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Dual-phase 16 slice CT angiography in stroke imaging: a poor man's multiphase study?
Nicola Morelli1,2, Eugenia Rota3, Paolo Immovilli4
1Neurology Unit, Guglielmo da Saliceto Hospital, Via Taverna 49, 29121, Piacenza, Italy. nicola.morelli.md@gmail.com.
Acta Neurologica Belgica
|September 10, 2018
Summary
Dual-phase CT angiography (d-CTA) effectively assesses intracranial collaterals in acute stroke patients using lower-speed scanners. Good collateral status on d-CTA predicts favorable outcomes, making it valuable for hospitals with limited technology.
Area of Science:
- Neurology
- Radiology
- Medical Imaging
Background:
- Multiphase CT angiography (CTA) requires high-speed scanners (≥64 slices) for effective collateral assessment in acute stroke.
- Many hospitals lack high-speed multidetector CT (MDCT) scanners, limiting their ability to perform advanced imaging.
- Intracranial collateral status is a crucial predictor of clinical outcome in stroke patients.
Purpose of the Study:
- To evaluate the feasibility and predictive value of dual-phase CTA (d-CTA) for grading intracranial collaterals.
- To assess whether d-CTA on a 16-slice MDCT scanner can predict clinical outcomes in patients with anterior circulation occlusions.
- To determine if d-CTA can serve as a viable alternative to single-phase CTA (s-CTA) in resource-limited settings.
Main Methods:
- A retrospective analysis of 42 acute stroke patients treated with endovascular reperfusion.
- Dual-phase CTA (d-CTA) and single-phase CTA (s-CTA) were performed using a 16-slice MDCT scanner with biphasic injection.
- Univariate and multivariate logistic regression analyses were used to identify independent predictors of favorable functional outcome at 3 months.
Main Results:
- Good collateral circulation status on d-CTA was significantly associated with lower median NIHSS scores at 24 hours (p=0.03) and discharge (p=0.04).
- Logistic regression identified age (OR 0.95, p=0.03) and good collateral status on d-CTA (OR 4.3, p<0.01) as independent predictors of favorable 3-month outcome.
- Single-phase CTA (s-CTA) was not found to be a significant predictor of clinical outcome.
Conclusions:
- Dual-phase CTA (d-CTA) is a valuable tool for assessing intracranial collaterals and predicting clinical outcomes in acute stroke patients.
- The d-CTA protocol adapted for lower-speed MDCT scanners offers a practical solution for hospitals without advanced imaging technology.
- Collateral assessment using d-CTA can guide treatment decisions and improve patient management in acute ischemic stroke.