Computed Tomography-Based Evaluation of Cerebrovascular Disease

Abstract Purpose Flat-panel computed tomography (FP-CT) is increasingly available in angiographic rooms and hybrid OR’s. Considering its easy access, cerebral imaging using FP-CT is an appealing modality for intra-procedural applications. The purpose of this systematic review is to assess the diagnostic accuracy of FP-CT compared with perfusion computed tomography (CTP) and perfusion magnetic resonance (MRP) in cerebral perfusion imaging. Methods We performed a systematic literature search in the Cochrane Library, MEDLINE, Embase, and Web of Science up to June 2019 for studies directly comparing FP-CT with either CTP or MRP in vivo. Methodological quality was assessed using the QUADAS-2 tool. Data on diagnostic accuracy was extracted and pooled if possible. Results We found 11 studies comparing FP-CT with CTP and 5 studies comparing FP-CT with MRP. Most articles were pilot or feasibility studies, focusing on scanning and contrast protocols. All patients studied showed signs of cerebrovascular disease. Half of the studies were animal trials. Quality assessment showed unclear to high risks of bias and low concerns regarding applicability. Five studies reported on diagnostic accuracy; FP-CT shows good sensitivity (range 0.84–1.00) and moderate specificity (range 0.63–0.88) in detecting cerebral blood volume (CBV) lesions. Conclusions Even though FP-CT provides similar CBV values and reconstructed blood volume maps as CTP in cerebrovascular disease, additional studies are required in order to reliably compare its diagnostic accuracy with cerebral perfusion imaging.

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Report from the Joint Commitee for Stroke Facilities -- XII. Computed Tomography in the Managemnt of Cerebrovascular Disease

Stroke ◽

10.1161/01.str.6.1.103 ◽

1975 ◽

Vol 6 (1) ◽

pp. 103-107 ◽

Cited By ~ 8

Keyword(s):

Computed Tomography ◽

Cerebrovascular Disease ◽

Stroke Facilities

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Perfusion CT scanning and CT angiography in the evaluation of extracranial-intracranial bypass grafts

Journal of Neurosurgery ◽

10.3171/2010.6.jns10117 ◽

2011 ◽

Vol 114 (4) ◽

pp. 978-983 ◽

Cited By ~ 9

Author(s):

Soenke Langner ◽

Steffen Fleck ◽

Rebecca Seipel ◽

Henry W. S. Schroeder ◽

Norbert Hosten ◽

...

Keyword(s):

Computed Tomography ◽

Cerebrovascular Disease ◽

Bypass Surgery ◽

Superficial Temporal Artery ◽

Ct Scanning ◽

Temporal Artery ◽

Perfusion Ct ◽

Time To Peak ◽

Bypass Patency ◽

Before And After

Object Extracranial-intracranial (EC-IC) bypass surgery remains an important treatment alternative for patients with occlusive cerebrovascular disease. The aim of the present study was to use perfusion CT and CT angiography (CTA) to evaluate cerebral hemodynamics and bypass patency in patients with occlusive cerebrovascular disease before and after EC-IC bypass surgery. Methods Ten patients underwent perfusion CT and CTA before and after bypass surgery. Preoperative and postoperative digital subtraction angiography served as the diagnostic gold standard. An artery bypass was established from the superficial temporal artery to a cortical branch of the middle cerebral artery. Perfusion CT scanning was performed at the level of the basal ganglia. Color-coded perfusion maps of cerebral blood volume, cerebral blood flow, and time to peak were calculated. Results Preoperative perfusion CT showed significant prolonged time to peak and reduced cerebral blood flow of the affected hemisphere. Postoperative neurological deterioration did not develop in any patient. Computed tomography angiography provided adequate evaluation of the anastomoses as well as the course and caliber of the bypass and confirmed bypass patency in all patients. Postoperative perfusion CT showed improved cerebral hemodynamics with a return to nearly normal perfusion parameters. Conclusions Computed tomography angiography is a noninvasive and reliable tool for evaluating patients with EC-IC bypass. Perfusion CT allows monitoring of hemodynamic changes after bypass surgery. The combination of both modalities enables noninvasive anatomical and functional analysis of superficial temporal artery–middle cerebral artery anastomoses using a single CT protocol. Hemodynamic evaluation of patients with occlusive cerebrovascular disease before and after surgery may improve the prediction of outcome and may help identify patients in whom a bypass procedure can be performed.

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