4D-CTA improves diagnostic certainty and accuracy in the detection of proximal intracranial anterior circulation occlusion in acute ischemic stroke

Abstract

IntroductionIn acute ischemic stroke, imaging of the cranio-cervical vessels is essential for intra-arterial treatment selection. Fast, reliable and easy accessible imaging is necessary 24 hours a day, 7 days a week. Radiologists in training and non-expert readers often perform initial reviewing. In this pilot study, the potential benefit of adding 4Dimensional-CT Angiography (4D-CTA) to the patient selection protocol for intra-arterial therapy is investigated.Materials and methodsTwenty-five datasets of prospectively recruited patients, eligible for intra-arterial treatment, were enrolled. Four radiologists-in-training consecutively reviewed CTA, CT-Perfusion and 4D-CTA (post-processed from CTP datasets) and scored: occlusion-presence and diagnostic certainty (scale 1–10). Time-to-diagnosis was registered.ResultsArterial occlusion was present in 8 patients. Accuracy improved from 88–92% after CTA and CTP assessment to 96–100% after 4D-CTA assessment (P-values >0,05). Mean diagnostic certainty improved from 7,2–8,6 to 8,8–9,3 (P-values all < 0,05). Mean time to diagnosis increased from 3, 5, 5 and 4 minutes after CTA to 9, 14, 12, and 10 minutes after 4D-CTA.Conclusion4D-CTA as an additive to regular CTA and CT-Perfusion in patients with acute ischemic stroke eligible for intra-arterial treatment shows a tendency to increase diagnostic accuracy and improves diagnostic certainty, when reviewed by radiologist in training, while only mildly prolonging time to diagnosis.

Diagnostic performance of an algorithm for automated large vessel occlusion detection on CT angiography

“…In general, experienced (neuro)radiologists are well-capable of identifying LVOs on CTA, enabling prompt diagnosis of acute ischemic stroke due to LVO. 4 5 Yet, such expertise is not always readily available, for instance in hospitals with lower caseloads and during off-hours when dedicated neuroradiologists are not on call. This may hamper fast and accurate CTA assessment.…”

Merging Multiphase CTA Images and Training Them Simultaneously with a Deep Learning Algorithm Could Improve the Efficacy of AI Models for Lateral Circulation Assessment in Ischemic Stroke

“…Moreover, 4D-CTA/CTP provides more accurate images of the arterial, arteriovenous, venous, and late venous phases based on perfusion time–density curves, and does not additionally increase the radiation dose. This multi-phase dynamic CTA evaluation of collateral flow has a high temporal resolution and a smoother baseline between patients, providing reliable original data for collateral circulation evaluation, enabling a complete assessment of collateral circulation [ 18 ] and improving diagnostic accuracy [ 19 ], as well as providing value in determining clinical prognosis [ 12 ]. Second, a residual convolutional neural network [ 20 ] was employed, which can improve the performance of image classification tasks while deepening the network.…”

Value of 4D CT Angiography Combined with Whole Brain CT Perfusion Imaging Feature Analysis under Deep Learning in Imaging Examination of Acute Ischemic Stroke

“…4D CTA combined with CTP imaging feature analysis can provide changes in cerebral vascular morphology in cerebral stroke. Wagemans et al [ 26 ] showed that 4D CTA improved the diagnostic accuracy of proximal intracranial anterior circulation occlusion in acute stroke. 4D CTA, used as an additive to conventional CTA and CTP in patients with AIS eligible for intraarterial therapy, showed a tendency to increase diagnostic accuracy and improve diagnostic certainty when reviewed by radiologists in training, while only slightly extending the time to diagnosis.…”