Abstract

Detection of single-phase CTA occult vessel occlusions in acute ischemic stroke using CT perfusion-basedwavelet-transformed angiography

posted by dsct.com | Jun 29, 2017

Purpose

To determine the detection rate of intracranial vessel occlusions using CT perfusion-based wavelet-transformed angiography (waveletCTA) in acute ischemic stroke patients, in whom single-phase CTA (spCTA) failed to detect an occlusion.

Material and Methods

Subjects were selected from a cohort of 791 consecutive patients who underwent multiparametric CT including wholebrainCT perfusion. Inclusion criteria were (1) significant cerebral blood flow (CBF) deficit, (2) no evidence of vessel occlusion on spCTA and (3) follow-up-confirmed acute ischemic infarction. waveletCTA was independently analysed by two readers regarding presence and location of vessel occlusions. Logistic regression analysis was performed to identify predictors of waveletCTA-detected occlusions.

Results

Fifty-nine patients fulfilled the inclusion criteria. Overall, an occlusion was identified using waveletCTA in 31 (52.5 %) patients with negative spCTA. Out of 47 patients with middle cerebral artery infarction, 27 occlusions (57.4 %) were detected by waveletCTA, mainly located in the M2 (15) and M3 segments (8). The presence of waveletCTA-detected occlusions was associated with larger CBF deficit volumes (odds ratio (OR) = 1.335, p = 0.010) and shorter times from symptom onset (OR = 0.306, p = 0.041).

Conclusions

waveletCTA is able to detect spCTA occult vessel occlusions in about half of acute ischemic stroke patients and may potentially identify more patients eligible for endovascular therapy.

Key points

  • waveletCTA is able to detect spCTA occult vessel occlusions in stroke patients.
  • waveletCTA-detected occlusions are associated with larger cerebral blood flow deficits.
  • waveletCTA has the potential to identify more patients eligible for endovascular therapy.
  • waveletCTA implies neither additional radiation exposure nor extra contrast Agent.

 

Authors: Kunz WG, Sommer WH, Havla L, Dorn F, Meinel FG, Dietrich O, Buchholz G, Ertl-Wagner B, Thierfelder KM.

Full text available at: Eur Radiol. 2016 Oct 8.



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