Seminars in Ultrasound, CT and MRI
Volume 27, Issue 3 , Pages 221-242 , June 2006

Computed Tomographic Angiography in Stroke Imaging: Fundamental Principles, Pathologic Findings, and Common Pitfalls

  • Rajiv Gupta

      Affiliations

    • Department of Radiology, Massachusetts General Hospital, Boston, MA
    • Corresponding Author InformationAddress reprint requests to: Rajiv Gupta, PhD, MD, Dept. of Radiology, 55 Fruit St., FND-216, Massachusetts General Hospital, Boston, MA 02114
    • ,
  • Stephen E. Jones

      Affiliations

    • Department of Radiology, Massachusetts General Hospital, Boston, MA
    • ,
  • Eline A.Q. Mooyaart

      Affiliations

    • Leiden University Medical Center, The Netherlands
    • ,
  • Stuart R. Pomerantz

      Affiliations

    • Department of Radiology, Massachusetts General Hospital, Boston, MA

References 

  1. In:  Ropper AH ,  McGraw H editor. Adams and Victor’s Principals of Neurology. ed 8. New York: McGraw Hill; 2005;p. 660–746
  2. American Heart Association . Heart Disease and Stroke Statistics—2003 Update. Dallas, TX: American Heart Association; 2002;
  3. Sudlow CL , Warlow CP . Comparable studies of the incidence of stroke and its pathological types (results from an inter-national collaboration) . Stroke . 1997;28:491–499
  4. White H , Boden-Albala B , Wang C , et al.  Ischemic stroke subtype incidence among whites, blacks, and Hispanics (the Northern Manhattan Study) . Circulation . 2005;111:1327–1331
  5. Leys D , Bandu L , Hénon H , et al.  Clinical outcome in 287 consecutive young adults (15 to 45 years) with ischemic stroke . Neurology . 2002;59:26–33
  6. Lev MH , Farkas J , Rodriguez VR , et al.  CT angiography in the rapid triage of patients with hyperacute stroke to intraarterial thrombolysis (accuracy in the detection of large vessel thrombus) . J Comput Assist Tomogr . 2001;25:520–528
  7. Schuknecht B . Latest techniques in head and neck CT angiography . Neuroradiology . 2004;46:208–213
  8. Becker CR , Hong C , Knez A , et al.  Optimal contrast application for cardiac 4-detector-row computed tomography . Invest Radiol . 2003;38:690–694
  9. Claves JL , Wise SW , Hopper KD , et al.  Evaluation of contrast densities in the diagnosis of carotid stenosis by CT angiography . AJR Am J Roentgenol . 1997;169:569–573
  10. Bae KT , Heiken JP , Brink JA . Aortic and hepatic peak enhancement at CT (effect of contrast medium injection rate—pharmacokinetic analysis and experimental porcine model) . Radiology . 1998;206:455–464
  11. Bae KT , Heiken JP , Brink JA . Aortic and hepatic contrast medium enhancement at CT. Part I. Prediction with a computer model . Radiology . 1998;207:647–655
  12. Bae KT . Peak contrast enhancement in CT and MR angiography: when does it occur and why? Pharmacokinetic study in a porcine model . Radiology . 2003;227:809–816
  13. Fleischmann D , Hittmair K . Mathematical analysis of arterial enhancement and optimization of bolus geometry for CT angiography using the discrete fourier transform . J Comput Assist Tomogr . 1999;23:474–484
  14. Han JK , Kim AY , Lee KY , et al.  Factors influencing vascular and hepatic enhancement at CT (experimental study on injection protocol using a canine model) . J Comput Assist Tomogr . 2000;24(3):400–406
  15. Bluemke DA , Chambers TP . Spiral CT angiography (an alternative to conventional angiography) . Radiology . 1995;195:317–319
  16. Cademartiri F , van der Lugt A , Luccichenti G , et al.  Parameters affecting bolus geometry in CTA (a review) . J Comput Assist Tomogr . 2002;26:598–607
  17. Brink JA . Use of high concentration contrast media (HCCM) (principles and rationale—body CT) . Eur J Radiol . 2003;45:53–58
  18. Fleischmann D . Use of high concentration contrast media (principles and rationale—vascular district) . Eur J Radiol . 2003;45:88–93
  19. Awai K , Hiraishi K , Hori S . Effect of contrast material injection duration and rate on aortic peak time and peak enhancement at dynamic CT involving injection protocol with dose tailored to patient weight . Radiology . 2004;230:142–150
  20. Rubin GD , Walker PJ , Dake MD , et al.  Three-dimensional spiral computed tomographic angiography (an alternative imaging modality for the abdominal aorta and its branches) . J Vasc Surg . 1993;18:656–665
  21. Rubin GD , Paik DS , Johnston PC , et al.  Measurement of the aorta and its branches with helical CT . Radiology . 1998;206:823–829
