Citation: Larrabure LN, Yu JF, Pung L, Amans MR, Cooke DL and Hetts SW. A Comparison of Flat-Panel CT to Non-Contrast Enhanced CT in the Detection of Intracranial Hemorrhage. Austin J Cerebrovasc Dis & Stroke. 2018; 5(2): 1079. Austin J Cerebrovasc Dis & Stroke - Volume 5 Issue 2 - 2018 ISSN : 2381-9103 | www.austinpublishinggroup.com Larrabure et al. © All rights are reserved Austin Journal of Cerebrovascular Disease & Stroke Open Access Abstract Purpose: Outcomes of acute ischemic strokes (AIS) are associated with length of time to reperfusion. Most AIS patients receive non-contrast enhanced CT (NECT) to detect intracranial hemorrhage and determine eligibility for intravenous tPA and/or mechanical embolectomy. We hypothesize that fat- panel CT (FPCT) images produced by modern x-ray angiography equipment are as sensitive to intracranial hemorrhage as standard NECT images. Methods: 19 cases were collected through a retrospective chart review of endovascular cases conducted at UCSF Mofftt-Long Hospital between April 2015 and December 2015. Two neuroradiologists independently viewed in random sequence the de-identifed images. Intra-rater and inter-rater agreements were assessed using overall percent agreement, positive percent agreement, and kappa statistic. FPCT’s sensitivity, specifcity, and positive and negative predictive value were calculated for the detection of intracranial hemorrhage (ICH), subarachnoid hemorrhage (SAH), intraventricular hemorrhage (IVH), intraparenchymal hemorrhage (IPH) and subdural hemorrhage (SDH). Results: Intra-rater and inter-rater agreements were suffcient for all categories of hemorrhage except SDH. Excluding SDH cases, FPCT has hemorrhage detection sensitivity of 0.89 (CI 0.75-0.97), specifcity of 1 (CI 0.85- 1), PPV of 1 (CI 0.90-1), and NPV of 0.85 (0.65 - 0.96). In the identifcation of hemorrhage location, FPCT has a sensitivity for SAH, IVH, and IPH of 0.68 (CI 0.48-0.84), 0.79 (CI 0.59-0.92), and 0.58 (CI 0.28-0.85), respectively. Conclusion: FPCT is similar to NECT in the detection of intracranial hemorrhage and has potential as a diagnostic test for intracranial hemorrhage during AIS imaging triage. Keywords: Stroke; Flat-panel computed tomography; Subarachnoid hemorrhage; Intraventricular hemorrhage; Intraparenchymal hemorrhage; Subdural hemorrhage Abbreviations AIS: Acute Ischemic Stroke; FPCT: Flat-panel Computed Tomography; NECT: Non-contrast Enhanced Computed Tomography; CT: Computed Tomography; UCSF: University of California, San Francisco; tPA: Tissue Plasminogen Activator; ICH: Intracranial Hemorrhage; SAH: Subarachnoid Hemorrhage; IVH: Intraventricular Hemorrhage; IPH: Intraparenchymal Hemorrhage; SDH: Subdural Hemorrhage; CI: Confdence Interval; PPV: Positive Predictive Value; NPV: Negative Predictive Value; SD: Standard Deviation; KVP: Kilovoltage Peak; FOV: Field of View; HU: Hounsfeld Unit; MRI: Magnetic Resonance Imaging; CTA: Computed Tomography Angiography; AVF: Arteriovenous Fistula; AVM: Arteriovenous Malformation Introduction In AIS, time is critically important: with 1.9 million neurons lost per minute, clinical outcomes afer reperfusion correlate with the time spent ischemic [1-3]. However, the current algorithm of care for AIS patients is to frst receive a NECT to identify possible contraindications for IV tPA such as intracranial hemorrhage Research Article A Comparison of Flat-Panel CT to Non-Contrast Enhanced CT in the Detection of Intracranial Hemorrhage Larrabure LN 1 *, Yu JF 1 , Pung L 2 , Amans MR 1 , Cooke DL 1 and Hetts SW 1 1 Department of Radiology and Biomedical Imaging, University of California, San Francisco, USA 2 Siemens Healthineers GmbH, Germany *Corresponding author: Larrabure LN, Department of Radiology and Biomedical Imaging, University of California, San Francisco, USA Received: April 20, 2018; Accepted: May 15, 2018; Published: June 12, 2018 or large completed brain infarction that would raise the risk for reperfusion hemorrhage in already dead brain tissue. If the patient is demonstrated by CT angiogram to have an intracranial large vessel occlusion, the patient is then transported to the angiography suite for endovascular mechanical embolectomy. Every minute counts in the treatment of AIS, with improved outcomes for less time between onset of the stroke and reperfusion [4-5]. Each step in the treatment protocol adds time until reperfusion. Angiography suites equipped with FPCT may be able to eliminate the need for imaging studies prior to the transport to the angiography suite. Previous studies have suggested that imaging in the angiography suite (FPCT) could be reliable and comparable to other forms of imaging in assessment of hemorrhage and blood volume [6-12]. If FPCT is determined to be as sensitive to ICH as standard NECT in this future prospective study, this would allow elimination of NECT imaging as a separate step in the AIS treatment protocol needed for IV tPA administration and embolectomy. If FPCT is comparable to NECT currently used in the early steps of triage of AIS, then it may be possible to decrease delay in treatment of patients and improve overall outcomes. In 2016, Leyhe, et al. performed a 102 patient retrospective study comparing FPCT to NECT and showed FPCT had comparable sensitivity and specifcity