Safety and Speed of a CT Imaging Protocol for the Entire Cerebrovascular Axis During Acute Stroke
Background: Newer generation CT scanners allow for rapid contrast enhanced imaging of the neurovascular axis during acute stroke. Methods: Using a multidetector CT scanner (GE Lightspeed®) we utilized the following imaging protocol in 38 consecutive patients: noncontrast axial CT of the brain (3.5 mm thickness), dynamic CT perfusion, and CT angiography from vertex to aortic arch (110 cc contrast using 18–20 ga IV at 3–4 cc/sec, scan delay 20 sec, 3:1 pitch, slice thickness 1.25 mm, 120 KV, 170 MA.) Results: Serum creatinine was unchanged in all subjects from baseline to hospital discharge; renal failure was not observed (table). One case of contrast extravasation occurred. Total imaging time was 27 ± 16 mins (mean ± SD; range 9–100 mins). Image quality was degraded by motion in 3 studies (7.9%). CTA was 91% sensitive (10 of 11 vessels) and 89% specific (32 of 36 vessels) for carotid disease compared with duplex, MRA and/or conventional angiography. Three of 3 cervical carotid occlusions were correctly identified by CTA. In the 35 patients imaged because of suspected stroke, 4 large vessel occlusions and 11 intracranial stenoses were revealed by review of acute CTA partition images. Conclusions: High-speed, multislice spiral CT scanners allow rapid and safe imaging of the entire cerebrovascular axis in patients with acute stroke and may reduce the need for additional imaging.