Color mapping boosts vessel interpretation in stroke CT

You mean we could actually get an objective damage diagnosis from this? Then our doctors will no longer be able to not map needed stroke protocols to damage locations.
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By Eric Barnes, AuntMinnie.com staff writerMarch 6, 2017

VIENNA - Color mapping of cerebral vasculature in 4D CT angiography (CTA) speeds interpretation and may improve accuracy in the detection of vessel occlusions in acute stroke patients, researchers said on Sunday at ECR 2017.
Investigators from Radboud University in Nijmegen, the Netherlands, studied patients with and without cerebral vessel occlusions using a postprocessing technique that color codes the contrast arrival time in acute stroke patients. The goal was to more easily detect delayed contrast arrival in occluded territories. Interpretation time was cut in half, and accuracy was slightly higher with the use of color coding, they found.
"The technique may increase accuracy in vessel occlusions -- though we need more patients and more radiologists to make a firm conclusion about this -- but I really think we can reduce reading time for the radiologists," said Midas Meijs, from Radboud's department of radiology and nuclear medicine, in his presentation.

Time is of the essence in interpretation for patients with acute stroke, which kills nearly 7 million people a year worldwide, according to World Health Organization estimates. Any technique that could speed up interpretation of contrast-enhanced CT while improving the accuracy of ischemic stroke interpretation would be a welcome addition to the clinician's toolbox.
The pilot study was designed to assess the utility of a new technique for 4D CTA for depicting intracranial vessel occlusions in acute stroke, Meijs said. 4D CT involves injecting the patient with a contrast agent and acquiring multiple CT images over time to reveal time-resolved images of the contrast agent filling the vasculature.
"If we look into the vessel, we can see that the time-enhancement curves for the veins, background, and arteries are quite different and quite distinct" on 4D CT, he said. "The problem with these acquisitions, however, is that every patient has a different contrast acquisition, depending on the vascular condition of the patient, the contrast, the injection rate of the contrast agent, and of course [differences] if the patient has a stroke."
The group performed whole-brain CT perfusion on a 320-detector-row scanner (Aquilion, Toshiba Medical Systems) in 10 patients with a single-vessel occlusion and in 10 controls. They obtained color-coded 4D CTA images by centering the color scale of vessel time to peak (TTP) on the modus of the TTP histogram.
The color-coding technique helps to visualize the 4D information from the scan, Meijs explained. Within a vessel mask, time-to-peak calculations for each vessel were assembled and used to create a flow window indicating the arrival time of the contrast agent within each vessel and vascular region.
Two neuroradiologists evaluated the temporal maximum intensity projection (MIP) of 4D CTA with and without color coding for the presence of vessel occlusion, "to see if we could find a difference," Meijs said. For the experiment, they measured time to detection and accuracy for the detection of vessel occlusion.
"Starting the clock, they looked for vessel occlusion, and once they found it the clock was stopped, and we measured the time to detect vessel occlusion," he said.