Multiphase computed tomography angiography derived from computed tomography perfusion data for the differential
Huaiyu Zhang1,2,3, Wenhao Liu3, Zhuang Zhang3,4
1Department of Radiology, Aerospace Center Hospital, Beijing, China.
Insights
Multiphase computed tomography angiography (mCTA) derived from computed tomography perfusion (CTP) data significantly improves the distinction between infundibular dilation (ID) and intracranial aneurysms (IA). This advanced imaging technique offers higher accuracy in differentiating these conditions, aiding clinical decision-making.
Area of Science:
- Neuroradiology
- Medical Imaging
- Vascular Neurology
Background:
- Distinguishing infundibular dilation (ID) from intracranial aneurysms (IA) is crucial due to differing clinical implications and treatment risks.
- Conventional single-phase computed tomography angiography (sCTA) has limitations in visualizing small intracranial artery branches.
- Multiphase computed tomography angiography (mCTA) shows promise for improved identification of vascular structures.
Purpose of the Study:
- To evaluate the efficacy of mCTA, reconstructed from computed tomography perfusion (CTP) data, in differentiating between IA and ID.
- To compare the diagnostic performance of mCTA-derived images with conventional sCTA.
Main Methods:
- Retrospective analysis of 35 patients with suspected IA or ID at the ICA-PComA junction.
- Reconstruction of simulated mCTA from 0.75 mm CTP data for detailed vascular branch assessment.
- Comparative analysis of diagnostic accuracy between sCTA (source and VR images) and mCTA (VR images) by two independent observers.
Main Results:
- mCTA demonstrated higher image reconstruction consistency (K=0.856) compared to sCTA (K=0.648).
- mCTA-derived VR images achieved superior diagnostic performance: 94.7% sensitivity, 87.5% specificity, and 91.4% accuracy in differentiating ID from IA.
- mCTA significantly improved the differentiation of ID from IA compared to sCTA (P=0.005 for VR, P=0.001 for source images).
Conclusions:
- Multiphase computed tomography angiography (mCTA) derived from CTP data enhances the distinction between infundibular dilation and intracranial aneurysms.
- mCTA offers improved diagnostic accuracy over conventional sCTA for evaluating these cerebrovascular findings.
- This advanced imaging approach aids in more precise clinical management decisions.
Background:
As infundibular dilation (ID) is less likely to cause hemorrhage or other clinical sequelae than an intracranial aneurysm (IA) and treating infundibulum itself may put the patient at unnecessary risk for stroke, it is important to distinguish between the ID and IA. Given the limitations of conventional single-phase computed tomography angiography (sCTA) to show small branches of intracranial arteries, the application of multiphase computed tomography angiography (mCTA) for identification seems promising. Our main objective was to evaluate whether using mCTA derived from computed tomography perfusion (CTP) data can improve distinction between IA and ID.
Methods:
A total of 35 patients diagnosed with IA or ID of the posterior communicating artery at its junction with the internal carotid artery junction (ICA-PComA) by sCTA at the 8th Medical Center of Chinese PLA General Hospital between January 2019 and May 2022 were retrospectively selected. All patients underwent CTP. The simulated mCTA was reconstructed from 0.75 mm CTP data for assessment of vascular branches. All data were processed separately by 2 CTA post-processors; 2 observers diagnosed IA and ID by source and volume rendering (VR) images of sCTA and VR images of mCTA, and compared the diagnostic efficacy of source and VR images of sCTA with VR images of mCTA.
Results:
The quality of the reconstructed images was more consistent between the 2 post-processors mCTA (K=0.856) than sCTA (K=0.648). The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of the source image for ID identification were 78.9%, 86.7%, 84.2%, 81.3%, and 80.0% for sCTA, 73.7%, 81.2%, 82.3%, 72.2%, and 77.2% for the VR image of sCTA, and 94.7%, 87.5%, 90.0%, 93.3%, and 91.4% for the VR image based on mCTA, respectively. The net reclassification index (NRI) of mCTA for VR and the source image of sCTA was 0.273 and 0.220, respectively. VR base on mCTA was on average better than VR and the source image of sCTA at differentiating ID from IA (P=0.005 and P=0.001, respectively).
Conclusions:
Compared to sCTA, mCTA is more helpful in improving the distinction of ID and IA.
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