scanner with ≥ 64 slices. Unfortunately, many hospitals are equipped with lower speed MDCT scanners. Herein, we present our experience performing dual-phase CTA (d-CTA) on a 16 slice MDCT with a biphasic rate injection to grade intracranial collaterals as predictor of clinical outcome. 42 patients were evaluated with both dual-phase CTA (d-CTA) and single-phase CTA (s-CTA) for occluded anterior intracranial circulation and collaterals. They were treated with endovascular reperfusion. Univariate and multivariate analyses were performed to define the independent predictors for favorable outcome at 3 months. Good collateral circulation status on d-CTA was associated with a lower median 24-h (5 vs. 7.5, p = 0.03) and discharge (2 vs. 4.6, p = 0.04) NIHSS. A logistic regression model showed that only age (OR 0.95, 95% CI 0.91–0.98, p = 0.03) and good collateral circulation status at d-CTA (OR 4.3, 95% CI 1.87–11.3, p < 0.01) were independent predictors of favorable functional outcome at 3 months, but that s-CTA was not. The collateral status on d-CTA can be a useful predictor for clinical outcome in acute stroke patients. The proposed protocol adapted to a low-speed MDCT scanner could be of particular interest in hospitals without access to the more up-to-date technology.

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Funding

This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors. The author(s) received no financial support for the research, authorship, and/or publication of this article.

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  1. All authors contributed equally to the manuscript.

Authors and Affiliations

  1. Neurology Unit, Guglielmo da Saliceto Hospital, Via Taverna 49, 29121, Piacenza, Italy

    Nicola Morelli, Paolo Immovilli & Donata Guidetti

  2. Radiology Unit, Guglielmo da Saliceto Hospital, Piacenza, Italy

    Nicola Morelli, Giuseppe Marchesi & Emanuele Michieletti

  3. Neurology Unit, San Giacomo Hospital, Novi Ligure, Alessandria, Italy

    Eugenia Rota

  4. Department of Radiology, St. John’s Medical Center, Tulsa, OK, USA

    John Morelli

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  1. Nicola Morelli
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  2. Eugenia Rota
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  3. Paolo Immovilli
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  4. Giuseppe Marchesi
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  5. Donata Guidetti
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  6. Emanuele Michieletti
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  7. John Morelli
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This is all those who: (1) made a substantial contribution to the concept or design of the work or acquisition, analysis or interpretation of data, (2) drafted the article or revised it critically for important intellectual content, (3) approved the version to be published, (4) each author should have participated sufficiently in the work to take public responsibility for appropriate portions of the content.

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Correspondence to Nicola Morelli.

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The study was approved by the Guglielmo da Saliceto Hospital Ethics Committee.

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Human and animal studies have been approved by local ethics committee and, therefore, have been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. Specific national laws have been observed, too.

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Morelli, N., Rota, E., Immovilli, P. et al. Dual-phase 16 slice CT angiography in stroke imaging: a poor man’s multiphase study?. Acta Neurol Belg 119, 187–192 (2019). https://doi.org/10.1007/s13760-018-1019-4

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  • DOI: https://doi.org/10.1007/s13760-018-1019-4

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