Keywords:
Interventional vascular, Neuroradiology brain, Digital radiography, CT, Fluoroscopy, Technical aspects, Computer Applications-General, Contrast agent-intravenous, Tissue characterisation, Ischaemia / Infarction, Haemodynamics / Flow dynamics
Authors:
J. Caroff1, P. Jittapiromsak2, C. Aubé1, D. Ruijters3, N. Benachour2, L. SPELLE2, J. Moret2; 1Angers/FR, 2Clichy/FR, 3Best/NL
DOI:
10.1594/ecr2013/C-1493
Purpose
Endovascular treatment is a promising approach for early stroke therapy (1).
However selecting the right acute ischemic stroke patients eligible for revascularization therapy can be challenging (2).
Cerebral blood volume (CBV) anomalies are correlated to definitive lesions (3).
The extent of pre-intervention CBV abnormality is a strong predictor of functional outcomes following endovascular stroke therapy (4).
Advanced modality imaging evaluation in acute ischemic stroke may lead to delay in endovascular reperfusion therapy.
Sheth et al.
showed that stroke patients selected with non contrast CT scan had significantly lower median times to groin puncture,
nearly twice shorter compared with perfusion CT scan and MRI (5).
Recently the feasibility of Flat panel detector CT (FPCT) CBV measurement within the angiographic suite has been described in acute stroke patients (6,
7).
This technique requires a steady state of brain parenchyma enhancement during whole acquisition (8) (Fig 1-2).
This steady state is a major parameter to ensure the reliability of CBV assessment.
CBV measurement using C-Arm CT is not an everyday tool,
and the acquisition technique is not yet codified.
Various protocols have been described,
using either venous or arterial injections.
The reality of the steady state during acquisition is usually assumed but not verified.
The purpose of this study is to determine a standard injection protocol ensuring enough steady state time for a reliable CBV measurement.