Related Experiment Video
Updated: May 28, 2026
Integrated Photoacoustic, Ultrasound, and Angiographic Tomography (PAUSAT) for NonInvasive Whole-Brain Imaging of Ischemic Stroke
Published on: June 2, 2023
Angiographic reconstructions from whole-brain perfusion CT for the detection of large vessel occlusion in acute
Andreas M J Frölich1, Marios N Psychogios, Ernst Klotz
1University Medicine Göttingen, Department of Neuroradiology, Robert-Koch-Str 40, 37075 Göttingen, Germany. andreas.froelich@med.uni-goettingen.de
Insights
Four-dimensional CT angiography (4D CTA) effectively detects intracranial large vessel occlusion in stroke patients. Combining 4D CTA with perfusion maps significantly improves accuracy for guiding endovascular therapy decisions.
Area of Science:
- Radiology
- Neurology
- Medical Imaging
Background:
- Multimodal CT imaging, including CT angiography (CTA) and volume perfusion CT, is vital for acute stroke assessment.
- Identifying intracranial large vessel occlusion is critical for treatment decisions and endovascular therapy eligibility.
Purpose of the Study:
- To evaluate the diagnostic accuracy of angiographic thin-slice volume perfusion CT reconstructions for detecting intracranial large vessel occlusion in stroke patients.
Main Methods:
- Fifty-eight acute stroke patients underwent nonenhanced CT, CTA, and volume perfusion CT on a 128-slice scanner.
- Conventional CTA and 4-dimensional CTA (4D CTA) reconstructions were generated from CTA and volume perfusion data.
- Intracranial vessel occlusions were assessed, and ischemic lesion distribution was analyzed on perfusion maps.
Main Results:
- CTA identified 33 occlusions in 30 patients (52%).
- 4D CTA detected 28 occlusions with 85% sensitivity and 97% positive predictive value.
- Combining 4D CTA with perfusion map analysis yielded 94% sensitivity and 100% positive predictive value.
Conclusions:
- Angiographic volume perfusion CT reconstructions are a feasible tool for detecting intracranial arterial occlusion in acute stroke.
- Simultaneous assessment of perfusion parameter maps enhances the sensitivity of 4D CTA for detecting occlusions.
- Further research is needed to compare time-resolved 4D CTA with single-phase CTA for diagnostic information.
Background And Purpose:
Multimodal CT imaging consisting of nonenhanced CT, CT angiography (CTA), and whole-brain volume perfusion CT is increasingly used for acute stroke imaging. In these patients, presence of vessel occlusion is an important factor governing treatment decisions and possible endovascular therapy. The goal of this study was to assess the value and diagnostic accuracy of angiographic thin-slice volume perfusion CT reconstructions for the detection of intracranial large vessel occlusion in patients with stroke.
Methods:
Fifty-eight patients with acute stroke received nonenhanced CT, CTA, and volume perfusion CT. All images were obtained on a 128-slice multidetector CT scanner. CT angiographic axial and coronal maximum-intensity projections of the head were reconstructed from conventional CTA and from the peak arterial scan of the volume perfusion CT data set (4-dimensional CTA). Images were assessed for the presence of intracranial vessel occlusion. The distribution of ischemic lesions was analyzed on perfusion parameter maps.
Results:
On CTA, 30 patients (52%) had a total of 33 occluded intracranial artery segments. Twenty-eight occlusions were identified on 4-dimensional CTA, resulting in an 85% sensitivity with a positive predictive value of 97%. When combined with an analysis of the perfusion parameter maps, sensitivity of 4-dimensional CTA increased to 94% with a positive predictive value of 100%.
Conclusions:
In acute stroke, angiographic volume perfusion CT reconstructions may be a feasible option to detect intracranial arterial occlusion and evaluate patients for endovascular therapy. Sensitivity for detection of intracranial arterial occlusion can be increased by simultaneous assessment of perfusion parameter maps. Future studies should assess whether time-resolved 4-dimensional CTA may offer additional diagnostically relevant information compared with single-phase CTA.
