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

Abstract

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.

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

“…13 However, the pre-MT ASPECTS can be very important for the treating neurointerventionalist in patients with wake-up strokes or unknown clinical onset as well as in scenarios in which intervention is prolonged and termination of the MT has to be discussed after multiple thrombectomy maneuvers. There is growing evidence that FDCT can be reliably used to exclude intracerebral hemorrhage 9,14,15 and that the use of timeresolved flat detector CTA and flat detector CTP is feasible, showing sufficient reliability for decision-making. 16,17 One of the most recent studies addressing the reliability of FDCT in acute stroke by Eckert et al 15 also reported data on the reliability of detecting ischemic changes on FDCT.…”

Evaluation of Sine Spin flat detector CT imaging compared with multidetector CT

“…Until recently, FDCT was used mainly in assessing acute periprocedural or postprocedural complications in the angiography suite 7 8. With the new generation of FDCT, the diagnostic accuracy for early ischemic lesions or intracranial hemorrhage is comparable to that of MDCT 5 9–11. This has potential implications for clinical workflows when acute stroke is suspected—‘one-stop shopping concept’12 13—as well as in predicting treatment outcomes and in decision making in the acute stroke setting in the angiography suite 14…”

Optimized Management of Endovascular Treatment for Acute Ischemic Stroke

“…In the past, inaccurate detection of intracranial hemorrhage was the biggest hurdle in using FDCT for stroke diagnosis 21 22 . This situation seems to be improved when FDCT is performed with the latest generation of angiography systems 23 . Leyhe et al reported not only high sensitivity and specificity for the detection of intracranial hemorrhage, but also demonstrated the feasibility of gray-white differentiation in the supratentorial region with the latest generation of FDCT 24 .…”