Free-Breathing, Non-Gated Heart-To-Brain CTA in Acute Ischemic Stroke: A Feasibility Study on Dual-Source CT

Abstract

PurposeTo validate the feasibility of free-breathing, non-gated, high-pitch heart-to-brain computed tomography arteriography (CTA) in acute ischemic stroke and the capability of non-gated heart-to-brain CTA in showing cardiac anatomy.Materials and MethodsThe study protocol was approved by the institutional medical ethics review board. Free-breathing, non-gated, high-pitch heart-to-brain CTA was performed on patients with acute ischemic stroke referred for multimodal CT using a third-generation dual-source CT. Patients scheduled for ECG-triggered heart-to-brain CTA served as controls. Quantitative and/or qualitative image quality of the four cardiac chambers, left atrial appendage, interventricular and interatrial septa, carotid arteries, and coronary arteries were evaluated and compared between the two groups.ResultsFree-breathing, non-gated, high-pitch heart-to-brain CTA was performed on 30 patients with acute ischemic stroke, whereas the control group included 31 cases. There is no significant difference in the image quality of CTAs between the two groups at cardiac chambers and carotid arteries. The image quality of coronary arteries also showed no significant difference between the two groups. The mean dose length products of CTA in the two groups were 129.1 ± 30.5 mGy cm and 121.6 ± 30.3 mGy cm, respectively. Cardiac abnormality can be shown in patients with acute ischemic stroke.ConclusionIt is feasible to use free-breathing, non-gated, high-pitch heart-to-brain CTA with dual-source CT in acute ischemic stroke for cardiac etiology screening.

Application of deep learning image reconstruction-high algorithm in one-stop coronary and carotid-cerebrovascular CT angiography with low radiation and contrast doses

“…Nevertheless, for carotid and cerebrovascular vessels, we have to admit that the image quality was not significantly improved using DLIR-H under the lower-dose conditions. Similarly, all the former one-stop C&CC-CTA protocols reported comparable or even worse image quality at the same site ( 12 , 14 , 15 ). We speculate that it might be attributed to the order of scanning, as the carotid and cerebrovascular arteries were always scanned behind coronary arteries in the one-stop scanning process.…”

“…Repeated examination for different sites will also increase the treatment expense. Recently, one-stop coronary and carotid-cerebrovascular CTA (C&CC-CTA) protocol using iterative reconstruction (IR) algorithm has been introduced and provides a potential clinically feasible examination for patients suspected with co-existing atherosclerosis disease ( 12 - 17 ). However, previously published one-stop C&CC-CTA protocols still presented with slightly high image noise, and the radiation and contrast dose are expected to be further reduced.…”

Diagnostic Value of Coronary Computed Tomography Angiography Image under Automatic Segmentation Algorithm for Restenosis after Coronary Stenting

“…When the heart was scanned by CTA, many different tissues were involved, including the heart, bone, lung, and coronary artery [ 17 , 18 ]. Different tissue densities were generated.…”

Heart-to-Brain Multiphasic CT Angiography and Cardiac Screening in Acute Ischemic Stroke—Technical Concepts for CT Cardiac Studies in Stroke Patients

“…Different techniques are available for screening heart using CT in stroke patients including the use of different gating techniques 9 and with single or dual energy 10 methods as follows: Retrospective electrocardiogram (ECG)-gated cardiac screening Non-ECG-gated extended Z-axis coverage cardiac screening Prospective-gated cardiac screening …”

“…Dual energy scanners have shown that even a free-breathing, non-gated, and high-pitch heart-to-brain CTA protocol can be incorporated in the multimodal CT of AIS without significant differences in image quality, or an increase of radiation dose in comparison to the breath-hold ECG-gated CTA. 9, 10 While extending the Z-axis without gating carries the least radiation dosage, image quality for diagnostic purposes is poorer than the other methods. Dual energy retrospective gating carries highest radiation with the best imaging quality.…”