Imaging Technology Could Reduce Stroke Brain Damage

A new study suggests that cone-beam computerized tomography (CT) could decrease delays in stroke patient care by up to an hour, giving them a better chance of making a full recovery.

Researchers at Royal Philips Electronics (Philips; Amsterdam, The Netherlands) and Toronto Western Hospital (TWH; Canada) conducted a study in 20 stroke patients, who were imaged using two unique cone-beam CTs, the first being a non-enhanced Philips XperCT ‘mask’ image, followed by a dual-phase contrast-enhanced XperCT. The dual-phase scans provided volumetric images of both ‘early’ and ‘late’ brain perfusion phases.

Specialized stroke analysis software then performed a subtraction of the two phases to highlight brain regions of delayed filling. The perfusion XperCT imaging acquired in the angiosuite was then evaluated by an experienced interventional neuroradiologist and compared to previously obtained standard CT and CT perfusion (CTP) imaging and follow-up CT imaging 24 hours later. The aim of the study was to evaluate if the cone-beam CT stroke imaging software could reduce the time between symptom onset and revascularization by endovascular mechanical thrombectomy (EVT).

The preliminary results showed that Philips XperCT stroke imaging software could provide the necessary diagnostic information required for treatment decision-making, including detection of ischemic core, collaterals (good, moderate, or bad) and vessel patency. More specifically, core definition compared to baseline CT, CTP, and follow-up CT demonstrated good predictability of the final infarct in cases with complete revascularization in less than 60 minutes after baseline imaging. The study was presented at the 15th Society of Neuro-Interventional Surgery (SNIS) meeting, held during July 2018 in San Francisco (CA, USA).

“Preliminary results from analysis of this cone-beam CT assessment suggests that in the future, eligible patients can bypass CT and go straight to the angiosuite for imaging and treatment,” said lead author Nicole Cancelliere, an interventional clinical research technologist at TWH. “Hospitals can reduce intra-facility transfer delays and hence the time of stroke symptom onset to treatment, which will significantly reduce brain damage and improve outcomes for patients.”

Cone beam CT imaging allows for the accurate detection of hemorrhage, occlusion site, ischemic core, and at-risk tissue, providing complete three-dimensional (3D) views of critical anatomical areas and higher resolution images than other imaging methods.