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Thrombus length estimation in acute ischemic stroke: a potential role for delayed contrast enhanced CT
Alex M Mortimer1, David H Little, Kishore S Minhas
1Department of Neuroradiology, Frenchay Hospital, Bristol, UK.
Journal of Neurointerventional Surgery
|May 25, 2013
Summary
CT angiography often overestimates thrombus length in acute ischemic stroke. Contrast-enhanced CT (CECT) provides a reliable method for accurate thrombus length estimation, improving treatment planning.
Area of Science:
- Neuroradiology
- Neuroimaging
- Cerebrovascular Diseases
Background:
- Thrombus length is critical for predicting recanalization in acute ischemic stroke treated with intravenous thrombolysis.
- Quantifying thrombus length using non-contrast CT (NCCT) or CT angiography (CTA) presents challenges due to limitations in visualizing the entire thrombus.
- Contrast-enhanced CT (CECT) can estimate infarct core, but its utility for thrombus length assessment requires investigation.
Purpose of the Study:
- To evaluate the reliability of thrombus length estimation using CT angiography (CTA) and contrast-enhanced CT (CECT) in patients with hyperacute ischemic stroke.
- To compare thrombus length measurements obtained from NCCT, CTA, and CECT.
- To determine if CECT provides a more accurate assessment of thrombus length than CTA.
Main Methods:
- A study of 15 consecutive patients (mean age 81) with internal carotid artery or middle cerebral artery occlusions.
- Patients underwent NCCT, CTA (bolus tracked technique), and CECT (80s post-CTA injection).
- Three radiologists assessed thrombus length on NCCT, CTA, and CECT, with inter-rater reliability assessed.
Main Results:
- CTA significantly overestimated thrombus length compared to both NCCT (p<0.001) and CECT (p<0.001).
- A good correlation was found between NCCT and CECT measurements (Pearson's r=0.90, p<0.001).
- High inter-rater reliability was observed for both NCCT (ICC=0.95) and CECT (ICC=0.98) assessments.
Conclusions:
- CT angiography frequently overestimates thrombus length because it fails to delineate the distal thrombus extent.
- Contrast-enhanced CT (CECT) offers a reliable method for accurately estimating thrombus length in acute ischemic stroke.
- CECT can overcome the limitations of CTA in thrombus length assessment, aiding in treatment decisions.
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