Latest generation of flat detector CT as a peri-interventional diagnostic tool: a comparative study with multidetector CT

Abstract

Background and purposeFlat detector CT (FDCT) has been used as a peri-interventional diagnostic tool in numerous studies with mixed results regarding image quality and detection of intracranial lesions. We compared the diagnostic aspects of the latest generation FDCT with standard multidetector CT (MDCT).Materials and methods102 patients were included in our retrospective study. All patients had undergone interventional procedures. FDCT was acquired peri-interventionally and compared with postinterventional MDCT regarding depiction of ventricular/subarachnoidal spaces, detection of intracranial hemorrhage, and delineation of ischemic lesions using an ordinal scale. Ischemic lesions were quantified with the Alberta Stroke Program Early CT Scale (ASPECTS) on both examinations. Two neuroradiologists with varying grades of experience and a medical student scored the anonymized images separately, blinded to the clinical history.ResultsThe two methods were of equal diagnostic value regarding evaluation of the ventricular system and the subarachnoidal spaces. Subarachnoidal, intraventricular, and parenchymal hemorrhages were detected with a sensitivity of 95%, 97%, and 100% and specificity of 97%, 100%, and 99%, respectively, using FDCT. Gray–white differentiation was feasible in the majority of FDCT scans, and ischemic lesions were detected with a sensitivity of 71% on FDCT, compared with MDCT scans. The mean difference in ASPECTS values on FDCT and MDCT was 0.5 points (95% CI 0.12 to 0.88).ConclusionsThe latest generation of FDCT is a reliable and accurate tool for the detection of intracranial hemorrhage. Gray–white differentiation is feasible in the supratentorial region.

One-Stop Management with Perfusion for Transfer Patients with Stroke due to a Large-Vessel Occlusion: Feasibility and Effects on In-Hospital Times

“…FPDCT angiography/perfusion overall 0 1 3 7 4 Detection of LVO 0 0 3 5 7 Evaluation of collaterals 0 0 4 5 6 FPDCT perfusion 1 1 3 6 4 Motion artifacts 1 2 4 5 3 Regarding the differentiation between ischemic and hemorrhagic stroke, which is particularly important in "mothership" (direct admission) patients, previous work from our group showed that FPDCT detects ICH with a high sensitivity and specificity, comparable with MDCT. 13 Furthermore the FPDCT perfusion dataset can be used to reconstruct FPDCT angiography as was pointed out by Yang et al 14 in a prior publication. In our sample, the quality of the reconstructed FPDCT angiography was sufficient to delineate the LVO in all cases and evaluate collaterals (Fig 1 and Table 2).…”

Interfacility Transfer Directly to the Neuroangiography Suite in Acute Ischemic Stroke Patients Undergoing Thrombectomy

“…Additionally, this approach may serve as a paradigm for direct transfer of patients with high suspicion for LVO directly from the field to the neuroangiography suite, particularly with improvements in the quality of CT technology within the neuroangiography suite in detecting hemorrhage and identifying early ischemic change. 25,26 …”

Diagnosing Early Ischemic Changes with the Latest-Generation Flat Detector CT: A Comparative Study with Multidetector CT

“…Innovative approaches to reduce door-to-groin times have been proposed recently for patients with LVO. 5,6,9,11 These approaches include the direct referral of MT-eligible patients to the angiography suite with a variation of imaging or no imaging proposed by the various authors. We have recently published an innovative one-stop-management protocol, which includes both nonconstrast imaging and multiphase CTA (acquired in the angiography suite).…”

“…8 Another, more recent study comparing peri-interventional FDCT with postinterventional MDCT after different neurointerventional procedures again showed high sensitivity and specificity for the detection of intracerebral hemorrhage in different locations. 9 However, this study was limited in the detection of early ischemic changes on FDCT by a long period between modalities (4.3 hours), the use of contrast-/postcontrast agent series, and the use of the ASPECTS as a complete score without the sensitivity/specificity analysis of the predefined brain regions.…”