Detection of single-phase CTA occult vessel occlusions in acute ischemic stroke using CT perfusion-based wavelet-transformed angiography

• Published in: European radiology Vol. 27; no. 6; pp. 2657 - 2664
• Main Authors: Kunz, Wolfgang G., Sommer, Wieland H., Havla, Lukas, Dorn, Franziska, Meinel, Felix G., Dietrich, Olaf, Buchholz, Grete, Ertl-Wagner, Birgit, Thierfelder, Kolja M.
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.06.2017; Springer Nature B.V
• Subjects: Aged; Brain - blood supply; Brain Ischemia - diagnostic imaging; Brain Ischemia - etiology; Cerebral Angiography - methods; Cerebrovascular Circulation - physiology; Cohort Studies; Computed Tomography Angiography - methods; Contrast agents; Contrast Media; Diagnostic Radiology; Female; Hemodynamics; Humans; Imaging; Infarction, Middle Cerebral Artery - complications; Infarction, Middle Cerebral Artery - diagnosis; Infarction, Middle Cerebral Artery - radiotherapy; Internal Medicine; Interventional Radiology; Ischemia; Male; Medical imaging; Medicine; Medicine & Public Health; Middle Aged; Neuro; Neuroradiology; Radiology; Signal to noise ratio; Stroke; Stroke - diagnostic imaging; Stroke - etiology; Ultrasound; Wavelet transforms; Germany; Thrombectomy; Stroke; Wavelet transform; Angiography; Thrombolysis
• ISSN: 0938-7994; 1432-1084; 1432-1084
• DOI: 10.1007/s00330-016-4613-y

Objectives To determine the detection rate of intracranial vessel occlusions using CT perfusion-based wavelet-transformed angiography (waveletCTA) in acute ischemic stroke patients, in whom single-phase CTA (spCTA) failed to detect an occlusion. Methods Subjects were selected from a cohort of 791 consecutive patients who underwent multiparametric CT including whole-brain CT perfusion. Inclusion criteria were (1) significant cerebral blood flow (CBF) deficit, (2) no evidence of vessel occlusion on spCTA and (3) follow-up-confirmed acute ischemic infarction. waveletCTA was independently analysed by two readers regarding presence and location of vessel occlusions. Logistic regression analysis was performed to identify predictors of waveletCTA-detected occlusions. Results Fifty-nine patients fulfilled the inclusion criteria. Overall, an occlusion was identified using waveletCTA in 31 (52.5 %) patients with negative spCTA. Out of 47 patients with middle cerebral artery infarction, 27 occlusions (57.4 %) were detected by waveletCTA, mainly located in the M2 (15) and M3 segments (8). The presence of waveletCTA-detected occlusions was associated with larger CBF deficit volumes (odds ratio (OR) = 1.335, p = 0.010) and shorter times from symptom onset (OR = 0.306, p = 0.041). Conclusions waveletCTA is able to detect spCTA occult vessel occlusions in about half of acute ischemic stroke patients and may potentially identify more patients eligible for endovascular therapy. Key points • waveletCTA is able to detect spCTA occult vessel occlusions in stroke patients . • waveletCTA-detected occlusions are associated with larger cerebral blood flow deficits . • waveletCTA has the potential to identify more patients eligible for endovascular therapy . • waveletCTA implies neither additional radiation exposure nor extra contrast agent .