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D. Byrne, J.P. Walsh and P.J. MacMahon
American Journal of Neuroradiology April 2018, 39 (4) E48; DOI: https://doi.org/10.3174/ajnr.A5536
D. Byrne
aDepartment of Radiology Mater Misericordiae University Hospital Dublin, Ireland
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J.P. Walsh
aDepartment of Radiology Mater Misericordiae University Hospital Dublin, Ireland
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P.J. MacMahon
bDepartment of Radiology Mater Misericordiae University Hospital Dublin, Ireland
cSchool of Medicine University College Dublin Dublin, Ireland
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We thank Drs Singh, Zerna, and Menon for their interest in our study,1 and we are grateful for the opportunity to address their comments. First, we would like to acknowledge the utility and value of multiphase CT angiography as a development in the assessment of acute stroke, first described by the Calgary Stroke Program. It is a dynamic, versatile, and multipurpose tool,2 with benefit in the detection of distal intracranial arterial occlusions as previously described by Yu et al.3 The purpose of our study was to demonstrate the effectiveness of an easily communicated imaging sign on multiphase CTA, “the delayed vessel sign,” which we have found to be intuitively understood even by junior trainees. It is a reliable indicator of an intracranial arterial occlusion, providing a rapid method to identify the precise site of occlusion. The sign is distinct from “asymmetric pial enhancement,” which we separately evaluated in our article; in clinical practice, we have found it to be a subtler imaging feature, especially when associated with distal vessel occlusions. We have recently developed a new postprocessing technique “subtraction multiphase CT angiography,” which increases the conspicuity of the delayed vessel sign by suppressing normally enhancing vessels (including pial vessels), enabling faster detection of intracranial arterial occlusions.4

References

  1. 1.↵
    1. Byrne D,
    2. Sugrue G,
    3. Stanley E, et al
    . Improved detection of anterior circulation occlusions: the “delayed vessel sign” on multiphase CT angiography. AJNR Am J Neuroradiol 2017;38:1911–16 doi:10.3174/ajnr.A5317 pmid:28798219
    Abstract/FREE Full Text
  2. 2.↵
    1. Menon BK,
    2. d'Esterre CD,
    3. Qazi EM, et al
    . Multiphase CT angiography: a new tool for the imaging triage of patients with acute ischemic stroke. Radiology 2015;275:510–20 doi:10.1148/radiol.15142256 pmid:25633505
    CrossRefPubMed
  3. 3.↵
    1. Yu AY,
    2. Zerna C,
    3. Assis Z, et al
    . Multiphase CT angiography increases detection of anterior circulation intracranial occlusion. Neurology 2016;87:609–16 doi:10.1212/WNL.0000000000002951 pmid:27385749
    Abstract/FREE Full Text
  4. 4.↵
    1. Byrne D,
    2. Walsh JP,
    3. Sugrue G, et al
    . Subtraction multiphase CT angiography: a new technique for faster detection of intracranial arterial occlusions. Eur Radiol 2017 Nov 13. [Epub ahead of print] doi:10.1007/s00330-017-5124-1 pmid:29134350
    CrossRefPubMed
  • © 2018 by American Journal of Neuroradiology
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American Journal of Neuroradiology: 39 (4)
American Journal of Neuroradiology
Vol. 39, Issue 4
1 Apr 2018
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D. Byrne, J.P. Walsh, P.J. MacMahon
American Journal of Neuroradiology Apr 2018, 39 (4) E48; DOI: 10.3174/ajnr.A5536

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D. Byrne, J.P. Walsh, P.J. MacMahon
American Journal of Neuroradiology Apr 2018, 39 (4) E48; DOI: 10.3174/ajnr.A5536
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