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Background and Purpose: Flat detector CT has been used as a periinterventional diagnostic tool in numerous studies with mixed results regarding image quality and detection of intracranial lesions. We compared the diagnostic aspects of the latest generation flat detector CT to a standard multidetector CT.Materials and Methods: One hundred and two patients were included in our retrospective study. All patients had undergone interventional procedures; flat detector CT was acquired periinterventionally and compared to a postinterventional multidetector CT regarding the depiction of ventricular/subarachnoidal spaces, the detection of intracranial hemorrhage and the delineation of ischemic lesions by using an ordinal scale. Ischemic lesions were quantified with the Alberta Stroke Program Early CT score on both exams. Two neuroradiologists of various experience grades and a medical student scored the anonymized images, blinded to clinical history.Results: The two methods were diagnostic equal in evaluating the ventricular system and the subarachnoidal spaces. Subarachnoidal, intraventicular and intraparenchymal hemorrhages were detected with a sensitivity of 95%, 94%, 100% and specificity of 97%, 97% and 99% respectively using flat detector CT. Grey-white differentiation was feasible in the majority of flat detector CT scans and ischemic lesions were detected with a sensitivity of 71% on flat detector CT, compared to multidetector CT scans. Alberta Stroke Program Early CT score values correlated highly with a correlation coefficient of r=0,78.Conclusion: The latest generation of flat detector CT is a reliable tool for the detection of intracranial hemorrhage and extended ischemic lesions. Flat detector CT acquired with angiography systems could be increasingly used in acute stroke diagnostics (so called one stop imaging) with a massive impact in door to groin times.