Interleaving Cerebral CT Perfusion with Neck CT Angiography. Part II: Clinical Implementation and Image Quality

M.T.H. Oei, F.J. Meijer, W.-J. van der Woude, E.J. Smit, B. van Ginneken, R. Manniesing and M. Prokop

European Radiology 2017;27(6):2411-2418



Objectives: Feasibility evaluation of the One-Step-Stroke protocol, which is an interleaved cerebral CTP with volumetric neck CTA (vCTA) scanning technique using wide-detector CT, and to assess the image quality of vCTA.

Methods: Twenty patients with suspicion of acute ischemic stroke were prospectively scanned and evaluated with a head and neck CTA and with the One-Step-Stroke protocol. Arterial enhancement and CNR in the carotid arteries was assessed. Three observers scored artifacts and image quality of the cervical arteries. The total z-coverage was evaluated.

Results: Mean enhancement in the carotid bifurcation was rated higher in the vCTA (595+-164HU) than CTA (441+-117HU). CNR was rated higher in vCTA. Image quality scores showed no significant difference in the region of the carotid bifurcation between vCTA and CTA. Lower neck image quality scores were slightly lower for vCTA due to artifacts, although not rated as diagnostically relevant. In 10 patients the origin of the left common carotid artery was missed by 1.6+-0.8 cm. Mean patients height was 1.8+-0.09 m. Carotid bifurcation and origin of vertebral arteries were covered in all patients.

Conclusion: The One-Step-Stroke protocol is feasible with good diagnostic image quality of vCTA, although full z-coverage is limited in tall patients.

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