Generic placeholder image

Current Medical Imaging

Editor-in-Chief

ISSN (Print): 1573-4056
ISSN (Online): 1875-6603

Research Article

Whole-Brain Volume CT Angiography can Effectively Detect Early Ischemic Cerebrovascular Diseases

Author(s): Shi-Feng Xiang, Jun-Tao Li, Su-Jun Yang, Fang-Fang Ding, Wei-Wei Wang, Shuang Huo, Jian-Wen Li, Wei-Yong Zhang and Bu-Lang Gao*

Volume 18, Issue 7, 2022

Published on: 18 March, 2022

Article ID: e061221198568 Pages: 8

DOI: 10.2174/1573405617666211206091831

Price: $65

Abstract

Objective: To investigate the role of whole-brain volume computed tomography (CT) perfusion in assessing early ischemic cerebrovascular diseases.

Materials and Methods: Seventy-two patients with early ischemic cerebrovascular diseases who had undergone routine CT scan and 320-row volume CT whole-brain perfusion imaging within 8 h after admission were retrospectively enrolled in this one-center case-sectional study. The perfusion parameters of cerebral blood flow (CBF), cerebral blood volume (CBV), mean transit time (MTT), time to peak (TTP), and dynamic CT angiogram (4D-CTA) were obtained and analyzed.

Results: Among 72 patients, 29 cases with 37 cerebral ischemic lesions were found in plain CT scan, whereas 51 cases with 76 lesions were found in whole-brain CT perfusion, with 30.6% more patients being detected. The CBF value was significantly lower in the abnormal than normal corresponding perfusion area in the healthy hemisphere (P<0.05), while the MTT and TTP values were significantly higher in the abnormal than the normal corresponding area (P<0.05). 4D-CTA image suggested that 59 cases had different degrees of stenosis or occlusion, including 11 mild, 18 moderate, 21 severe, and 9 occlusive cases. Four-D-CTA imaging could detect significantly (P<0.05) more patients with abnormal perfusion in severe cerebral vascular stenosis or occlusion than those with no, mild or moderate stenosis (93.33% vs. 16.67%) (P<0.05). The stenosis of intracranial and carotid arteries was positively correlated with MTT and TTP values (P<0.05).

Conclusion: Whole-brain volume CT angiography can comprehensively display early cerebral ischemic lesions, cerebral blood perfusion status, and cerebral vascular stenosis, providing valuable information for early detection of ischemic cerebral diseases and appropriate treatment planning.

Keywords: Ischemic cerebrovascular disease, 320-row volume CT, perfusion imaging, cerebral hemodynamics, arterial stenosis, angiography.

