Kunz Wolfgang G, Sommer Wieland H, Havla Lukas, Dorn Franziska, Meinel Felix G, Dietrich Olaf, Buchholz Grete, Ertl-Wagner Birgit, Thierfelder Kolja M
Institute for Clinical Radiology, Ludwig-Maximilian-University Hospital Munich, Marchioninistr. 15, 81377, Munich, Germany.
Josef Lissner Laboratory for Biomedical Imaging of the Institute for Clinical Radiology, Ludwig-Maximilian-University Hospital Munich, Munich, Germany.
Eur Radiol. 2017 Jun;27(6):2657-2664. doi: 10.1007/s00330-016-4613-y. Epub 2016 Oct 8.
To determine the detection rate of intracranial vessel occlusions using CT perfusion-based wavelet-transformed angiography (waveletCTA) in acute ischemic stroke patients, in whom single-phase CTA (spCTA) failed to detect an occlusion.
Subjects were selected from a cohort of 791 consecutive patients who underwent multiparametric CT including whole-brain CT perfusion. Inclusion criteria were (1) significant cerebral blood flow (CBF) deficit, (2) no evidence of vessel occlusion on spCTA and (3) follow-up-confirmed acute ischemic infarction. waveletCTA was independently analysed by two readers regarding presence and location of vessel occlusions. Logistic regression analysis was performed to identify predictors of waveletCTA-detected occlusions.
Fifty-nine patients fulfilled the inclusion criteria. Overall, an occlusion was identified using waveletCTA in 31 (52.5 %) patients with negative spCTA. Out of 47 patients with middle cerebral artery infarction, 27 occlusions (57.4 %) were detected by waveletCTA, mainly located in the M2 (15) and M3 segments (8). The presence of waveletCTA-detected occlusions was associated with larger CBF deficit volumes (odds ratio (OR) = 1.335, p = 0.010) and shorter times from symptom onset (OR = 0.306, p = 0.041).
waveletCTA is able to detect spCTA occult vessel occlusions in about half of acute ischemic stroke patients and may potentially identify more patients eligible for endovascular therapy.
• waveletCTA is able to detect spCTA occult vessel occlusions in stroke patients. • waveletCTA-detected occlusions are associated with larger cerebral blood flow deficits. • waveletCTA has the potential to identify more patients eligible for endovascular therapy. • waveletCTA implies neither additional radiation exposure nor extra contrast agent.
确定在单相CT血管造影（spCTA）未能检测到闭塞的急性缺血性中风患者中，使用基于CT灌注的小波变换血管造影（小波CTA）检测颅内血管闭塞的比率。
从791例接受包括全脑CT灌注在内的多参数CT检查的连续患者队列中选取研究对象。纳入标准为：（1）显著的脑血流量（CBF）不足；（2）spCTA未发现血管闭塞的证据；（3）随访证实为急性缺血性梗死。两名阅片者独立分析小波CTA以确定血管闭塞的存在情况和位置。进行逻辑回归分析以确定小波CTA检测到的闭塞的预测因素。
59例患者符合纳入标准。总体而言，在31例（52.5%）spCTA结果为阴性的患者中，通过小波CTA检测到了血管闭塞。在47例大脑中动脉梗死患者中，小波CTA检测到27例闭塞（57.4%），主要位于M2段（15例）和M3段（8例）。小波CTA检测到的闭塞与更大的CBF缺损体积相关（优势比（OR）=1.335，p=0.010），且与症状发作后的时间较短相关（OR=0.306，p=0.041）。
小波CTA能够在约一半的急性缺血性中风患者中检测到spCTA隐匿的血管闭塞，并且可能潜在地识别出更多适合血管内治疗的患者。
• 小波CTA能够检测中风患者中spCTA隐匿的血管闭塞。• 小波CTA检测到的闭塞与更大的脑血流量缺损相关。• 小波CTA有潜力识别出更多适合血管内治疗的患者。• 小波CTA既不意味着额外的辐射暴露，也不意味着额外使用造影剂。
