Single rotation CTA of extracranial carotids integrated with cerebral CTP provides sufficient quality for decision making in patients with ischaemic stroke

2020 ◽  
pp. 197140092097458
Author(s):  
Siong Chuong Wong ◽  
Klaus A Hausegger ◽  
Luca De Paoli
Keyword(s):  
Computed Tomography ◽  
Decision Making ◽  
Image Quality ◽  
Ischaemic Stroke ◽  
Contrast Medium ◽  
Computed Tomography Angiography ◽  
Hounsfield Units ◽  
Computed Tomography Perfusion ◽  
Symptomatic Carotid ◽  
Cerebral Computed Tomography

Purpose Large volume computed tomography scanners with 16 cm Z-axis single rotation coverage enable joggle-mode scanning of cerebral computed tomography perfusion and single rotation computed tomography angiography of cervical arteries. Our study aims to evaluate the feasibility of scanning cervical arteries, acquired with single rotation computed tomography angiography during computed tomography perfusion in ischaemic stroke patients. Materials and methods A total of 143 patients were scanned with a single contrast medium injection of 60 ml. Hounsfield units of the cervical arteries and veins were objectively measured and carotid bifurcations were subjectively reviewed. The incidence of artefacts and supra-aortic vessel coverage was recorded. Results Single rotation computed tomography angiography of the neck demonstrated supra-aortic vessels to their origins in 58 (40.6%) patients. Ninety-nine per cent (1140/1152) of arterial segments were adequately opacified (≥150 Hounsfield units). Arteries were adequately contrasted compared to veins in 81.3% (915/1126) of segments. However, the opacification was reversed in 14.0% (158/1126) of segments, indicating a delayed timing of acquisition; 95.5% (273/286) of carotid bifurcations were of good image quality. Measurement of internal carotid artery stenosis in single rotation computed tomography angiography according to the North American Symptomatic Carotid Endarterectomy Trial correlated well with digital subtraction angiography ( R=0.87, P<0.05). Significant artefacts resulted from metal/dental implants (10.5%), contrast in central veins (7.7%) and the shoulder region (4.9%). Conclusion Single rotation computed tomography angiography of the neck incorporated into cerebral computed tomography perfusion with single contrast medium administration revealed adequate image quality for further decision-making in our patient sample. The main drawbacks were inadequate coverage of supra-aortic arteries and possible delay in timing of the joggle.

scholarly journals Contrast medium administration with a body surface area protocol in step-and-shoot coronary computed tomography angiography with dual-source scanners

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Liang Jin ◽  
Yiyi Gao ◽  
Yingli Sun ◽  
Cheng Li ◽  
Pan Gao ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Image Quality ◽  
Contrast Medium ◽  
Surface Area ◽  
Body Surface Area ◽  
Body Surface ◽  
Computed Tomography Angiography ◽  
Coronary Computed Tomography Angiography ◽  
Diagnostic Image Quality ◽  
Coronary Computed Tomography

Abstract We evaluated the feasibility and image quality of prospective electrocardiography (ECG)-triggered coronary computed tomography angiography (CCTA) using a body surface area (BSA) protocol for contrast-medium (CM) administration on both second- and third-generation scanners (Flash and Force CT), without using heart rate control. One-hundred-and-eighty patients with suspected coronary heart disease undergoing CCTA were divided into groups A (BSA protocol for CM on Flash CT), B (body mass index (BMI)-matched patients; BMI protocol for CM on Flash CT), and C (BMI-matched patients; BSA protocol for CM on Force CT). Patient characteristics, quantitative and qualitative measures, and radiation dose were compared between groups A and B, and A and C. Of the 180 patients, 99 were male (median age, 62 years). Average BSA in groups A, B, and C was 1.80 ± 0.17 m2, 1.74 ± 0.16 m2, and 1.64 ± 0.17 m2, respectively, with groups A and C differing significantly (P < 0.001). Contrast volume (50.50 ± 8.57 mL vs. 45.00 ± 6.18 mL) and injection rate (3.90 ± 0.44 mL/s vs. 3.63 ± 0.22 mL/s) differed significantly between groups A and C (P < 0.001). Groups A and C (both: all CT values > 250 HU, average scores > 4) achieved slightly lower diagnostic image quality than group B. The BSA protocol for CM administration was feasible in both Flash and Force CT, and therefore may be valuable in clinical practice.

The role of computed tomography perfusion in the diagnosis of brain ischaemic stroke

2008 ◽  
Vol 149 (23) ◽  
pp. 1059-1065 ◽  
Author(s):  
Szabolcs Halász ◽  
Tamás Puskás
Keyword(s):  
Computed Tomography ◽  
Ischaemic Stroke ◽  
Spiral Ct ◽  
Computed Tomography Perfusion

A többszeletes spirál-CT-berendezések széles körű alkalmazása és a perfúziós szoftverek bevezetése lehetővé tette az agyi véráramlás CT-vizsgálatát. Cél és módszerek: A szerzők ismertetik az agyi perfúziós CT-vizsgálatok elvét, technikáját, amelyet az elmúlt másfél évben 96 betegükön végzett vizsgálatuk tapasztalataival egészítenek ki. A folyamatos technikai fejlődés eredményeként a közeljövőben lehetővé válik a teljes agy perfúziós CT-vizsgálata. Következtetések: Az agy perfúziós CT-vizsgálata gyors, viszonylag olcsó és a stroke kórismézésében pontos diagnózist eredményez.