Graphical Abstract
[1]
Benjamin EJ, Blaha MJ, Chiuve SE, et al. Heart disease and stroke statistics-2017 update: A report from the american heart association. Circulation 2017; 135(10): e146-603.
[http://dx.doi.org/10.1161/CIR.0000000000000485] [PMID: 28122885]
[2]
Musuka TD, Wilton SB, Traboulsi M, Hill MD. Diagnosis and management of acute ischemic stroke: Speed is critical. CMAJ 2015; 187(12): 887-93.
[http://dx.doi.org/10.1503/cmaj.140355] [PMID: 26243819]
[3]
Hankey GJ. Stroke. Lancet 2017; 389(10069): 641-54.
[http://dx.doi.org/10.1016/S0140-6736(16)30962-X] [PMID: 27637676]
[4]
Vagal A, Meganathan K, Kleindorfer DO, Adeoye O, Hornung R, Khatri P. Increasing use of computed tomographic perfusion and computed tomographic angiograms in acute ischemic stroke from 2006 to 2010. Stroke 2014; 45(4): 1029-34.
[http://dx.doi.org/10.1161/STROKEAHA.113.004332] [PMID: 24569815]
[5]
Kleindorfer D, Lindsell CJ, Brass L, Koroshetz W, Broderick JP. National US estimates of recombinant tissue plasminogen activator use: ICD-9 codes substantially underestimate. Stroke 2008; 39(3): 924-8.
[http://dx.doi.org/10.1161/STROKEAHA.107.490375] [PMID: 18239184]
[6]
Manniesing R, Oei MT, van Ginneken B, Prokop M. Quantitative dose dependency analysis of whole-brain CT perfusion imaging. Radiology 2016; 278(1): 190-7.
[http://dx.doi.org/10.1148/radiol.2015142230] [PMID: 26114226]
[7]
Menon BK, O’Brien B, Bivard A, et al. Assessment of leptomeningeal collaterals using dynamic CT angiography in patients with acute ischemic stroke. J Cereb Blood Flow Metab 2013; 33(3): 365-71.
[http://dx.doi.org/10.1038/jcbfm.2012.171] [PMID: 23149554]
[8]
Murayama K, Suzuki S, Matsukiyo R, et al. Preliminary study of time maximum intensity projection computed tomography imaging for the detection of early ischemic change in patient with acute ischemic stroke. Medicine (Baltimore) 2018; 97(9): e9906.
[http://dx.doi.org/10.1097/MD.0000000000009906] [PMID: 29489691]
[9]
Langel C, Popovic KS. Infarct-core CT perfusion parameters in predicting post-thrombolysis hemorrhagic transformation of acute ischemic stroke. Radiol Oncol 2018; 53(1): 25-30.
[http://dx.doi.org/10.2478/raon-2018-0048] [PMID: 30864425]
[10]
Yu Y, Han Q, Ding X, et al. Defining core and penumbra in ischemic stroke: A voxel- and volume-based analysis of whole brain ct perfusion. Sci Rep 2016; 6: 20932.
[http://dx.doi.org/10.1038/srep20932] [PMID: 26860196]
[11]
Mayer TE, Hamann GF, Baranczyk J, et al. Dynamic CT perfusion imaging of acute stroke. AJNR Am J Neuroradiol 2000; 21(8): 1441-9.
[PMID: 11003276]
[12]
Tan JC, Dillon WP, Liu S, Adler F, Smith WS, Wintermark M. Systematic comparison of perfusion-CT and CT-angiography in acute stroke patients. Ann Neurol 2007; 61(6): 533-43.
[http://dx.doi.org/10.1002/ana.21130] [PMID: 17431875]
[13]
Zhang SX, Yao YH, Zhang S, et al. Comparative study of DSC-PWI and 3D-ASL in ischemic stroke patients. J Huazhong Univ Sci Technolog Med Sci 2015; 35(6): 923-7.
[http://dx.doi.org/10.1007/s11596-015-1529-8] [PMID: 26670447]
[14]
Nour M, Scalzo F, Liebeskind DS. Ischemia-reperfusion injury in stroke. Intervent Neurol 2013; 1(3-4): 185-99.
[http://dx.doi.org/10.1159/000353125] [PMID: 25187778]
[15]
Wang X, Lo EH. Triggers and mediators of hemorrhagic transformation in cerebral ischemia. Mol Neurobiol 2003; 28(3): 229-44.
[http://dx.doi.org/10.1385/MN:28:3:229] [PMID: 14709787]
[16]
Kablau M, Kreisel SH, Sauer T, et al. Predictors and early outcome of hemorrhagic transformation after acute ischemic stroke. Cerebrovasc Dis 2011; 32(4): 334-41.
[http://dx.doi.org/10.1159/000331702] [PMID: 21921596]
[17]
Sussman ES, Connolly ES Jr. Hemorrhagic transformation: A review of the rate of hemorrhage in the major clinical trials of acute ischemic stroke. Front Neurol 2013; 4: 69.
[http://dx.doi.org/10.3389/fneur.2013.00069] [PMID: 23772220]
[18]
Xu S, Wang L, Zhao L. Clinical application value of brain CT perfusion imaging in the treatment of acute ischemic stroke thrombolytic therapy. Exp Ther Med 2019; 17(5): 3971-6.
[http://dx.doi.org/10.3892/etm.2019.7431] [PMID: 30988778]
[19]
Smit EJ, Vonken EJ, van der Schaaf IC, et al. Timing-invariant reconstruction for deriving high-quality CT angiographic data from cerebral CT perfusion data. Radiology 2012; 263(1): 216-25.
[http://dx.doi.org/10.1148/radiol.11111068] [PMID: 22332063]
[20]
Smit EJ, Vonken EJ, van Seeters T, et al. Timing-invariant imaging of collateral vessels in acute ischemic stroke. Stroke 2013; 44(8): 2194-9.
[http://dx.doi.org/10.1161/STROKEAHA.111.000675] [PMID: 23760216]
[21]
Cao R, Qi P, Liu Y, Ma X, Shen Z, Chen J. Improving prognostic evaluation by 4d CTA for endovascular treatment in acute ischemic stroke patients: A preliminary study. J Stroke Cerebrovasc Dis 2019; 28(7): 1971-8.
[http://dx.doi.org/10.1016/j.jstrokecerebrovasdis.2019.03.038] [PMID: 30981581]
[22]
Han A, Yoon DY, Chang SK, et al. Accuracy of CT angiography in the assessment of the circle of Willis: Comparison of volume-rendered images and digital subtraction angiography. Acta Radiol 2011; 52(8): 889-93.
[http://dx.doi.org/10.1258/ar.2011.110223] [PMID: 21828003]
[23]
Hendrikse J, Klijn CJ, van Huffelen AC, Kappelle LJ, van der Grond J. Diagnosing cerebral collateral flow patterns: Accuracy of non-invasive testing. Cerebrovasc Dis 2008; 25(5): 430-7.
[http://dx.doi.org/10.1159/000121344] [PMID: 18349537]
[24]
Koga M, Kimura K, Minematsu K, Yamaguchi T. Relationship between findings of conventional and contrast-enhanced transcranial color-coded real-time sonography and angiography in patients with basilar artery occlusion. AJNR Am J Neuroradiol 2002; 23(4): 568-71.
[PMID: 11950645]
[25]
Schellinger PD, Richter G, Kohrmann M, Dorfler A. Noninvasive angiography (magnetic resonance and computed tomography) in the diagnosis of ischemic cerebrovascular disease. Techniques and clinical applications. Cerebrovasc Dis 2007; 24(Suppl. 1): 16-23.
[http://dx.doi.org/10.1159/000107375] [PMID: 17971635]
[26]
Kortman HG, Smit EJ, Oei MT, Manniesing R, Prokop M, Meijer FJ. 4D-CTA in neurovascular disease: A review. AJNR Am J Neuroradiol 2015; 36(6): 1026-33.
[http://dx.doi.org/10.3174/ajnr.A4162] [PMID: 25355812]
[27]
Wagemans BA, van Zwam WH, Nelemans PJ, van Oostenbrugge RJ, Postma AA. 4D-CTA improves diagnostic certainty and accuracy in the detection of proximal intracranial anterior circulation occlusion in acute ischemic stroke. PLoS One 2017; 12(2): e0172356.
[http://dx.doi.org/10.1371/journal.pone.0172356] [PMID: 28234928]
[28]
In ’t Veld M, Fronczek R, Dos Santos MP, van Walderveen MAA, Meijer FJA, Willems PWA. High sensitivity and specificity of 4D-CTA in the detection of cranial arteriovenous shunts. Eur Radiol 2019; 29(11): 5961-70.
[http://dx.doi.org/10.1007/s00330-019-06234-4] [PMID: 31089848]

Rights & Permissions Print Cite
© 2024 Bentham Science Publishers | Privacy Policy