Dual-Layer Detector Cone-Beam CT Angiography for Stroke Assessment: First-in-Human Results (the Next Generation X-ray...

Area of Science:

• Medical Imaging
• Neurology
• Interventional Radiology

Background:

• Intravenous (IV) cone-beam CT angiography (CBCTA) in the angiography suite is a potential alternative to conventional CT angiography (CTA) for stroke patients.
• The primary goal is to reduce door-to-thrombectomy time, a critical factor in stroke treatment.
• However, CBCTA image quality is often limited by artifacts, necessitating further evaluation.

Purpose of the Study:

• To evaluate a prototype dual-layer detector cone-beam CT angiography system against conventional CTA.
• The study aimed to assess image quality, specifically vessel conspicuity and artifact presence, in stroke patients.

Main Methods:

• A prospective, single-center trial included patients with ischemic or hemorrhagic stroke.
• Dual-layer cone-beam CT angiography (70-keV virtual monoenergetic images) and CTA were compared.
• Vessel conspicuity and artifact presence were assessed in eleven matched intracranial arterial segments.

Main Results:

• Twenty-one patients with matched image sets were analyzed.
• Dual-layer cone-beam CT angiography was found to be noninferior to CTA for evaluating intracranial arteries relevant to thrombectomy.
• Artifacts were more common in dual-layer cone-beam CT angiography, but vessel conspicuity was rated noninferior for most segments.

Conclusions:

• Dual-layer detector cone-beam CT angiography virtual monoenergetic images can be noninferior to CTA in stroke patients under specific conditions.
• Limitations include longer scan times and lack of contrast media bolus tracking with the prototype.
• Excluding scans with technical issues, readers deemed dual-layer cone-beam CT angiography noninferior to CTA, despite increased artifacts.