Comparison of sequential multi-detector CT and cone-beam CT perfusion maps in 39 subjects with anterior circulation acute ischemic stroke due to a large vessel occlusion.

Abstract

Purpose: The critical time between stroke onset and treatment was targeted for reduction by integrating physiological imaging into the angiography suite, potentially improving clinical outcomes. The evaluation was conducted to compare C-Arm cone beam CT perfusion (CBCTP) with multi-detector CT perfusion (MDCTP) in patients with acute ischemic stroke (AIS).

Approach: Thirty-nine patients with anterior circulation AIS underwent both MDCTP and CBCTP. Imaging results were compared using an in-house algorithm for CBCTP map generation and RAPID for post-processing. Blinded neuroradiologists assessed images for quality, diagnostic utility, and treatment decision support, with non-inferiority analysis (two one-sided tests for equivalence) and inter-reviewer consistency (Cohen's kappa).

Results: The mean time from MDCTP to angiography suite arrival was $50\pm 34\min$ , and that from arrival to the first CBCTP image was $21\pm 8\min$ . Stroke diagnosis accuracies were 96% [93%, 97%] with MDCTP and 91% [90%, 93%] with CBCTP. Cohen's kappa between observers was 0.86 for MDCTP and 0.90 for CBCTP, showing excellent inter-reader consistency. CBCTP's scores for diagnostic utility, mismatch pattern detection, and treatment decisions were noninferior to MDCTP scores (alpha = 0.05) within 20% of the range. MDCTP was slightly superior for image quality and artifact score (1.8 versus 2.3, $p<0.01$ ).

Conclusions: In this small paper, CBCTP was noninferior to MDCTP, potentially saving nearly an hour per patient if they went directly to the angiography suite upon hospital arrival.