Computed Tomography for NeurologyYou think ahead. We innovate ahead.

Thank you for accompanying Stéphane on his stroke journey. We are grateful that we were able to contribute to his fast diagnosis and successful treatment with our solutions.

One morning, Stéphane collapsed. His wife immediately dialed the emergency number. Stéphane was half-paralyzed on the right side and had trouble talking and understanding. The ambulance came and took him immediately to the hospital.


² _{https://www.world-stroke.org/world-stroke-day-campaign/about-stroke/impact-of-stroke}

Now let’s have a closer look at the diagnosis and treatment pathway of Stéphane and how through Siemens Healthineers' comprehensive imaging and automated zero-click post-processing solutions, he got a second chance in life.

As a first step to assess the severity of the stroke, the NIH Stroke Scale assessment was conducted to measure the neurological function and deficits. The assessment revealed a score greater than 6.

The next step was performing an immediate native CT scan. Hemorrhage was ruled out and the AI-based Brain Hemorrhage* detection application, which runs directly on the scanner, concluded the analysis without raising any flags for suspected brain hemorrhage.

Meanwhile the high contrast-to-noise ratio of the native head CT scan, ensures that subtle nuances that are indicative of early signs of ischemia are visualized. Hypodense regions were noticed on the right hemisphere, indicating areas with early signs of suspected ischemia.


^{* The products/features (mentioned herein) are not commercially available in all countries. Their future availability cannot be guaranteed.}

To detect and localize the clot causing the ischemia, intracranial CT Angiography was performed. The acquired images helped the care team to get more insights, where through constructing a maximum intensity projection (MIP) image, an occlusion in the middle cerebral artery is confirmed.

The critical question before going to mechanical thrombectomy is to understand how much core infarct and how much salvage tissue there is. This can be easily achieved by acquiring a CT brain perfusion scan.

Using Flex-4D spiral acquisition on our SOMATOM X.cite* scanner enables a temporal sampling of 1.5 sec and 10 cm coverage, ensuring the full coverage of the supratentorial area and protecting the eye lenses.

After the scan, the perfusion maps were automatically generated with zero-click interaction from the radiologist. Based on this information a penumbra map was calculated with an encouraging mismatch ratio. The care team decided to send Stéphane to the Angio suite for thrombectomy.


^{* The products/features (mentioned herein) are not commercially available in all countries. Their future availability cannot be guaranteed.}

Stéphane is now sent to the angio suite for thrombectomy

Device navigation with Neuro device protocol during thrombetomy

Roadmap:
Create your own guide

• Vessel map to ease catheter and device navigation
• Constant image quality through the whole procedure
• Supported by functionalities like “show progress” or “vessel map” to ease your procedure workflow

DSA Roadmap:

• Select any DSA reference image as roadmap mask
• Increase image quality of vessel map
• Use already acquired DSA scene
• Reduce dose by skipping dedicated vessel map acquisition for roadmap

Fortunately, the thrombectomy procedure was successful with an excellent outcome, providing Stéphane with a second chance in life.

To detect potential hemorrhagic transformations, a 24-hour follow-up scan was conducted, where SOMATOM On.site* mobile CT scanner was used to scan the patient directly at his bed in the ICU department. The native CT scan showed some hyperdense regions, which indicates whether a hemorrhage or contrast extravasation post thrombectomy. To get the definite answer, the care team decided to go for a Dual Energy CT scan at the radiology department. Hyperdense regions were reconfirmed with the first native CT scan.


_{* The products/features (mentioned herein) are not commercially available in all countries. Their future availability cannot be guaranteed.}

Thanks to the dual energy CT imaging capabilities, it is now easy to get the answer!
The iodine maps comparing hyperdense spots with areas of negativity on the virtual non-contrast (VNC) reconstruction indicate that the hyperdense spots were due to contrast extravasation not a hemorrhage.

Thank you for accompanying Stéphane on his stroke journey. We are grateful that we were able to contribute to his fast diagnosis and successful treatment with our solutions.

Native: 120 kVp | CTDI_vol 44.1 mGy

Quantum HD | 120 kVp | CTDI_vol 15.5 mGy

CTDI_vol 8.5 mGy

Native: 120 kVp | CTDI_vol 8.17 mGy | Perfusion: 70kVp | CTDI_vol 180 mGy 

0.2mm | 120 kVp | DLP 442 mGy*cm 

Quantum HD | 120 kVp | CTDI_vol 10 mGy | DLP 375 mGy*cm 

Native: 120kVp | CTDI_vol 42 mGy – CTA 70kVp | CTDI_vol 2.96 mGy – CT Perfusion 70kVp | CTDI_vol 103 mGy 

Native: 120 kVp | CTDI_vol 40.07 mGy | Perfusion: 70kVp | CTDI_vol 158.11 mGy | CT Angiography: 90kVp | CTDI_vol 7.07 mGy 

Native: 120 kVp | CTDI_vol 41.07 mGy | Perfusion: 70kVp | CTDI_vol 158.11 mGy | Carotid CTA: 90kV | CTDI_vol 7.07 mGy 

TwinSpiral Dual Energy CT: 80/Sn150 KV | CTDI_vol 37.06 mGy 

Sn130 kV | CTDI_vol 24.07 mGy 

Native: 120 kVp | CTDI_vol 38.4 mGy | CTA: 80kV | CTDI_vol 6.3 mGy

Native: 120 kVp | CTDI_vol 44.1 mGy