Acute Ischemic Stroke : Infarct Core Estimation On Ct Angiography Source Images Depends On Ct Angiography Protocol Page 7

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NEURORADIOLOGY:
Infarct Core Estimation on CT Angiography Source Images Depends on Protocol
Pulli et al
Figure 2
Figure 2: Axial, A, C, CT angiography source images and, B, D, DW images. Ischemic lesions are outlined in red. A, B, Images in
65-year-old woman with NIHSSS of 16 and right ICA and MCA M1 occlusion imaged with protocol 1. A, CT angiography source
images were acquired 5 hours 20 minutes after symptom onset, and, B, DW images were acquired 20 minutes after the CT
examination. The hypoattenuating area in A (13.1 mL) matches the area of decreased diffusion in B (15.2 mL). C, D, Images in
66-year-old woman with NIHSSS of 16 and right MCA M1 occlusion imaged with protocol 2. C, CT angiography source images
were acquired 4 hours 30 minutes after symptom onset, and, D, DW images were acquired 23 minutes after the CT examina-
tion. The hypoattenuating area in C (159.5 mL) is much larger than the lesion in D (25.3 mL).
Discussion
volumes on CT angiography source im-
consistent
overestimation
compared
In patients with anterior-circulation
ages obtained with our newer, rapid
with DW imaging infarct volumes. In-
acute ischemic stroke who are imaged
CT angiography protocol represented
terrater agreement was worse with the
within 9 hours of symptom onset, the
signifi cantly overestimated volumes of
new protocol than with the old pro-
extent of hypoattenuation on CT an-
restricted diffusion at concurrent DW
tocol. Additionally, atrial fi brillation,
giography source images varies with
imaging, while analysis of images ob-
likely a marker for reduced cardiac
the acquisition protocol. Specifi cally,
tained with our older, slower protocol
output, and shorter time from contrast
we demonstrated that hypoattenuating
revealed reasonable agreement and no
material injection to image acquisition
599
Radiology: Volume 262: Number 2—February 2012
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