  22. Schoellnast H , Tillich M , Deutschmann HA , et al.  Abdominal multidetector row computed tomography (reduction of cost and contrast material dose using saline flush) . J Comput Assist Tomogr . 2003;27:847–853
  23. Schoellnast H , Tillich M , Deutschmann MJ , et al.  Aortoiliac enhancement during computed tomography angiography with reduced contrast material dose and saline solution flush (influence on magnitude and uniformity of the contrast column) . Invest Radiol . 2004;39:20–26
  24. Bader TR , Prokesch RW , Grabenwoger F . Timing of the hepatic arterial phase during contrast-enhanced computed tomography of the liver (assessment of normal values in 25 volunteers) . Invest Radiol . 2000;35:486–492
  25. Hopper KD , Mosher TJ , Kasales CJ , et al.  Thoracic spiral CT (delivery of contrast material pushed with injectable saline solution in a power injector) . Radiology . 1997;205:269–271
  26. Haage P , Schmitz-Rode T , Hubner D , et al.  Reduction of contrast material dose and artifacts by a saline flush using a double power injector in helical CT of the thorax . AJR Am J Roentgenol . 2000;174:1049–1053
  27. Cademartiri F , Nieman K , van der Lugt A , et al.  Intravenous contrast material administration at 16-detector row helical CT coronary angiography (test bolus versus bolus-tracking technique) . Radiology . 2004;233:817–823
  28. Kalra MK , Maher MM , Toth TL , et al.  Strategies for CT radiation dose optimization . Radiology . 2004;230(3):619–628
  29. McCollough CH , Schueler BA . Calculation of effective dose . Med Phys . 2000;27:828–837
  30. Kalender WA . Computed Tomography (Fundamentals, System Technology, Image Quality, Applications) . Erlangen: Publicis Corporate Publishing; 2005;
  31. Flohr T , Ohnesorge B , Schaller S . Design, Technique, and Future Perspective of Multislice CT Scanners . In:  Reiser MF ,  Takahashi M ,  Modic M editor. Multislice CT . Berlin, Heidelberg: Springer-Verlag; 2004;p. 3–16
  32. Kalra MK , Maher MM , Rizzo S , et al.  Radiation exposure and projected risks with multidetector-row computed tomography scanning (clinical strategies and technologic developments for dose reduction) . J Comput Assist Tomogr . 2004;28:S46–S49
  33. Rovira A , Grive E , Rovira A , et al.  Distribution territories and causative mechanisms of ischemic stroke . Eur Radiol . 2005;15:416–426
  34. Bartlett ES , Walters TD , Symons SP , et al.  Quantification of carotid stenosis on CT angiography . AJNR Am J Neuroradiol . 2006;27:13–19
  35. Caplan LR , Wityk RJ , Glass TA , et al.  New England Medical Center Posterior Circulation registry . Ann Neurol . 2004;56:389–398
  36. Kumral E , Bayulkem G , Evyapan D , et al.  Spectrum of anterior cerebral artery territory infarction (clinical and MRI findings) . Eur J Neurol . 2002;9:615–624
  37. Oelerich M , Stogbauer F , Kurlemann G , et al.  Craniocervical artery dissection (MR imaging and MR angiographic findings) . Eur Radiol . 1999;9:1385–1391
  38. Pelkonen O , Tikkakoski T , Pyhtinen J , et al.  Cerebral CT and MRI findings in cervicocephalic artery dissection . Acta Radiol . 2004;45:259–265
  39. Nunez DB , Torres-Leon M , Munera F . Vascular injuries of the neck and thoracic inlet (helical CT-angiographic correlation) . Radiographics . 2004;24:1087–1098
  40. Smith ER , Scott RM . Surgical management of moyamoya syndrome . Skull Base . 2005;15:15–26
  41. Gonzales-de Larrazabal C , Bhoey HK , Lim MCL . Use of multidetector CT in the diagnosis of moyamoya disease . Medicamundi . 2005;49:3–11
  42. Zabramski JM . Vasospasm after subarachnoid hemorrhage. In:  Bederson JB editors. Subarachnoid Hemorrhage (Pathophysiology and Management.). Park Ridge, IL: American Association of Neurological Surgeons; 1997;p. 127–156
  43. Dumont AS , Dumont RJ , Chow MM , et al.  Cerebral vasospasm after subarachnoid hemorrhage (putative role of inflammation) . Neurosurgery . 2003;53:123–133
  44. Anderson GB , Ashford R , Steinke DE , et al.  CT angiography for the detection of cerebral vasospasm in patients with acute subarachnoid hemorrhage . Am J Neuroradiol . 2000;21:1011–1015
  45. Bousser MG . Cerebral venous thrombosis (diagnosis and management) . J Neurol . 2000;247:252–258
  46. Grossman GI , Youssam DM . In: Neuroradiology (The Requisites). ed 2. Philadelphia: Mosby; 2003;
  47. Osborn AG , Blaser SI , Salzman KL . Pocket Radiologist (Brain Top 100 Diagnoses) . Philadelphia, PA: W.B. Saunders Co.; 2003;
