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Acta Radiol. 2019 Mar 12:284185119836220. doi: 10.1177/0284185119836220. [Epub ahead of print]

Visualization of large vessel occlusion, clot extent, and collateral supply using volume perfusion flat detector computed tomography in acute stroke patients.

Author information

1
1 Department of Neuroradiology, University Hospital Erlangen, Erlangen, Germany.
2
2 Department of Neurology, University Hospital Erlangen, Erlangen, Germany.

Abstract

BACKGROUND:

Flat detector computed tomography angiography (FDCTA) can be reconstructed from volume perfusion flat detector computed tomography (VP-FDCT). Thus, CTA equivalent stroke imaging might be feasible within the angio suite.

PURPOSE:

To evaluate the diagnostic accuracy of FDCTA in detecting large vessel occlusion (LVO) and collateral supply in acute stroke patients.

MATERIAL AND METHODS:

Sixteen patients with LVO of the anterior circulation were analyzed retrospectively. Each patient underwent a multimodal CT stroke protocol, subsequent VP-FDCT, and digital subtraction angiography (DSA) for endovascular stroke therapy. Angiographic images reconstructed secondarily from VP-FDCT were evaluated with regard to visualization of LVO, Collateral Score (CS), Clot Burden Score (CBS), and image quality.

RESULTS:

Image quality of FDCTA was sufficient for diagnosis with a strong correlation between CTA and FDCTA (median score: CTA = 4 ± 0.447; FDCTA = 4 ± 0.5). Detection of LVO could be achieved with high sensitivity and specificity for FDCTA and CTA (97.9%, 95% confidence interval [CI] = 96.0-99.9; 92.6%, 95% CI = 84.3-100.0 vs. 96.8%, 95% CI = 93.2-100.0; 86.3%, 95% CI = 88.2-95.2). CBS and CS assessment showed no significant difference between FDCTA and CTA for both readers (reader1CBS: P = 0.751, reader1CS: P = 0.718; reader2CBS: P = 0.164; reader2CS: P = 0.582) and an excellent interrater agreement (CTACBSICC = 0.984, FDCTACBSICC = 0.951; CTACSICC = 0.754, FDCTACSICC = 0.789).

CONCLUSION:

FDCTA, reconstructed from VP-FDCT data, allows reliable detection of ICA or MCA M1 segment occlusion comparable to CTA and may provide information concerning the clot extent with sufficient image quality.

KEYWORDS:

Central nervous system; flat detector computed tomography; interventional; stroke

PMID:
30862169
DOI:
10.1177/0284185119836220

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