Diagnosing Early Ischemic Changes with the Latest-Generation Flat Detector CT: A Comparative Study with Multidetector CT

Maier, Ilko; Leyhe, Johanna Rosemarie; Tsogkas, Ioannis; Behme, Daniel; Schregel, Katharina; Knauth, Michael; Schnieder, Marlena; Liman, Jan; Psychogios, Marios‐Nikos

doi:10.3174/ajnr.a5595

Cited by 24 publications

(15 citation statements)

References 18 publications

(34 reference statements)

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“…These findings are consistent with our quantitative image analysis that showed that our new XperCT protocol had a significantly higher signal to noise ratio (2.08 +/-0.64 vs. 1.15 +/-0.27) compared to the standard XperCT protocol. Our findings are also consistent with other groups' findings that early ischemic changes can be detected with newer generation CBCT imaging [20].…”

Section: Discussionsupporting

confidence: 93%

Novel flat-panel cone-beam CT compared to multi-detector CT for assessment of acute ischemic stroke: A prospective study

Nicholson

Cancelliere

Bracken³

et al. 2021

European Journal of Radiology

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Cone beam CT (CBCT) imaging assessment of acute ischemic stroke (AIS) patients with large-vessel occlusion (LVO) in the angiosuite may improve stroke workflow and decrease time to recanalization. In order for this workflow to gain widespread acceptance, current CBCT imaging needs further development to improve image quality. Our study aimed to compare the image quality of a new CBCT protocol performed directly in the angiosuite with imaging from multidetector CT as a gold standard. Methods: AIS patients with an LVO who were candidates for endovascular treatment were prospectively included in this study. Following conventional multidetector CT (MDCT), patients underwent unenhanced cone beam CT (XperCT, Philips) imaging in the angiosuite, using two different protocols: a standard 20.8 s XperCT and/or an improved 10.4 s XperCT protocol. Images were evaluated using both qualitative and quantitative methods. Results: We included 65 patients in the study. Patients received CBCT imaging prior to endovascular treatment; 18 patients were assessed with a standard 20.8 s protocol scans and 47 with a newer 10.4 s scan. The quantitative analysis showed that the mean contrast-to-noise ratio (CNR) was significantly higher for the newer 10.4 s protocol compared with the 20.8 s protocol (2.08 +/-0.64 vs. 1.15 +/-0.27, p < 0.004) and the mean image noise was significantly lower for the 10.4 s XperCTs when compared with the 20.8 s XperCTs (6.30 +/-1.34 vs. 7.82 +/-2.03, p=<0.003). Qualitative analysis, including 6 measures of image quality, demonstrated that 74.1 % of the 10.4 s XperCT scans were ranked as 'Acceptable' for assessing parenchymal imaging in AIS patients(scoring 3-5 points on a 5-point Likert-scale), compared with 32.4 % of the standard 20.8 s XperCT and 100 % of the MDCT scans. Compared to the MDCT studies, 83 % of the 10.4 s XperCT scans were deemed sufficient image quality for a direct-to-angiosuite selection, compared to only 11 % for the standard 20.8 s scans. The largest image quality improvements included grey/white matter differentiation (59 % improvement), and reduction of image noise and artefacts (63 % & 50 % improvement, respectively). Conclusions: Continued advances in cone-beam CT allow marked improvements in image quality for the assessment of brain parenchyma, which supports a direct-to-angiosuite approach for AIS patients eligible for thrombectomy treatment.

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Section: Discussionsupporting

confidence: 93%

Novel flat-panel cone-beam CT compared to multi-detector CT for assessment of acute ischemic stroke: A prospective study

Nicholson

Cancelliere

Bracken³

et al. 2021

European Journal of Radiology

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“…And 5) Is there (and what is the extend of the) infarct core? For question 1 and 2, there is growing evidence that latest generation FDCTs are able to reliably exclude ICH [ 20 , 21 ] as well as can reliably be used for the determination of ASPECTS [ 21 , 22 ].…”

Section: Discussionmentioning

confidence: 99%

Validation of collateral scoring on flat-detector multiphase CT angiography in patients with acute ischemic stroke