scholarly journals A technical note on intra-arterial cone-beam computed tomography for the evaluation of flow-diverter stents: Image quality differences between diluted and non-diluted contrast medium

2019 ◽  
Vol 26 (2) ◽  
pp. 164-169
Author(s):  
Naci Kocer ◽  
Sedat G Kandemirli ◽  
Daniel Ruijters ◽  
Michalis Mantatzis ◽  
Osman Kizilkilic ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Image Quality ◽  
Contrast Medium ◽  
Cone Beam Computed Tomography ◽  
Vessel Wall ◽  
Flow Diverter ◽  
Cone Beam ◽  
Gray Scale ◽  
Stent Deployment ◽  
Contrast Technique

Background Design of flow-diverter stents for flexibility, tractability, and low profile limits their radiopacity on conventional digital subtraction angiography. Cone-beam computed tomography (CBCT) offers higher spatial resolution for the evaluation of flow-diverter stents. However, CBCT requires optimal dilution and timing of contrast medium for simultaneous visualization of the stent, arterial lumen, and vessel wall. There are only limited data on the effects of different contrast dilutions on CBCT image quality in neurointerventional applications. Materials and methods In our institution, intra-arterial CBCTs were acquired during stent deployment and at follow-ups with 10% diluted contrast. We had recently started acquiring intra-arterial CBCTs with non-diluted contrast. Retrospective analysis of our flow-diverter data identified eight cases with different aneurysm locations who had intra-arterial CBCT with 10% diluted contrast immediately after flow-diverter stent deployment and with non-diluted contrast technique during follow-ups. For each case, the image quality between diluted and non-diluted contrast techniques was compared qualitatively by assessing stent visualization and quantitatively by plotting gray-scale intensity values along the vessel lumen. Results In two sets of CBCT images per each case, there was no substantial difference between diluted and non-diluted CBTC techniques for the evaluation of stent architecture and lumen opacification. Gray-scale intensity values perpendicular to the lumen revealed similar intensity values along the neighboring parenchyma, vessel wall, and lumen for the two different contrast techniques. Conclusion Intra-arterial CBCT angiography can be performed without contrast dilution and still achieve adequate image quality in certain cerebral aneurysms treated with flow diverter. The non-diluted contrast technique avoids the time loss during preparation of diluted contrast and installation of diluted contrast to the injector in angiography suites with a single power injector.

scholarly journals Serial Quantitative Computed Tomography Perfusion in Aneurysmal Subarachnoid Hemorrhage

2016 ◽  
Vol 43 (3) ◽  
pp. 375-380 ◽  
Author(s):  
Cheemun Lum ◽  
Matthew J. Hogan ◽  
John Sinclair ◽  
Shane English ◽  
Howard Lesiuk ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Subarachnoid Hemorrhage ◽  
Middle Cerebral Artery ◽  
Transit Time ◽  
Cerebral Artery ◽  
Computed Tomography Angiography ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Mean Transit Time ◽  
Arterial Diameter ◽  
Computed Tomography Perfusion

AbstractPurpose: Computed tomography perfusion (CTP) has been performed to predict which patients with aneurysmal subarachnoid hemorrhage are at risk of developing delayed cerebral ischemia (DCI). Patients with severe arterial narrowing may have significant reduction in perfusion. However, many patients have less severe arterial narrowing. There is a paucity of literature evaluating perfusion changes which occur with mild to moderate narrowing. The purpose of our study was to investigate serial whole-brain CTP/computed tomography angiography in aneurysm-related subarachnoid hemorrhage (aSAH) patients with mild to moderate angiographic narrowing. Methods: We retrospectively studied 18 aSAH patients who had baseline and follow-up whole-brain CTP/computed tomography angiography. Thirty-one regions of interest/hemisphere at six levels were grouped by vascular territory. Arterial diameters were measured at the circle of Willis. The correlation between arterial diameter and change in CTP values, change in CTP in with and without DCI, and response to intra-arterial vasodilator therapy in DCI patients was evaluated. Results: There was correlation among the overall average cerebral blood flow (CBF; R=0.49, p<0.04), mean transit time (R=–0.48, p=0.04), and angiographic narrowing. In individual arterial territories, there was correlation between changes in CBF and arterial diameter in the middle cerebral artery (R=0.53, p=0.03), posterior cerebral artery (R=0.5, p=0.03), and anterior cerebral artery (R=0.54, p=0.02) territories. Prolonged mean transit time was correlated with arterial diameter narrowing in the middle cerebral artery territory (R=0.52, p=0.03). Patients with DCI tended to have serial worsening of CBF compared with those without DCI (p=0.055). Conclusions: Our preliminary study demonstrates there is a correlation between mild to moderate angiographic narrowing and serial changes in perfusion in patients with aSAH. Patients developing DCI tended to have progressively worsening CBF compared with those not developing DCI.

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