4D-CTA improves diagnostic certainty and accuracy in the detection of proximal intracranial anterior circulation occlusion in acute ischemic stroke

• Published in: PloS one 2017-02, Vol.12 (2), p.e0172356-e0172356
• Main Authors: Wagemans, Bart A J M, van Zwam, Wim H, Nelemans, Patricia J, van Oostenbrugge, Robert J, Postma, Alida A
• Format: Article
• Language: English
• Subjects: Analysis; Angiography; Automation; Biology and Life Sciences; Blood vessels; Brain Ischemia - diagnostic imaging; Brain Ischemia - physiopathology; Brain Ischemia - therapy; Care and treatment; CAT scans; Cerebral Angiography - methods; Cerebrovascular Circulation - physiology; Computed tomography; Computed Tomography Angiography - methods; Datasets; Diagnosis; Diagnostic imaging; Diagnostic systems; Female; Humans; Ischemia; Male; Medical diagnosis; Medical imaging; Medicine and Health Sciences; Neuroimaging; Occlusion; Patients; People and Places; Perfusion; Perfusion Imaging - methods; Research and Analysis Methods; Stroke; Stroke - diagnostic imaging; Stroke - physiopathology; Stroke - therapy; Thrombolytic Therapy; Tomography, X-Ray Computed - methods; Training
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0172356

In acute ischemic stroke, imaging of the cranio-cervical vessels is essential for intra-arterial treatment selection. Fast, reliable and easy accessible imaging is necessary 24 hours a day, 7 days a week. Radiologists in training and non-expert readers often perform initial reviewing. In this pilot study, the potential benefit of adding 4Dimensional-CT Angiography (4D-CTA) to the patient selection protocol for intra-arterial therapy is investigated. Twenty-five datasets of prospectively recruited patients, eligible for intra-arterial treatment, were enrolled. Four radiologists-in-training consecutively reviewed CTA, CT-Perfusion and 4D-CTA (post-processed from CTP datasets) and scored: occlusion-presence and diagnostic certainty (scale 1-10). Time-to-diagnosis was registered. Arterial occlusion was present in 8 patients. Accuracy improved from 88-92% after CTA and CTP assessment to 96-100% after 4D-CTA assessment (P-values >0,05). Mean diagnostic certainty improved from 7,2-8,6 to 8,8-9,3 (P-values all < 0,05). Mean time to diagnosis increased from 3, 5, 5 and 4 minutes after CTA to 9, 14, 12, and 10 minutes after 4D-CTA. 4D-CTA as an additive to regular CTA and CT-Perfusion in patients with acute ischemic stroke eligible for intra-arterial treatment shows a tendency to increase diagnostic accuracy and improves diagnostic certainty, when reviewed by radiologist in training, while only mildly prolonging time to diagnosis.