Comparison of sequential multi-detector CT and cone-beam CT perfusion maps in 39 subjects with anterior circulation acute ischemic stroke due to a large vessel occlusion

Purpose The critical time between stroke onset and treatment was targeted for reduction by integrating physiological imaging into the angiography suite, potentially improving clinical outcomes. The evaluation was conducted to compare C-Arm cone beam CT perfusion (CBCTP) with multi-detector CT perfusion (MDCTP) in patients with acute ischemic stroke (AIS). Approach Thirty-nine patients with anterior circulation AIS underwent both MDCTP and CBCTP. Imaging results were compared using an in-house algorithm for CBCTP map generation and RAPID for post-processing. Blinded neuroradiologists assessed images for quality, diagnostic utility, and treatment decision support, with non-inferiority analysis (two one-sided tests for equivalence) and inter-reviewer consistency (Cohen's kappa). Results The mean time from MDCTP to angiography suite arrival was 50 +/- 34 min, and that from arrival to the first CBCTP image was 21 +/- 8 min. Stroke diagnosis accuracies were 96% [93%, 97%] with MDCTP and 91% [90%, 93%] with CBCTP. Cohen's kappa between observers was 0.86 for MDCTP and 0.90 for CBCTP, showing excellent inter-reader consistency. CBCTP's scores for diagnostic utility, mismatch pattern detection, and treatment decisions were noninferior to MDCTP scores (alpha = 0.05) within 20% of the range. MDCTP was slightly superior for image quality and artifact score (1.8 versus 2.3, p<0.01). Conclusions In this small paper, CBCTP was noninferior to MDCTP, potentially saving nearly an hour per patient if they went directly to the angiography suite upon hospital arrival.