Stroke Evaluation in the Interventional Suite Using Dual-Layer Detector Cone-Beam CT: a First-in-human Prospective...

Area of Science:

• Neuroradiology
• Medical Imaging
• Stroke Management

Background:

• Cone-beam CT (CBCT) in interventional suites offers potential to reduce door-to-thrombectomy times.
• Limitations of CBCT include artifacts and poor gray-white matter differentiation, impacting diagnostic accuracy.
• This study evaluated dual-layer CBCT as an alternative to conventional CT for acute stroke imaging.

Purpose of the Study:

• To compare the diagnostic performance of non-contrast brain dual-layer CBCT with standard CT in stroke patients.
• To assess hemorrhage detection accuracy and ASPECTS scoring using dual-layer CBCT.
• To evaluate subjective and objective image quality differences between dual-layer CBCT and CT.

Main Methods:

• Prospective single-center study of consecutive stroke patients (ischemic or hemorrhagic).
• Neuroradiologists assessed hemorrhage detection and ASPECTS accuracy on dual-layer CBCT (75 keV monoenergetic images) versus CT.
• Subjective image quality (Likert scales) and objective metrics were analyzed; non-inferiority was statistically determined.

Main Results:

• 27 participants included in the hyperacute/acute stroke phase.
• Majority analysis confirmed 100% hemorrhage detection accuracy (lower CI 86%) and 90% ASPECTS accuracy (lower CI 85%).
• Sensitivity for hemorrhage detection was 66%, specificity 97%; however, subjective and objective image quality were inferior to CT.

Conclusions:

• Dual-layer CBCT demonstrated non-inferior accuracy for hemorrhage detection and ASPECTS scoring compared to CT in a small cohort.
• Despite lower image quality, dual-layer CBCT may be a viable tool for stroke evaluation within the interventional suite.
• Further research is warranted to optimize CBCT protocols for stroke imaging.