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Updated: Nov 8, 2025
Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
Effects of multiphase versus single-phase CT angiography for the detection of distal cerebral vessel occlusion
Gerald M Hefferman1,2, Grayson L Baird3,4, David W Swenson3
1Department of Diagnostic Imaging, Rhode Island Hospital and the Warren Alpert Medical School of Brown University, Providence, RI, USA. ghefferm@gmail.com.
Insights
Multiphase CTA (mCTA) significantly improves sensitivity and reduces reading time for detecting distal cerebral occlusions compared to single-phase CTA (sCTA). This enhanced imaging technique boosts radiologist confidence and accuracy, especially for emergency radiologists.
Area of Science:
- Medical Imaging
- Radiology
- Neuroscience
Background:
- Cerebrovascular occlusions are a leading cause of stroke.
- Accurate and timely detection of these occlusions is crucial for effective treatment.
- Multiphase CT angiography (mCTA) has shown promise in evaluating proximal cerebrovascular disease.
Purpose of the Study:
- To evaluate if the diagnostic benefits of multiphase CT angiography (mCTA) extend to the detection of distal cerebral vasculature occlusions.
- To compare the performance of mCTA versus single-phase CTA (sCTA) in identifying distal cerebrovascular occlusions.
Main Methods:
- A retrospective study involving four radiologists (two neuroradiologists, two emergency radiologists) interpreting 104 patient studies each.
- Each radiologist performed two reading sessions, one with sCTA and one with mCTA, for a total of 832 interpretations.
- Diagnostic accuracy, decision time, and reader confidence were quantitatively assessed and compared between sCTA and mCTA.
Main Results:
- mCTA demonstrated a significant 5.0% increase in sensitivity (91.6% to 96.6%) for detecting distal occlusions.
- Reading time decreased significantly with mCTA (66.7s to 59.6s), and diagnostic confidence increased.
- mCTA eliminated accuracy disparities between neuroradiologists and emergency radiologists, significantly improving sensitivity for emergency radiologists.
Conclusions:
- Multiphase CT angiography (mCTA) enhances sensitivity and negative predictive value for detecting distal cerebral occlusions.
- mCTA leads to reduced reading times and increased diagnostic confidence.
- The use of mCTA standardizes accuracy across different radiologist specialties, improving overall diagnostic performance.
Purpose:
The goal of this study was to determine whether the benefits of multiphase CTA (mCTA) over single-phase CTA (sCTA) for the detection of proximal cerebrovascular occlusions similarly extend to the distal cerebral vasculature.
Methods:
Four attending radiologists, two neuroradiologists and two emergency radiologists, contributed as readers to this retrospective study. For each reader, two sessions were conducted, one using sCTA and one using mCTA. During each session, the reader interpreted the studies of 104 patients who underwent imaging for suspicion of acute ischemic stroke, resulting in a total of 832 interpretations. Changes in diagnostic accuracy, time to render final decision, and reported levels of reader confidence were quantitatively assessed. Further analysis comparing the effects for neuroradiologists versus emergency radiologists was additionally conducted.
Results:
Using mCTA resulted in a significant 5.0% absolute increase in sensitivity (91.6% vs. 96.6%, p = .004) and an insignificant increase in specificity (99.5% vs. 99.7%, p = .39). A significant reduction in reading time (66.7 s vs. 59.6 s, p = .001) and an increase in diagnostic confidence (2.26 vs. 2.58, p < .001) were observed. Using sCTA, higher sensitivity was achieved by neuroradiologists than emergency radiologists (96.0% vs. 86.9%, p = .002); using mCTA resulted in an absolute increase in sensitivity of 0.9% (97.4%, p = .44) for neuroradiologists and 9.6% (96.5%, p < .001) for emergency radiologists, eliminating significant differences between the groups (p = 0.57).
Conclusion:
The use of mCTA results in increased sensitivity and negative predictive value, decreased reading time, increased diagnostic confidence, and the elimination of differences in accuracy between neuroradiologists and emergency radiologists.
