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A “one-stop-shop” 4D CTA protocol using 320-row CT for advanced imaging in acute ischemic stroke: a technical note

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Abstract

This technical note describes a novel CT scan protocol that includes a non-enhanced CT, dynamic CTA, and perfusion of the whole brain and CTA of the carotid arteries using a 320-row area detector CT scanner, with a unique contrast injection and acceptable radiation exposure dose in patients presenting with acute ischemic stroke. The acquisition parameters and reconstruction parameters will be discussed including the use of model-based iterative reconstruction (MBIR), time summing (tMIP), and subtraction techniques to optimize the results of this protocol.

Key Points• Scanning on a 320-row area detector CT can achieve both brain perfusion with dynamic angiography and reconstructed arterial and venous CTA, and supra aortic trunk angiography, in a single acquisition.

• It provides, in a single exam, a full diagnostic workup, i.e., all the acquisitions that are needed to make a quick decision, with reasonable exposure to ionizing radiation and reduced amount of medium contrast, in case of acute ischemic stroke presentation.

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Abbreviations

CTA:

Computed tomography angiography

CTP:

Computed tomography perfusion

DLP:

Dose length product

FIRST:

Forward-projected model-based iterative reconstruction solution

LCD:

Low contrast detectability

MBIR:

Model-based iterative reconstruction

MRI:

Magnetic resonance imaging

MTT:

Mean transit time

NECT:

Non-enhanced computed tomography

NIHSS:

National Institute of Health Stroke Score

rCBF:

Relative cerebral blood flow

rCBV:

Relative cerebral blood volume

ROI:

Region of interest

SAT:

Supra aortic trunk

tMIP:

Time maximum intensity projection

TTP:

Time to peak

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Acknowledgments

The authors thank the radiology technicians Mr. Leprêtre Alexis and Ms. Montier Corinne for their implication in the study.

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Authors and Affiliations

  1. Service d’Imagerie Médicale, CHU de la Cavale Blanche, Boulevard Tanguy Prigent, 29609, Brest Cedex, France

    Julien Ognard, Brieg Dissaux, Michel Nonent, Jean-Christophe Gentric & Douraïed Ben Salem

  2. Laboratoire de traitement de l’information médicale—LaTIM (Inserm UMR 1101), 5 Avenue Foch, 29200, Brest Cedex, France

    Julien Ognard & Douraïed Ben Salem

  3. Groupe d’Étude de la Thrombose Occidentale, CHU de la Cavale Blanche, Boulevard Tanguy Prigent, 29609, Brest Cedex, France

    Brieg Dissaux, Michel Nonent & Jean-Christophe Gentric

  4. CT Division, Canon Medical Systems France, 7 Rue Ampère BP 14, 92802, Puteaux Cedex, France

    Karim Haioun

Authors
  1. Julien Ognard
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  2. Brieg Dissaux
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  3. Karim Haioun
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  4. Michel Nonent
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  5. Jean-Christophe Gentric
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  6. Douraïed Ben Salem
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Corresponding author

Correspondence to Julien Ognard.

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Guarantor

The scientific guarantor of this publication is Prof. Ben Salem Douraied.

Conflict of interest

One of the authors (Haioun Karim) who provided us technical data about the new acquisition is an employee of Canon Medical Systems France. The other authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Statistics and biometry

One of the authors has significant statistical expertise (JO) but no complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was waived by the Institutional Review Board.

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Institutional Review Board approval was obtained.

Methodology

• Observational

• Performed at one institution

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Ognard, J., Dissaux, B., Haioun, K. et al. A “one-stop-shop” 4D CTA protocol using 320-row CT for advanced imaging in acute ischemic stroke: a technical note. Eur Radiol 29, 4930–4936 (2019). https://doi.org/10.1007/s00330-019-06041-x

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  • DOI: https://doi.org/10.1007/s00330-019-06041-x

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