Dynamic Angiography and Perfusion Imaging Using Flat Detector CT in the Angiography Suite: A Pilot Study in Patients with Acute Middle Cerebral Artery Occlusions

The FD-CT imaging protocol. The application is initiated (1) by 2 bidirectional mask runs. The contrast injection is started (2), and with a delay of 5 seconds, the acquisition of the dynamic fill runs (3) is initiated. Each fill run may be reconstructed as an FD-CTA (A–E), serving as “dynamic” contrast-enhanced angiography (4D CTA). In this example, 5 of 7 fill runs are displayed as MIP images (5-mm section thickness). Early arterial inflow is visible in A. During the arterial phase (B), left MCA occlusion (red arrow) is obvious. The late arterial phase (C) shows developing contrast attenuation increase in the left peripheral MCA branches, while during the venous phase (D), they are well-seen (green arrow). Filling is due to collateral flow. During the late venous phase (E), left peripheral MCA branches are still visible. Matlab software was used to display the parameter maps (F). Scaling is provided (color bar). Each ASPECTS region was represented by a button. By simply clicking on the desired button, the side and region of the assumed perfusion abnormality were recorded. C = caudate; L = lentiform; IC = internal capsule; I = insular ribbon; M1 = anterior MCA cortex; M2 = MCA cortex lateral to insular ribbon; M3 = posterior MCA cortex; M4, M5, and M6 are anterior, lateral, and posterior MCA territories immediately superior to M1, M2, and M3, rostral to the basal ganglia.