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Spiral computed tomography angiography in the assessment of middle cerebral artery occlusive disease
1Department of Medicine, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong.
Insights
Computed tomography angiography (CTA) shows promise for diagnosing middle cerebral artery stenosis and occlusion in acute ischemic stroke patients. This technique is feasible and potentially useful, warranting further investigation into its diagnostic accuracy.
Area of Science:
- Neurology
- Radiology
- Vascular Imaging
Background:
- Intracranial cerebral artery stenosis is a significant cause of ischemic stroke.
- Diagnostic methods for intracranial stenosis require further evaluation for accuracy and feasibility.
- Spiral computed tomography angiography (CTA) has not been previously reported for intracranial stenosis.
Purpose of the Study:
- To investigate the feasibility of CTA in diagnosing intracranial occlusive disease.
- To assess the correlation between CTA and transcranial Doppler (TCD) in middle cerebral artery (MCA) stenosis/occlusion.
- To evaluate CTA's potential role in the diagnosis of acute ischemic stroke secondary to MCA disease.
Main Methods:
- Prospective pilot study involving 10 patients with acute ischemic stroke and suspected MCA stenosis or occlusion.
- Diagnosis and severity assessment of MCA stenosis/occlusion initially performed using transcranial Doppler (TCD).
- Comparison of TCD findings with results obtained from spiral computed tomography angiography (CTA).
Main Results:
- Transcranial Doppler identified seven cases of MCA stenosis and five cases of MCA occlusion.
- CTA confirmed TCD diagnoses in all but one patient with MCA occlusion, likely due to embolus propagation.
- CTA demonstrated feasibility and potential utility in diagnosing MCA occlusive disease.
Conclusions:
- Spiral computed tomography angiography (CTA) is a feasible imaging technique for evaluating middle cerebral artery (MCA) occlusive disease.
- CTA shows potential as a diagnostic tool for intracranial stenosis and occlusion in the context of acute ischemic stroke.
- Further research is necessary to establish the definitive validity, sensitivity, and specificity of CTA for MCA occlusive disease.
Abstract:
There has been no report on the use of spiral computed tomography angiography (CTA) in the investigation of intracranial cerebral artery stenosis. A prospective pilot study was conducted to investigate the feasibility of CTA in the diagnosis of intracranial occlusive disease and its correlation with transcranial Doppler. With transcranial Doppler, 10 patients with acute ischaemic stroke with middle cerebral artery stenosis or occlusion were identified. There were seven middle cerebral artery stenoses and five middle cerebral artery occlusions. The CTA confirmed all diagnoses by transcranial Doppler except in one patient with middle cerebral artery occlusion in whom the embolus had probably propagated. The results showed that CTA is feasible and potentially useful in the diagnosis of middle cerebral artery occlusive disease. Further studies are required to assess its validity, sensitivity, and specificity in the diagnosis of middle cerebral artery occlusive disease.