Optimization of the Sequence of Computed Tomography Angiography and Perfusion in One-Stop-Shop CT Imaging for Acute Ischemic Stroke.

Abstract

BACKGROUND In the "one-stop-shop" stroke computed tomography (CT) scanning protocol, CT perfusion (CTP) can be performed either before or after CT angiography (CTA). This study analyzed the effect of different scanning strategies in one-stop-shop stroke CT on CTA image quality and perfusion parameters, aiming to optimize the scanning sequence of CTP and CTA in the one-stop-shop stroke CT protocol. MATERIAL AND METHODS We retrospectively analyzed 115 patients with suspected acute ischemic stroke admitted to our hospital between March and June 2024 and implemented 2 scanning strategies: CTP before CTA (group A, n=51) and CTA before CTP (group B, n=64) using 64-row CT equipment. The differences in CT values of the basilar artery, middle cerebral artery, superior sagittal sinus, and straight sinus, as well as craniocerebral perfusion parameter values and subjective scores of the CTA image quality, were compared between the 2 groups. The difference between venous CT values and the expert consensus-recommended intracranial venous CT value of 150 Hounsfield units (HU) was also compared. RESULTS There were no significant differences in arterial CT values or perfusion parameter values between groups A and B (P>0.0125). However, there was a significant difference in superior sagittal sinus CT values between the groups (P<0.0125). Group A showed more venous contamination (P<0.025), and its superior sagittal sinus CT value was significantly higher than the expert consensus-recommended value of 150 HU (P<0.0125). CONCLUSIONS CTA before CTP had no significant effect on perfusion parameters and was associated with reduced venous contamination. This strategy may serve as a practical alternative in similar 64-slice CT one-stop-shop stroke protocols.