Abstract
Objective
To describe and evaluate a novel technical development to improve detection of intracranial vessel occlusions using multiphase CT angiography (MPCTA).
Materials and methods
The institutional ethics committee approved the study. Fifty patients (30 consecutive distal (M2 or smaller) anterior circulation occlusions, ten M1 occlusions, ten cases without occlusion) presenting with suspected AIS who underwent MPCTA were included. Post-processing of MPCTA studies created “subtraction” and “delayed enhancement” (DE) datasets. Initially, non-contrast CT and MPCTA studies for each patient were evaluated. Readers' confidence, speed and sensitivity of detection of intracranial vessel occlusions were recorded. After an interval of at least 4 weeks, readers were provided with post-processed images and studies were re-evaluated.
Results
While the sensitivity of detection of intracranial vessel occlusions was equal for both conventional MPCTA and subMPCTA, the mean time taken to identify a vessel occlusion decreased by 64 % using subMPCTA (16 s vs. 45 s with conventional MPCTA) (p<0.001). In addition, confidence in interpretation improved (from 4.4 to 4.9) using subMPCTA (p<0.001).
Conclusion
SubMPCTA is a novel technique that aids in identifying small intracranial vessel occlusions in the suspected AIS patient. SubMPCTA increases confidence in interpretation and reduces the time taken to detect intracranial vessel occlusions.
Key Points
• SubMPCTA processes MPCTA data to better demonstrate intracranial arterial occlusions.
• SubMPCTA increases confidence and speed of interpretation of MPCTA studies.
• SubMPCTA may aid in rapidly differentiating acute ischaemic stroke from stroke mimics.
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Abbreviations
- A2:
-
Second segment of the anterior cerebral artery
- A3:
-
Third segment of the anterior cerebral artery
- ACA:
-
Anterior cerebral artery
- AICA:
-
Anterior inferior cerebellar artery
- AIS:
-
Acute ischaemic stroke
- CT:
-
Computed tomography
- DSA:
-
Digital subtraction angiography
- ICA:
-
Internal carotid artery
- IVO:
-
Intracranial vessel occlusion
- M1:
-
First segment of the middle cerebral artery
- M2:
-
Second segment of the middle cerebral artery
- M3:
-
Third segment of the middle cerebral artery
- MCA:
-
Middle cerebral artery
- MIP:
-
Maximum intensity projection
- MPCTA:
-
Multiphase computed tomographic angiography
- MRI:
-
Magnetic resonance imaging
- NCCT:
-
Non-contrast computed tomography
- NIHSS:
-
National Institute of Health Stroke Scale
- NPV:
-
Negative predictive value
- PACS:
-
Picture Archiving and Communicating Systems
- PICA:
-
Posterior inferior cerebellar artery
- PPV:
-
Positive predictive value
- SCA:
-
Superior cerebellar artery
- SPCTA:
-
Single-phase computed tomographic angiography
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Acknowledgements
We would like to acknowledge the assistance provided by Jonathan Siung in this project.
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The scientific guarantor of this publication is Dr Peter MacMahon.
Conflict of interest
The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.
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The authors state that this work has not received any funding.
Statistics and biometry
One of the authors has significant statistical expertise.
Informed consent
Written informed consent was waived by the Institutional Review Board.
Ethical approval
Institutional Review Board approval was obtained.
Study subjects or cohorts overlap
Some study subjects or cohorts have been previously reported in American Journal of Radiology (AJNR), October 2017 “Improved Detection of Anterior Circulation Occlusions: The Delayed Vessel Sign on Multiphase CT Angiography”.
Methodology
• retrospective
• diagnostic or prognostic study
• performed at one institution
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Byrne, D., Walsh, J.P., Sugrue, G. et al. Subtraction multiphase CT angiography: A new technique for faster detection of intracranial arterial occlusions. Eur Radiol 28, 1731–1738 (2018). https://doi.org/10.1007/s00330-017-5124-1
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DOI: https://doi.org/10.1007/s00330-017-5124-1