Interleaving cerebral CT perfusion with neck CT angiography. Part II: clinical implementation and image quality

Marcel T. H. Oei,Bram van Ginneken,Ewoud J. Smit,Frederick J. A. Meijer,Willem-Jan van der Woude,Rashindra Manniesing,Mathias Prokop

doi:10.1007/s00330-016-4592-z

Marcel T. H. Oei, Bram van Ginneken + Show 5 more

Open Access

https://doi.org/10.1007/s00330-016-4592-z

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Abstract

ObjectivesFeasibility evaluation of the One-Step Stroke Protocol, which is an interleaved cerebral computed tomography perfusion (CTP) and neck volumetric computed tomography angiography (vCTA) scanning technique using wide-detector computed tomography, and to assess the image quality of vCTA.MethodsTwenty patients with suspicion of acute ischaemic stroke were prospectively scanned and evaluated with a head and neck CTA and with the One-Step Stroke Protocol. Arterial enhancement and contrast-to-noise ratio (CNR) in the carotid arteries was assessed. Three observers scored artefacts and image quality of the cervical arteries. The total z-coverage was evaluated.ResultsMean enhancement in the carotid bifurcation was rated higher in the vCTA (595 ± 164 HU) than CTA (441 ± 117 HU). CNR was rated higher in vCTA. Image quality scores showed no significant difference in the region of the carotid bifurcation between vCTA and CTA. Lower neck image quality scores were slightly lower for vCTA due to artefacts, although not rated as diagnostically relevant. In ten patients, the origin of the left common carotid artery was missed by 1.6 ± 0.8 cm. Mean patient height was 1.8 ± 0.09 m. Carotid bifurcation and origin of vertebral arteries were covered in all patients.ConclusionsThe One-Step Stroke Protocol is feasible with good diagnostic image quality of vCTA, although full z-coverage is limited in tall patients.Key Points• Interleaving cerebral CTP with neck CTA (One-Step Stroke Protocol) is feasible• Diagnostic quality of One-Step Stroke Protocol neck CTA is similar to conventional CTA• One-Step Stroke Protocol neck CTA suffers from streak artefacts in the lower neck• A limitation of One-Step Stroke Protocol CTA is lack of coverage in tall patients• Precise planning of One-Step Stroke Protocol neck CTA is necessary in tall patients

Highlights

Stroke is one of the leading causes of mortality worldwide [1]
We present a novel scanning technique for wide-detector Computed tomography (CT) scanners that could obviate the need for a separate head and neck CT angiography (CTA) acquisition, which we consider a One-Step Stroke Protocol
Approval for this prospective study was obtained and informed consent was waived by the ethics committee of our institution, as in our institution a cerebral non-contrast-enhanced CT (NCCT), cerebral CT perfusion (CTP), and head and neck CTA is routinely performed in the workup of acute ischaemic stroke patients

Summary

Introduction

Stroke is one of the leading causes of mortality worldwide [1]. With Btime is brain^ as the motto, rapid identification of the presence and extent of cerebral ischaemia is essential for treatment decisions. Computed tomography (CT) remains a frequently used modality for patients presenting with symptoms of acute ischaemic stroke to the emergency department because CT is readily and widely available. A CT protocol in the diagnostic work-up of ischaemic stroke usually includes a non-contrast-enhanced CT (NCCT), head and neck CT angiography (CTA) and cerebral CT perfusion (CTP). The combination of CTA and CTP has been shown to be helpful in selecting patients for endovascular treatment [2]

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