Increased incidence of napkin-ring sign plaques on cervicocerebral computed tomography angiography associated with the risk of acute ischemic stroke occurrence

Wu, Jingping; Zou, Ying; Meng, Xiao; Fan, Zhaoyang; van der Geest, Rob; Cui, Fang; Li, Jianyong; Zhang, Tengyuan; Zhang, Fan

doi:10.1007/s00330-023-10404-w

Cited by 1 publication

(1 citation statement)

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“…In addition, hrMRI requires specialized receiver coils making it less applicable compared with computed tomography (CT) angiography (CT in clinical settings). Conventional CTA can provide arterial lumen and wall assessment and display plaque type, plaque density, and ulceration on relatively larger vessels such as the extracranial carotid and coronary arteries [ 4 – 9 ]. CT, however, is prone to blooming artifacts caused by high-attenuation iodinated contrast which may conceal the intima side of the vessel wall [ 10 ].…”

Section: Introductionmentioning

confidence: 99%

Detectability of intracranial vessel wall atherosclerosis using black-blood spectral CT: a phantom and clinical study

Zhang,

Yao,

Langzam

et al. 2024

Eur Radiol Exp

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Background Computed tomography (CT) is the usual modality for diagnosing stroke, but conventional CT angiography reconstructions have limitations. Methods A phantom with tubes of known diameters and wall thickness was scanned for wall detectability, wall thickness, and contrast-to-noise ratio (CNR) on conventional and spectral black-blood (SBB) images. The clinical study included 34 stroke patients. Diagnostic certainty and conspicuity of normal/abnormal intracranial vessels using SBB were compared to conventional. Sensitivity/specificity/accuracy of SBB and conventional were compared for plaque detectability. CNR of the wall/lumen and quantitative comparison of remodeling index, plaque burden, and eccentricity were obtained for SBB imaging and high-resolution magnetic resonance imaging (hrMRI). Results The phantom study showed improved detectability of tube walls using SBB (108/108, 100% versus conventional 81/108, 75%, p < 0.001). CNRs were 75.9 ± 62.6 (mean ± standard deviation) for wall/lumen and 22.0 ± 17.1 for wall/water using SBB and 26.4 ± 15.3 and 101.6 ± 62.5 using conventional. Clinical study demonstrated (i) improved certainty and conspicuity of the vessels using SBB versus conventional (certainty, median score 3 versus 0; conspicuity, median score 3 versus 1 (p < 0.001)), (ii) improved sensitivity/specificity/accuracy of plaque (≥ 1.0 mm) detectability (0.944/0.981/0.962 versus 0.239/0.743/0.495) (p < 0.001), (iii) higher wall/lumen CNR of SBB of (78.3 ± 50.4/79.3 ± 96.7) versus hrMRI (18.9 ± 8.4/24.1 ± 14.1) (p < 0.001), and (iv) excellent reproducibility of remodeling index, plaque burden, and eccentricity using SBB versus hrMRI (intraclass correlation coefficient 0.85–0.94). Conclusions SBB can enhance the detectability of intracranial plaques with an accuracy similar to that of hrMRI. Relevance statement This new spectral black-blood technique for the detection and characterization of intracranial vessel atherosclerotic disease could be a time-saving and cost-effective diagnostic step for clinical stroke patients. It may also facilitate prevention strategies for atherosclerosis. Key points • Blooming artifacts can blur vessel wall morphology on conventional CT angiography. • Spectral black-blood (SBB) images are generated from material decomposition from spectral CT. • SBB images reduce blooming artifacts and noise and accurately detect small plaques. Graphical Abstract

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Section: Introductionmentioning

confidence: 99%