Imaging of Acute Stroke

Vaishali Choksi, MD; Douglas J. Quint, MD; Pia Maly-Sundgren, MD; Ellen Hoeffner, MD

Disclosures

Appl Radiol. 2005;34(2):10-19. 

In This Article

CT Angiography

CT angiography (CTA) is best performed on a late-generation multislice CT scanner on which a fast thin-section volumetric spiral examination is performed during a time-optimized bolus of IV contrast material injection with opacification of blood vessels.[9,26] Complete imaging of the craniocervical circulation from the aortic arch through the circle of Willis region can be performed in as little as 20 seconds. High-resolution two-dimensional (2D) (multiplanar reformatted [MPR]) or three-dimensional (3D) reconstructed images presented as maximum intensity projection (MIP) or shaded surface display (SSD) images (Figure 7) can be obtained. CT angiography can be performed at the same time that a dedicated cranial CT examination is performed, as CTA requires relatively little patient cooperation, is a quick examination, and can identify sites of intracranial or extracranial vessel stenosis or occlusion as possible underlying causes of a patient's acute symptoms. It can, therefore, potentially identify the source of an ischemic process to aid in the planning of (sometimes emergent) definitive therapy.

CT angiography of carotid artery disease in a 71-year-old man with acute onset of slurred speech, left facial droop, and left hand clumsiness. No acute intracranial abnormalities had been found on a head CT scan (not shown). The symptoms completely resolved over several hours, consistent with a transient ischemic attack (TIA). Duplex ultrasound indicated no flow in either internal carotid artery (not shown). (A) CT angiography of the neck confirms complete occlusion of the internal carotid arteries bilaterally (arrowheads). (B) CT angiography of the circle of Willis (COW) shows collateral flow with opacification of major COW branches. LA1 = patent A1 segment of the left anterior cerebral artery; ACoA = widely patent anterior communicating artery; LM1 = patent left middle cerebral artery; LPoCoA = patent left posterior communicating artery; LP1 = patent P1 segment of the left posterior cerebral artery; RA1 = patent A1 segment of the right anterior cerebral artery; RM1 = patent right middle cerebral artery; RPoCoA = patent right posterior communicating artery giving rise to the distal right posterior cerebral artery (RPCA); a = absent P1 segment of the right posterior cerebral artery.

CT angiography of carotid artery disease in a 71-year-old man with acute onset of slurred speech, left facial droop, and left hand clumsiness. No acute intracranial abnormalities had been found on a head CT scan (not shown). The symptoms completely resolved over several hours, consistent with a transient ischemic attack (TIA). Duplex ultrasound indicated no flow in either internal carotid artery (not shown). (A) CT angiography of the neck confirms complete occlusion of the internal carotid arteries bilaterally (arrowheads). (B) CT angiography of the circle of Willis (COW) shows collateral flow with opacification of major COW branches. LA1 = patent A1 segment of the left anterior cerebral artery; ACoA = widely patent anterior communicating artery; LM1 = patent left middle cerebral artery; LPoCoA = patent left posterior communicating artery; LP1 = patent P1 segment of the left posterior cerebral artery; RA1 = patent A1 segment of the right anterior cerebral artery; RM1 = patent right middle cerebral artery; RPoCoA = patent right posterior communicating artery giving rise to the distal right posterior cerebral artery (RPCA); a = absent P1 segment of the right posterior cerebral artery.

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