Flat Detector Angio-CT following Intra-Arterial Therapy of Acute Ischemic Stroke: Identification of Hemorrhage and Distinction from Contrast Accumulation due to Blood-Brain Barrier Disruption

Kau, Thomas; Hauser, Michael; Obmann, Sonja-Maria; Niedermayer, M.; Weber, Johannes; Hausegger, K. A.

doi:10.3174/ajnr.a4021

Cited by 13 publications

(17 citation statements)

References 30 publications

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“…This approach revealed a moderate sensitivity of FPCT for detection of intracranial and specifically intraventricular hematomas compared to MDCT (68% and 62%, respectively). This corresponds to the sensitivity of 58% recently reported by Kau et al in patients examined with FPCT after acute stroke interventions [9]. These results likely demonstrate a currently limited ability of FPCT to depict the full extent and anatomical distribution of intracranial hematomas.…”

Section: Discussionsupporting

confidence: 79%

“…However, before this approach can be considered for clinical implementation, the diagnostic accuracy of FPCT needs to be assessed. Previous reports have demonstrated the principal ability of FPCT to depict intracranial hematomas in humans [1, 2, 9] as well as in an animal model [10] while raising concern for a limited sensitivity, particularly related to beam hardening artifacts. However, sufficiently high sensitivity is required to exclude hemorrhage with certainty.…”

Section: Introductionmentioning

confidence: 99%

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Voxel-Based Sensitivity of Flat-Panel CT for the Detection of Intracranial Hemorrhage: Comparison to Multi-Detector CT

et al. 2016

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ObjectivesFlat-panel CT (FPCT) allows cross-sectional parenchymal, vascular and perfusion imaging within the angiography suite, which could greatly facilitate acute stroke management. We hypothesized that FPCT offers equal diagnostic accuracy compared to multi-detector CT (MDCT) as a primary tool to exclude intracranial hemorrhage.Methods22 patients with intracranial hematomas who had both MDCT and FPCT performed within 24 hours were retrospectively identified. Patients with visible change in hematoma size or configuration were excluded. Two raters independently segmented hemorrhagic lesions. Data sets and corresponding binary lesion maps were co-registered to compare hematoma volume. Diagnostic accuracy of FPCT to detect hemorrhage was calculated from voxel-wise analysis of lesion overlap compared to reference MDCT.ResultsMean hematoma size was similar between MDCT (16.2±8.9 ml) and FPCT (16.1±8.6 ml), with near perfect correlation of hematoma sizes between modalities (ρ = 0.95, p<0.001). Sensitivity and specificity of FPCT to detect hemorrhagic voxels was 61.6% and 99.8% for intraventricular hematomas and 67.7% and 99.5% for all other intracranial hematomas.ConclusionsIn this small sample containing predominantly cases with subarachnoid hemorrhage, FPCT based assessment of hemorrhagic volume in brain yields acceptable accuracy compared to reference MDCT, albeit with a limited sensitivity on a voxel level. Further assessment and improvement of FPCT is necessary before it can be applied as a primary imaging modality to exclude intracranial hemorrhage in acute stroke patients.

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Section: Discussionsupporting

confidence: 79%

Section: Introductionmentioning

confidence: 99%

Voxel-Based Sensitivity of Flat-Panel CT for the Detection of Intracranial Hemorrhage: Comparison to Multi-Detector CT

et al. 2016

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“…Data acquired with this modality are very useful in decision-making process in terms of peri-procedural complications of neuroendovascular procedures which makes it the most important evolution tool in neurointerventional radiology in the last years. It enables to confirm (or exclude) intracranial hemorrhage or acute hydrocephalus and gives the opportunity to assess the anatomic relation between vessels, bony structures and implanted devices such as stents and coils [13][14][15][16]. As no major peri-procedural complication occurred during our present study, we were unable to evaluate the feasibility of VasoCT for detection of such events.…”

Section: Discussionmentioning

confidence: 86%

Visualization of novel microstents in patients with unruptured intracranial aneurysms with contrast-enhanced flat panel detector CT

Poncyljusz

Zwarzany

Safranow

2015

European Journal of Radiology

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“…Irie et al 27) performed intracranial evaluation using FPCT after craniotomy and endovascular treatment and reported its usefulness. The quality of FPCT images is sufficient for the assessment of novel lesions after endovascular treatment for acute ischemic stroke, but it is insufficient for the differentiation between hemorrhage and contrast extravasation similar to conventional CT. 28) Recently, the contrast extravasation as a result of an improvement in the recanalization rate. 11) Second, involvement of IV-tPA.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of the CT High-density Area after Endovascular Treatment for Acute Ischemic Stroke

Takei

Irie

Tanaka

et al. 2017

JNET

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Objective: To evaluate the relationship between the incidence of the CT high-density area that appears immediately after endovascular treatment for acute ischemic stroke with postprocedural hemorrhagic transformation and its significance in the clinical outcome.Methods: Ten patients with ischemic stroke of the anterior circulation encountered between May 2014 and December 2015 in whom recanalization could be achieved within 8 hours after the onset were retrospectively analyzed. In addition, 695 patients presented in 13 reports were divided into thrombolysis and mechanical thrombectomy groups, and the postprocedural incidence of CT high-density areas was compared between the two groups.Results: Postprocedural CT high-density areas were observed in six (60%) of our patients. Hemorrhagic transformation occurred in three of them, but no exacerbation of neurological symptoms was noted. The incidence of postprocedural CT high-density areas was 43.1% (191/443) in the thrombolysis group and 71.8% (188/262) in the mechanical thrombectomy group including our patients, being significantly higher in the latter group (p <0.01). Conclusion:Although CT high-density areas appear more frequently after mechanical thrombectomy than after thrombolysis, they are considered to be infrequently developed into hemorrhagic transformation and exert relatively few negative effects on the neurological outcome.

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Flat Detector Angio-CT following Intra-Arterial Therapy of Acute Ischemic Stroke: Identification of Hemorrhage and Distinction from Contrast Accumulation due to Blood-Brain Barrier Disruption

Cited by 13 publications

References 30 publications

Voxel-Based Sensitivity of Flat-Panel CT for the Detection of Intracranial Hemorrhage: Comparison to Multi-Detector CT

Voxel-Based Sensitivity of Flat-Panel CT for the Detection of Intracranial Hemorrhage: Comparison to Multi-Detector CT

Visualization of novel microstents in patients with unruptured intracranial aneurysms with contrast-enhanced flat panel detector CT

Evaluation of the CT High-density Area after Endovascular Treatment for Acute Ischemic Stroke

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