Mortimer Alex, Flood Richard, Dunkerton Sophie, McClelland Sarah Beth, Minks David, Crossley Robert, Wareham James, Smith Aubrey, Cox Anthony, Bosnell Rose
Department on Interventional Neuroradiology, North Bristol NHS Trust, Bristol, UK.
Department on Stroke Medicine and Vascular Neurology, North Bristol NHS Trust, Bristol, UK.
Interv Neuroradiol. 2025 Jan 28:15910199251315790. doi: 10.1177/15910199251315790.
Early identification and quantification of core infarct is of importance in stroke management for treatment selection, prognostication, and complication prediction. Non-contrast computed tomography (CT) (NCCT) remains the primary tool, but it suffers from limited sensitivity and inter-rater variability; CT perfusion is inconsistently available and commonly blighted by movement artefact. We assessed the performance of a standardised form of CT angiographic source imaging (CTASI) obtained through addition of a delayed phase at 40 seconds post-contrast injection (DP40) following fast-acquisition CT angiography.
Contrast resolution between ischaemic and normal grey matter (GM) was compared qualitatively and quantitatively to NCCT. Using Alberta Stroke Program Early CT Score (ASPECTS), DP40 low density was compared to NCCT and venous phase CT perfusion source images (CTPSI) and to 24-hour NCCT ASPECTS in patients with timely endovascular recanalisation (Thrombolysis In Cerebral Infarction 2C/3).
Seventy-four patients with a proximal middle cerebral artery or terminal internal carotid artery occlusion were included. The mean attenuation difference between ischaemic and normal GM increased from 4.86+/-3.12 HU (NCCT) to 9.30+/-3.14 HU (DP40) (p < 0.0001). Subjective assessment by two raters revealed that DP40 improved ischaemic tissue conspicuity in 39 to 41 (78-82%) of cases (kappa 0.805, standard error 0.108, 95% confidence interval: 0.593-1.000). The correlation between ASPECTS on baseline imaging and eventual 24-hour ASPECTS improved from R = 0.7197 for NCCT to R = 0.9875 for DP40 (z = 7.89, p < 0.0001). The correlation between DP40 and venous phase CTPSI ASPECTS was 0.9681, p < 0.0001.
DP40 CTASI represent a simple technique for improving detection and estimation of extent of ischaemia over NCCT and show close correlation with surrogate measures of infarct core.
早期识别和量化核心梗死灶对于卒中管理中治疗方案的选择、预后评估及并发症预测至关重要。非增强计算机断层扫描（CT）（NCCT）仍是主要手段，但存在敏感性有限和阅片者间差异的问题；CT灌注检查并非总能进行，且常因运动伪影而受影响。我们评估了一种标准化的CT血管造影源图像（CTASI）的性能，该图像是在快速采集CT血管造影后于注射造影剂40秒时添加延迟期（DP40）获得的。
将缺血性灰质（GM）与正常GM之间的对比分辨率与NCCT进行定性和定量比较。使用阿尔伯塔卒中项目早期CT评分（ASPECTS），将DP40低密度与NCCT、静脉期CT灌注源图像（CTPSI）以及接受及时血管内再通治疗（脑梗死溶栓2C/3）患者的24小时NCCT ASPECTS进行比较。
纳入74例大脑中动脉近端或颈内动脉末端闭塞的患者。缺血性GM与正常GM之间的平均衰减差异从4.86±3.12 HU（NCCT）增加到9.30±3.14 HU（DP40）（p < 0.0001）。两名阅片者的主观评估显示，在39至41例（78 - 82%）病例中，DP40提高了缺血组织的显见度（kappa值0.805，标准误差0.108，95%置信区间：0.593 - 1.000）。基线成像时的ASPECTS与最终24小时ASPECTS之间的相关性从NCCT的R = 0.7197提高到DP40的R = 0.9875（z = 7.89，p < 0.0001）。DP40与静脉期CTPSI ASPECTS之间的相关性为0.9681，p < 0.0001。
DP40 CTASI是一种简单的技术，与NCCT相比可提高缺血的检测和范围估计，且与梗死核心的替代指标密切相关。
