Steroid-Responsive Large Vessel Vasculitis: Application of Whole-Brain 320-Detector Row Dynamic Volume CT Angiography and Perfusion

Abstract

SUMMARY:A patient with suspected giant cell arteritis and prior negative findings on superficial temporal artery biopsy was evaluated with 320-detector row CT angiography (CTA) and whole-brain perfusion. Corticosteroid treatment was initiated on the basis of CT angiography findings of arteritis and a cortical perfusion deficit. The patient's symptoms and perfusion imaging findings resolved following therapy. Whole-brain CTA and imaging was helpful in the diagnosis and monitoring this patient with suspected vasculitis. Large vessel cerebral vasculitis (LVCV) represents involvement of the internal carotid artery (ICA); intracranial vertebral arteries; the basilar artery; and the M1, A1, and P1 segments of the middle, anterior, and posterior cerebral arteries (MCA, ACA, and PCA, respectively).1 There is a wide range of diagnostic imaging strategies for patients with clinically suspected LVCV, including multidetector CT (MDCT), MR imaging, positron-emission tomography (PET), and Doppler sonography.2 Three-hundred-twentyϪdetector row CT enables whole-brain perfusion CT (PCT) and quantitative measurements of regional cerebral blood flow and volume (rCBF and rCBV). Such perfusion imaging potentially allows rapid reliable visualization of the effects of cerebral autoregulation mechanisms in parenchymal ischemia.Combined with CT angiography (CTA), PCT has demonstrated clinical utility in acute ischemia.3,4 The major drawback of PCT to date has been the limited volume coverage achieved with 64-section CT imaging.3 The 320 ϫ 0.5 mm detector configuration overcomes this limitation and enables assessment of the entire brain using iodinated contrast opacification for a period of time, so-called "dynamic volume CT." The specific advantage in vasculitis is that abnormalities may not follow vascular distributions, requiring whole-brain PCT to identify all findings. We report a patient who underwent dynamic volume CT before and after treatment for suspected LVCV. Case ReportA 39-year-old right-handed man presented with a left temporal headache, which did not have specific aggregating or relieving factors. The physical examination findings were normal, with the exception of absent reflexes in the right biceps. Pertinent signs included an elevated erythrocyte sedimentation rate (ESR) of 106 mm/h, a C-reactive protein level of 8 mg/L, and a borderline white blood cell count of 11,000 cellsL/ mm 3 . The patient had normal findings on CSF analysis. The medical history was significant for left-sided headaches and a negative prior biopsy of the left superficial temporal artery (STA) for suspected giant cell arteritis (GCA). The differential diagnosis included primary headaches, vasculitis, transient ischemic attack, and impending stroke. Dynamic volume CT (AquilionONE; Toshiba, Tochigi-ken, Japan) was performed during infusion of 70-mL iodinated contrast media (ioversol, Optiray 350; Mallinckrodt, St. Louis, Mo) at 5 mL/s. Single-rotation whole-brain volume datasets were acquired (80 kV, 100 mA, 1-second rotation) intermittently in 2 st...

Surgical Planning for Composite Tissue Allotransplantation of the Face Using 320-Detector Row Computed Tomography

“…Computed tomographic angiography readily separates arteries versus veins. The acquisition was tailored for tissue perfusion analyses akin to reports in the brain 16,17 and the heart. 18 Clinical use in stroke includes perfusion with wide-area detector CT overcoming limitations in volume coverage to achieve up to a 16-cm scan range.…”

Quantitative Evaluation of the Penumbra and Ischemic Core in Acute Cerebral Infarction Using Whole-Brain CT Perfusion

“…In the region in which the TTP is prolonged to a value equal to or greater than the mean value in the normal hemisphere + 2 SD, the penumbra* is defined as the region in which the CBV value is 2 mL/100 g or more tire brain to be obtained at one time [15][16][17][18][19][20][21] . In the present study, whole-brain CTP was performed in patients with acute cerebral ischemia using a 320-row area detector CT scanner and a CTP analysis algorithm that has been developed to provide outstanding quantitative analysis capabilities.…”

“…In the present study, whole-brain CTP was performed using a 320-row area detector CT scanner and a CTP analysis algorithm that has been developed to provide outstanding quantitative analysis capabilities, and quantitative values were measured using an automatic ROI analysis program. The use of a 320-row area detector CT scanner has overcome the problem of a limited scan range, permitting the entire brain to be evaluated [15][16][17][18][19][20][21] . In addition, the use of the automatic ROI analysis program eliminates the problem of inconsistent results depending on the subjective judgment of the reader, making it possible to obtain objective CTP evaluation results.…”

The Role of Imaging in the Diagnosis of Central Nervous System Vasculitis

“…CT angiography on multislice CT can be used in the evaluation of large vessel vasculitis [8]. This has the advantage of being noninvasive and has a spatial resolution of about 0.4 mm [5].…”