  48. Ozsvath RR , Casey SO , Lustrin ES , et al.  Cerebral venography (comparison of CT and MR projection venography) . AJR Am J Roentgenol . 1997;169:1699–1707
  49. Karthikeyan D , Vijay S , Kumar T , et al.  Cerebral venous thrombosis—spectrum of CT findings . Ind J Radiol Imag . 2004;14(2):129–137
  50. Casey S , Alberico R , Patel M , et al.  Cerebral CT venography . Radiology . 1996;198:163–170
  51. van Gijn J , Rinkel GJE . Subarachnoid haemorrhage (diagnosis, causes and management) . Brain . 2001;124:249–278
  52. Suarez JI , Tarr RW , Selman WR . Aneurysmal subarachnoid hemorrhage . N Engl J Med . 2006;354:387–396
  53. Parlea L , Fahrig R , Holdsworth DW , et al.   An analysis of the geometry of saccular intracranial aneurysms. AJNR Am J Neuroradiol. 1999;20:1079–1089
  54. Hoh BL , Cheung AC , Rabinov JD , et al.  Results of a prospective protocol of computed tomographic angiography in place of catheter angiography as the only diagnostic and pretreatment planning study for cerebral aneurysms by a combined neurovascular team . Neurosurgery . 2004;54:1329–1340
  55. Al-Shahi R , Warlow C . A systematic review of the frequency and prognosis of arteriovenous malformations of the brain in adults . Brain . 2001;124:1900–1926
  56. Barrett JF , Keat N . Artifacts in CT (recognition and avoidance) . Radiographics . 2004;24:1679–1691
  57. Brown JH , Lustrin ES , Lev MH , et al.  Reduction of aneurysm clip artifacts on CT angiograms (a technical note) . AJNR Am J Neuroradiol . 1999;20:694–696
  58. Colbeth RE , Boyce SJ , Fong R , et al.   40 × 30 cm flat panel imager for angiography, R&F, and cone-beam CT applications. Proc SPIE Med Imag. 2001;Vol. 4320: San Diego, CA,
  59. Roos G , Colbeth RE , Mollov I , et al.   Multiple gain ranging readout method to extend the dynamic range of amorphous silicon flat panel imagers. Proc SPIE Med Imag. 2004;Vol. 5368: San Diego, CA,
  60. Grasruck M , Suess C , Steirstorfer K , et al.   Evaluation of Image quality and dose on a flat-panel CT scanner. Proc SPIE Med Imag. 2005;Vol. 5745: San Diego, CA,
  61. Gupta R , Grasruck M , Suess C , et al.   Ultra-high resolution flat-panel volume CT (fundamental principles, design architecture and system characterization). Eur Radiol. 2006; (in press)
  62. Gupta R , Bartling S , Basu S , et al.  Experimental flat-panel high-spatial-resolution volume CT of the temporal bone . AJNR Am J Neuroradiol . 2004;25:1417–1424
  63. Popescu S , Steirstorfer K , Flohr T , et al.   Design and evaluation of a prototype volume CT scanner. Proc SPIE Med Imag. 2005;Vol. 5745: San Diego, CA,
  64. Bartling S, Stierstorfer K, Grasruck M, et al: Assessment of middle and inner ear implants using ultra-high resolution flat-panel CT. The Radiological Society of North America 90th Scientific Assembly and Annual Meeting (RSNA-2004)
  65. Gupta R, Grasruck M, Stierstorfer K, et al: Anatomy of a ultra-high resolution flat-panel CT: a pictorial introduction to fundamental principles and technology. The Radiological Society of North America 90th Scientific Assembly and Annual Meeting (RSNA-2004)
  66. Gupta R, Stierstorfer K, Popescu S, et al: Temporal bone imaging using a large field-of-view, rotating flat-panel CT scanner. The Radiological Society of North America 89th Scientific Assembly and Annual Meeting (RSNA-2003)
  67. Stierstorfer K, Flohr Th, Gupta R, et al.Performance evaluation of a flat-panel CT system. The Radiological Society of North America 89th Scientific Assembly and Annual Meeting (RSNA-2003)
  68. Gupta R, Bartling S, Ross WR, et al: Benefits of ultra-high spatial resolution in head CT: experimental assessment. The Radiological Society of North America 88th Scientific Assembly and Annual Meeting (RSNA-2002)
  69. Bartling S, Shukla V, Hayman A, et al: Ultra-high resolution axial and coronal anatomy of temporal bone. J Comp-Assist Tomogr (in press)
  70. Rodt T , Bartling S , Gupta R , et al.  Optimization of temporal bone CT and 3D-imaging (an experimental approach) . Comp Aid Surg . 2002;7:107–126
  71. Freiherr G . CT vendors press quest for more speed, slices. Diagnostic Imaging Vol Technol Advis. 2001;25–26

PII: S0887-2171(06)00025-4

doi: 10.1053/j.sult.2006.02.007

Seminars in Ultrasound, CT and MRI
Volume 27, Issue 3 , Pages 221-242 , June 2006

Article Tools

* Image Usage & Resolution