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. 2022 Jan;32(1):281-289.
doi: 10.1007/s00330-021-08084-5. Epub 2021 Jun 15.

Variability of acquisition phase of computed tomography angiography in acute ischemic stroke in a real-world scenario

Johannes A R Pfaff  1   2 , Bianka Füssel  3 , Marcial E Harlan  3 , Alexander Hubert  3 , Martin Bendszus  3
Affiliations

Variability of acquisition phase of computed tomography angiography in acute ischemic stroke in a real-world scenario

Johannes A R Pfaff et al. Eur Radiol. 2022 Jan.

Abstract

Objectives: The informative value of computed tomography angiography (CTA) depends on the contrast phase in the vessels which may differ depending on the level of local expertise.

Methods: We retrospectively measured vessel contrast density from CTA scans in patients presenting with acute ischemic stroke to a comprehensive stroke center (CSC) or to one of eight primary stroke centers (PSC). CTAs were classified into arterial or venous phases as well as into 1 of 5 phases (early arterial, peak arterial, equilibrium, peak venous, and late venous).

Results: Overall, n = 871 CTAs (CSC: n = 431 (49.5%); PSC: n = 440 (50.5%)) were included in the final analysis. A higher venous than arterial contrast density at the level of the circle of Willis was only rarely observed (overall n = 13 (1.5%); CSC: n = 3/431 (0.7%); PCS: n = 10/440 (2.3%); p = 0.09). CTAs acquired in the CSC showed more often an early arterial contrast phase (CSC: n = 371 (86.1%); PSC: n = 153 (34.8%), p < 0.01). Equilibrium contrast phase, i.e., a slightly stronger arterial contrast with clear venous contrast filling, was more frequent in CTAs from the PSCs (CSC: n = 6 (1.4%); PSC: n = 47 (10.7%); p < 0.01).

Conclusions: Despite different technical equipment and examination protocols, the overall number of CTAs with venous contrast was low and did not differ between the CSC and the PCSs. Differences between the further differentiated contrast phases indicate potential for further improvement of CTA acquisition protocols.

Key points: • Despite different technical equipment and examination protocols in the diagnostic workup of acute ischemic stroke, the total number of computed tomography angiography (CTA) with venous contrast was low (n = 13/871; 1.5%). • A higher venous than arterial contrast density at the level of the circle of Willis was not more frequent in CTAs from the centers with a high patient volume (comprehensive stroke center) compared to the hospital with lower patient volume (primary stroke centers). • Differences between the further differentiated contrast phases indicate that there is potential for further improvement of CTA acquisition protocols.

Keywords: Computed tomography angiography; Contrast media; Stroke.

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Conflict of interest statement

Dr. Pfaff reports personal fees from Stryker outside the submitted work.

Ms. Füssel, Mr. Harlan, and Dr. Hubert have nothing to disclose.

The authors of this manuscript declare relationships with the following companies: Dr. Bendszus reports personal fees from Boehringer Ingelheim, BBraun, Vascular Dynamics, Bayer, Merck, Teva, Grifols, and Springer; grants and personal fees from Novartis and Guerbet; grants from Siemens, Hopp Foundation, from DFG, European Union, and Stryker, outside the submitted work.

Figures

Fig. 1
Fig. 1
Flowchart of included and excluded CTA exams. CSC = comprehensive stroke center; CTA = computed tomography angiography; PSC = primary stroke center
Fig. 2
Fig. 2
Distribution of CTA studies in each phase according to anatomical level in the final analysis (n = 871). *Missing values due to artifacts (e.g., movement, extracorporeal material) that prevent reliable measurement of the HU. CTA = computed tomography angiography
See this image and copyright information in PMC

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