This is an education resource only. Ordering of all procedure codes on this website are subject to the Canberra Health Services guidelines for imaging orders.
CT ANGIOGRAPHY ACUTE STROKE
*This code should only be ordered after consultation with the stroke neurologist. The stroke neurologist needs to be present in the CT department in order for a perfusion study to be performed. This is because the neurologist needs to review the images at the time of acquisition in order to facilitate the correct treatment.
INDICATIONS (1-5)
*This code should only be ordered after consultation with the stroke neurologist. The stroke neurologist needs to be present in the CT department in order for a perfusion study to be performed. This is because the neurologist needs to review the images at the time of acquisition in order to facilitate the correct treatment.
Potential neurological symptoms in the presence of an Acute Stroke
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Muscular: difficulty walking, paralysis with weak muscles, problems with coordination, or paralysis of one side of the body
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Visual: blurred vision, double vision, sudden visual loss, or temporary loss of vision in one eye
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Speech: difficulty speaking, slurred speech, or speech loss
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Whole body: fatigue, light-headedness, or vertigo
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Limbs: numbness or weakness
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Facial: muscle weakness or numbness
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Also common: balance disorder, difficulty swallowing, headache, inability to understand, mental confusion, pins and needles or reduced sensation of touch
These symptoms should be assessed for onset and clinical correlation with a neurologists recommendation.
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Assess whether a stroke is haemorrhage or ischaemic in nature to enact the appropriate treatment in a timely manner (e.g. endovascular clot retrieval or intravenous thrombolysis)
PATHOLOGY DEMONSTRATED (6)
Non-Contrast Brain
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In addition to a rapid overview of the brain that may demonstrate unexpected non-stroke findings (e.g. tumours) it specifically allows for the following stroke-related features to be sought:
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Intracerebral haemorrhages
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Established acute cerebral infarction
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Calculation of ASPECT score
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Hyperdense artery sign
Perfusion study
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Calculation of perfusion parameters (cerebral blood flow, cerebral blood volume, time-to-peak, mean transit time)
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Identification of penumbra vs infarct core
CT Angio Arch to COW
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Occlusive thromboembolism
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Arterial dissection
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Aneurysms and arteriovenous malformations
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Bovine arch
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Spot sign in cerebral haemorrhage
PATIENT PREPARATION
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Patient able to lie still for 15 minutes
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Not claustrophobic (sedation may be given)
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Metal artefacts removed from the region of interest
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No respiratory distress when lying supine
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Not allergic to Iodine based Contrast
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Patient to have 18G cannula in anterior cubital fossa to allow a 7ml/s flow rate (20G cannula acceptable if flushing to 5ml/s)
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Neurology to be present for approval of Perfusion study and review
ANATOMY INCLUDED
CT Brain - Non Contrast (Axial)
Angiography Arch to COW (Axial)
CT Brain - Non Contrast (Coronal)
Angiography Arch to COW (Coronal)
CT Brain - Non Contrast (Sagittal)
Angiography Arch to COW (Sagittal)
CT 4D Perfusion (Axial)
CT 4D Perfusion (Coronal)
REFERENCES
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Radiopaedia. CT Head. [Internet]. 2010 [updated 01 Dec 2021, cited 23 Nov 2021]. Available from https://radiopaedia.org/articles/ct-head
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American College of Radiology (ACR). Appropriateness Criteria. [Internet]. 2022 [Updated 2021, cited 23 Nov 2021]. Available from https://www.acr.org/Clinical-Resources/ACR-Appropriateness-Criteria
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Radiopaedia. Ischaemic Stroke. [Internet]. 2011. [updated 25 Nov 2021, accessed 25 Nov 2021]. Available from https://radiopaedia.org/articles/ischaemic-stroke
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Radiopaedia. Stroke. [Internet]. 2009. [updated 19 Apr 2021, accessed 23 Nov 2021]. Available from https://radiopaedia.org/articles/stroke?lang=gb
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Birenbaum D, Bancroft LW, Felsberg GJ. Imaging in Acute Stroke. 2011. Western Journal of Emergency Medicine. 12 (1). 67-76.
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Eisenberg RL., Johnson NM. Comprehensive Radiographic Pathology. 5th Edition. Elsevier Mosby, 2012