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Subtraction multiphase CT angiography: A new technique for faster detection of intracranial arterial occlusions

  • Computed Tomography
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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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Authors and Affiliations

Authors

Corresponding author

Correspondence to Danielle Byrne.

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Guarantor

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.

Funding

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

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