256-Sec(on

Mul(detector CT Angiography of the Caro(d Arteries: Evalua(on of Image Quality, Examina(on Time and Pa(ent Dose
Jason M. Johnson, Marianne S. Reed, Heather N. Burbank and Christopher G. Filippi.
Eastern Neuroradiological Society 23rd Annual Meeting, September 15 - 18, Chatham, MA.

Disclosures
No contributors have any relevant disclosures.

Background
Stroke is currently the second leading cause of death in the world causing 9% of all deaths, ranking aFer heart disease and before cancer. IndicaHons for cerebrovascular disease treatments are changing. Assessment for large vessel occlusion or hemodynamically signicant stenosis is criHcal in treatment decision.

Background
Increased prevalence of >64-slice MDCT. Newer CT scanners oer improved scanning Hmes, detector coverage, resoluHon and radiaHon dose. No systemaHc evaluaHon of image quality has been previously performed on this type of scanner for cerebrovascular evaluaHons.

Background
As scanner speed improves, achieving opHmal Hming of the contrast bolus becomes increasingly dicult. Issue most severe with 100+ detector scanners where the rapid CT acquisiHon can outpace the ow of contrast-opacied blood.

Time Density Curve vs Fixed Delay Scan

TDC oers custom Hming based on individual paHent vascular and cardiac output idiosyncrasies. Technologist dependent. Fixed delay more consistent results.

Early scan

Purpose
To perform a systemaHc evaluaHon of image quality, paHent dose, and examinaHon Hme in a 256-slice scanner.

Methods

Methods
RetrospecHvely review of 256-secHon CTA in 50 consecuHve paHents during a 6-month period w/ acute cerebrovascular event. Scan quality assessed using quanHtaHve assessment of arterial opacicaHon. Occluded segments were evaluated.

Methods
QuanHtaHve assessment performed by measuring a`enuaHon values in 8 extra- cranial caroHd artery segments from the proximal common caroHd artery to the distal cervical internal caroHd artery. Threshold of 150 HU used as an indicator of acceptable opacicaHon.

Methods
Vascular contrast between arteries and veins assessed by measuring a`enuaHon within corresponding venous segments and recording the number of segments in which the a`enuaHon dierence was greater than 50 HU. Results compared with control group of 50 paHents imaged with similar parameters on a 64-secHon CT scanner.

Methods

Methods

Results
64- 256- Chi- sec(on sec(on squared Acceptable 365 381 NS segments (93.4%) (97.2%) (absolute) Acceptable 361 376 segments (92.3%) (95.9%) (contrast) Segments 391 392 NS

NS

Results
64- sec(on DLP 1550 (mGy*cm) 159.8 256- T-test sec(on 1414 p < 0.001 113.9

Scan Hme (s)

Conclusion
256-secHon CTA imaging protocol for caroHd arteries yields high-quality studies in >95% of cases. Scan Hme is modestly improved. Current scanning protocol oered a staHsHcally signicant dose reducHon of approximately 10% over 64-secHon CTA.

Future DirecHon
Can we achieve >95% appropriate segment opacicaHon and achieve:
RadiaHon dose reducHon
80 keV Zdom IteraHve reconstrucHon techniques

Contrast dose reducHon

More accurate bolus tracking

Thanks!