Advantages of Extended Brain Perfusion Computed Tomography 9.6 cm Coverage With Time Resolved Computed Tomography-Angiography in Comparison to Standard Stroke-Computed Tomography

Objective: Recent technical developments have led to an extension of perfusion computed tomography (PCT) scan range to cover nearly the entire brain and to reconstruct time resolved (4d) CT-angiography (CTA) datasets from the PCT data. The purpose of this study was to compare the results of simulated standard PCT and extended PCT with 4d-CTA. Materials and Methods: Extended multimodal stroke CT (unenhanced cranial CT, CTA, and PCT) was acquired in 72 patients. PCT images with a scan coverage of 9.6 cm in the z-axis, simulated 2 cm PCT images at the level of the basal ganglia comparable to standard PCT, standard supra-aortic CTA, and 4d-CTA images were reconstructed. Two readers assessed the PCT image quality as well as pathologic findings in extended and simulated PCT, CTA, and 4d-CTA. The brain was divided into 4 axial segments. The independent samples t test was applied to test differences between data for significance. Results: In 75.0% of all patient exams, pathologic findings were observed in the PCT; these were located in 138 brain segments. In 24.1% of all 54 exams with pathologic PCT findings, the pathology would have been missed on standard PCT. The longer scan coverage resulted in a different final diagnosis in 34.7% of all exams. Quality of the PCT parameter maps was on average very good both for the supratentoric and the infratentoric brain areas (4.28 and 4.18, respectively, on a 5-point scale). In 90% of all exams with pathologic changes in the CTA, these abnormalities were also noted on 4d-CTA. In only 2.8% of all cases, the additional time resolution of the 4d-CTA provided additional information. Conclusion: Extending the scan coverage of PCT from 2 cm to 9.6 cm led to an augmentation of clinically important information in the imaging of acute stroke.