Detection of single-phase CTA occult vessel occlusions in acute ischemic stroke using CT perfusion-based wavelet-transformed angiography

Eur Radiol. 2017 Jun;27(6):2657-2664. doi: 10.1007/s00330-016-4613-y. Epub 2016 Oct 8.


Objectives: To determine the detection rate of intracranial vessel occlusions using CT perfusion-based wavelet-transformed angiography (waveletCTA) in acute ischemic stroke patients, in whom single-phase CTA (spCTA) failed to detect an occlusion.

Methods: Subjects were selected from a cohort of 791 consecutive patients who underwent multiparametric CT including whole-brain CT perfusion. Inclusion criteria were (1) significant cerebral blood flow (CBF) deficit, (2) no evidence of vessel occlusion on spCTA and (3) follow-up-confirmed acute ischemic infarction. waveletCTA was independently analysed by two readers regarding presence and location of vessel occlusions. Logistic regression analysis was performed to identify predictors of waveletCTA-detected occlusions.

Results: Fifty-nine patients fulfilled the inclusion criteria. Overall, an occlusion was identified using waveletCTA in 31 (52.5 %) patients with negative spCTA. Out of 47 patients with middle cerebral artery infarction, 27 occlusions (57.4 %) were detected by waveletCTA, mainly located in the M2 (15) and M3 segments (8). The presence of waveletCTA-detected occlusions was associated with larger CBF deficit volumes (odds ratio (OR) = 1.335, p = 0.010) and shorter times from symptom onset (OR = 0.306, p = 0.041).

Conclusions: waveletCTA is able to detect spCTA occult vessel occlusions in about half of acute ischemic stroke patients and may potentially identify more patients eligible for endovascular therapy.

Key points: • waveletCTA is able to detect spCTA occult vessel occlusions in stroke patients. • waveletCTA-detected occlusions are associated with larger cerebral blood flow deficits. • waveletCTA has the potential to identify more patients eligible for endovascular therapy. • waveletCTA implies neither additional radiation exposure nor extra contrast agent.

Keywords: Angiography; Stroke; Thrombectomy; Thrombolysis; Wavelet transform.

MeSH terms

  • Aged
  • Brain / blood supply
  • Brain Ischemia / diagnostic imaging
  • Brain Ischemia / etiology
  • Cerebral Angiography / methods
  • Cerebrovascular Circulation / physiology
  • Cohort Studies
  • Computed Tomography Angiography / methods
  • Contrast Media
  • Female
  • Humans
  • Infarction, Middle Cerebral Artery / complications
  • Infarction, Middle Cerebral Artery / diagnosis*
  • Infarction, Middle Cerebral Artery / radiotherapy*
  • Male
  • Middle Aged
  • Stroke / diagnostic imaging
  • Stroke / etiology*


  • Contrast Media