Maier

Scalzo²,

Leyhe

et al. 2018

PLoS ONE

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BackgroundThe pivotal impact of collateral circulation on outcomes in endovascular therapy has fueled the development of numerous CTA collateral scales, yet synchronized validation with conventional angiography has never occurred. We validated multiphase flat-detector CTA (mpFDCTA) for collateral imaging in patients undergoing endovascular stroke treatment.Materials and methodsConsecutive acute ischemic stroke patient data, including mpFDCTA shortly followed by digital subtraction angiography (DSA), in the setting of acute ICA- or MCA-occlusions were analyzed. An independent core lab scored mpFDCTA with an established collateral scale and separately graded American Society of Interventional and Therapeutic Neuroradiology (ASITN) collateral score on DSA, blind to all other data.Results24 consecutive cases (age 76.7 ± 7.3 years; 58.3% women; baseline NIHSS median 17 (4–23)) of acute ICA- or MCA-occlusion were analyzed. Time from mpFDCTA to intracranial DSA was 23.04 ± 7.6 minutes. Median mpFDCTA collateral score was 3 (0–5) and median DSA ASITN collateral score was 2 (0–3), including the full range of potential collateral grades. mpFDCTA and ASITN collateral score were strongly correlated (r = 0.86, p<0.001). mpFDCTA provided more complete collateral data compared to selective DSA injections in cases of ICA-occlusion. ROC analyses for prediction of clinical outcomes revealed an AUC of 0.76 for mpFDCTA- and 0.70 for DSA ASITN collaterals.ConclusionsmpFDCTA in the angiography suite provides a validated measure of collaterals, offering distinct advantages over conventional angiography. Direct patient transfer to the angiography suite and mpFDCTA collateral grading provides a novel and reliable triage paradigm for acute ischemic stroke.

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“…Current DTAS imaging protocols are based largely on the use of FP-CT with rotational C-arm systems (Figure). FP-CT offers the possibility to perform cross-sectional imaging, although it is still inferior to conventional multislice CT. 28 Noncontrast FP-CT can be used to detect the presence of ICH with a very high sensitivity comparable to that of multislice CT. 29 The latest-generation FP-CT allows detection of a large infarct core 30 with a significant reduction of artifacts. 31 The main difference between DTAS protocols published by different research groups lies in the use of FP-CTA with IV contrast (Table ).…”

Section: Imaging Protocols For Dtasmentioning

confidence: 99%

Direct Transfer to Angiosuite in Acute Stroke

2021

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Time to reperfusion is one of the strongest predictors of functional outcome in acute stroke due to a large vessel occlusion (LVO). Direct transfer to angiography suite (DTAS) protocols have shown encouraging results in reducing in-hospital delays. DTAS allows bypassing of conventional imaging in the emergency room by ruling out an intracranial hemorrhage or a large established infarct with imaging performed before transfer to the thrombectomy-capable center in the angiography suite using flat-panel CT (FP-CT). The rate of patients with stroke code primarily admitted to a comprehensive stroke center with a large ischemic established lesion is <10% within 6 hours from onset and remains <20% among patients with LVO or transferred from a primary stroke center. At the same time, stroke severity is an acceptable predictor of LVO. Therefore, ideal DTAS candidates are patients admitted in the early window with severe symptoms. The main difference between protocols adopted in different centers is the inclusion of FP-CT angiography to confirm an LVO before femoral puncture. While some centers advocate for FP-CT angiography, others favor additional time saving by directly assessing the presence of LVO with an angiogram. The latter, however, leads to unnecessary arterial punctures in patients with no LVO (3%–22% depending on selection criteria). Independently of these different imaging protocols, DTAS has been shown to be effective and safe in improving in-hospital workflow, achieving a reduction of door-to-puncture time as low as 16 minutes without safety concerns. The impact of DTAS on long-term functional outcomes varies between published studies, and randomized controlled trials are warranted to examine the benefit of DTAS.

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Diagnosing Early Ischemic Changes with the Latest-Generation Flat Detector CT: A Comparative Study with Multidetector CT

Cited by 24 publications

References 18 publications

Novel flat-panel cone-beam CT compared to multi-detector CT for assessment of acute ischemic stroke: A prospective study

Novel flat-panel cone-beam CT compared to multi-detector CT for assessment of acute ischemic stroke: A prospective study

Validation of collateral scoring on flat-detector multiphase CT angiography in patients with acute ischemic stroke

Direct Transfer to Angiosuite in Acute Stroke

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