A Comparison of Flat-Panel CT to Non-Contrast Enhanced CT in the Detection of Intracranial Hemorrhage

                         http://austinpublishinggroup.com/cerebrovascular-disease-stroke/

InAIS, time is critically important: with 1.9 million neurons lost per minute, clinical outcomes after reperfusion correlate with the time spent ischemic. However, the current algorithm of care for AIS patients is to first receive a NECT to identify possible contraindications for IV tPA such as intracranial hemorrhage or large completed brain infarction that would raise the risk for reperfusion hemorrhage in already dead brain tissue. If the patient is demonstrated by CT angiogram to have an intracranial large vessel occlusion, the patient is then transported to the angiography suite for endovascular mechanical embolectomy. Every minute counts in the treatment of AIS, with improved outcomes for less time between onset of the stroke and reperfusion. Each step in the treatment protocol adds time until reperfusion. Angiography suites equipped with FPCT may be able to eliminate the need for imaging studies prior to the transport to the angiography suite. Previous studies have suggested that imaging in the angiography suite (FPCT) could be reliable and comparable to other forms of imaging in assessment of hemorrhage and blood volume. If FPCT is determined to be as sensitive to ICH as standard NECT in this future prospective study, this would allow elimination of NECT imaging as a separate step in the AIS treatment protocol needed for IV tPA administration and embolectomy. If FPCT is comparable to NECT currently used in the early steps of triage of AIS, then it may be possible to decrease delay in treatment of patients and improve overall outcomes. In 2016, Leyhe, et al. performed a 102 patient retrospective study comparing FPCT to NECT and showed FPCT had comparable sensitivity and specificity.

to NECT in the detection of SAH, IVH, and IPH. Building on this study, our group is preparing an international multicenter prospective study collaboration with the Leyhe group, comparing standard stroke management with NECT to one stop management with FPCT in the endovascular suite. In preparation for this collaboration, a study ensuring comparability in a tertiary cerebrovascular referral center in North America is warranted. We aim to assess the detectability of brain hemorrhages using FPCT images specifically in our tertiary hospital’s population.