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Cardiac computed tomography (CT) scanning is an advanced cardiac imaging technique that utilizes CT technology, with or without intravenous (IV) contrast, to produce accurate cross-sectional virtual slices of specific areas of the heart, coronary circulation, and major blood vessels such as the aorta, pulmonary veins, and arteries. The computer processes these slices to generate three-dimensional images. Multidetector CT (MDCT) is a rapid form of CT scanning that captures multiple slices...
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Calcium-Scoring CT ScanA calcium-scoring CT scan, also known as coronary artery calcium (CAC) scan, detects calcium deposits in the coronary arteries. This test assesses the risk of coronary artery disease (CAD), which can lead to cardiovascular events such as angina, heart failure, and sudden cardiac arrest.A calcium-scoring CT scan is generally recommended for individuals at intermediate risk of CAD without symptoms. It includes:Men aged 40-75 and women aged 50-75: Especially those with a...
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Diagnosing acute coronary syndrome or ACS begins with a thorough patient history. Notable symptoms include central, crushing chest pain radiating to the left arm, neck, jaw, or back, along with shortness of breath, sweating (diaphoresis), nausea, vomiting, dizziness, and palpitations.It is crucial to note any history of cardiac illnesses and assess risk factors, including age, gender, smoking, hypertension, diabetes, hyperlipidemia, and a sedentary lifestyle.During physical examination, vital...
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Optimal Multiphase Computed Tomographic Angiography-based Infarct Core Estimations for Acute Ischemic Stroke.

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Multiphase computed tomographic angiography (mCTA) improves prediction of small infarct cores for endovascular treatment (EVT) selection. Combining mCTA collateral assessment with ASPECTS scores enhances patient selection for EVT, improving inter-rater reliability.

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Area of Science:

  • Neurology
  • Radiology
  • Medical Imaging

Background:

  • Accurate infarct core volume prediction is crucial for endovascular treatment (EVT) in ischemic stroke.
  • Multiphase computed tomographic angiography (mCTA) offers potential parameters for infarct core assessment.
  • Current methods for patient selection may benefit from improved predictive accuracy.

Purpose of the Study:

  • To evaluate the efficacy of different computed tomographic angiography (CTA) parameters and the Alberta Stroke Program Early CT Score (ASPECTS) in predicting infarct core volumes.
  • To compare the predictive capabilities of single-phase CTA collaterals (sCTAc), multiphase CTA collaterals (mCTAc), ASPECTS, and their combined interpretation for EVT patient selection.
  • To assess the inter-rater reliability of these methods in predicting infarct core thresholds.

Main Methods:

  • Analysis of 142 consecutive ischemic stroke patients who underwent both mCTA and stroke magnetic resonance imaging (MRI).
  • Comparison of CTA-based collateral scores (sCTAc, mCTAc) and ASPECTS for predicting infarct core volumes (<31 ml, <70 ml, ≥100 ml).
  • Evaluation of combined interpretation of collateral scores and ASPECTS for patient selection and inter-rater reliability.

Main Results:

  • Combined interpretation of collateral scores and ASPECTS significantly improved prediction of smaller infarct volumes (<31 ml) compared to ASPECTS alone.
  • Optimal predictive capability and inter-rater reliability were achieved with sCTAc (3-5) and ASPECTS (6-10).
  • For larger infarct volumes (≥100 ml), sCTAc (0-2) and mCTAc (0-2) performed comparably to ASPECTS (0-5) with better inter-rater reliability.

Conclusions:

  • mCTA parameters, particularly collateral assessment, enhance the accuracy of predicting lower infarct core volumes for EVT.
  • The combined use of CTA collaterals and ASPECTS improves patient selection for EVT, especially for smaller infarcts.
  • Excluding patients with large infarct cores using mCTA can enhance inter-rater reliability in EVT candidate selection.