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Xue Z, Peng D, Sun Z, Wu C, Xu B, Wang F, Zhou D, Dong T. Intraoperative Perfusion Computed Tomography in Carotid Endarterectomy: Initial Experience in 16 Cases. Med Sci Monit 2016; 22:3362-3369. [PMID: 27657307 PMCID: PMC5036379 DOI: 10.12659/msm.897356] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND This study aimed to evaluate the changes in perfusion computed tomography (PCT) parameters in carotid endarterectomy (CEA), and to discuss the use of intraoperative PCT in CEA. MATERIAL AND METHODS Sixteen patients with carotid stenosis who also underwent CEA with intraoperative CT were recruited in this study. We calculated quantitative data on cerebral blood flow (CBF), cerebral blood volume (CBV), time to peak (TTP), and the relative parameter values, including relative CBF (rCBF), relative CBV (rCBV), and relative TTP (rTTP). The role of PCT was assessed and compared to conventional monitoring methods. RESULTS There were no significant differences in any of the parameters in the anterior cerebral artery (ACA) territory (P>0.05). In the middle cerebral artery (MCA) territory, the CBF and CBV increased and TTP decreased in the operated side during CEA; the rCBF and rCBV increased and the rTTP decreased significantly (P<0.05). In 16 patients, CT parameters were improved, SSEP was normal, and MDU was abnormal. In 3 patients, CBF increased by more than 70% during CEA. Relative PCT parameters are sensitive indicators for detecting early cerebral hemodynamic changes during CEA. Cerebral hemodynamics changed significantly in the MCA territory during CEA. CONCLUSIONS Intraoperative PCT could be an important adjuvant monitoring method in CEA.
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Affiliation(s)
- Zhe Xue
- Department of Neurosurgery, Chinese PLA General Hospital, Beijing, China (mainland)
| | - Dingwei Peng
- Department of Neurosurgery, Chinese PLA General Hospital, Beijing, China (mainland)
| | - Zhenghui Sun
- Department of Neurosurgery, Chinese PLA General Hospital, Beijing, China (mainland)
| | - Chen Wu
- Department of Neurosurgery, Chinese PLA General Hospital, Beijing, China (mainland)
| | - Bainan Xu
- Department of Neurosurgery, Chinese PLA General Hospital, Beijing, China (mainland)
| | - Fuyu Wang
- Department of Neurosurgery, Chinese PLA General Hospital, Beijing, China (mainland)
| | - Dingbiao Zhou
- Department of Neurosurgery, Chinese PLA General Hospital, Beijing, China (mainland)
| | - Tianxiang Dong
- Department of Radiology, Chinese PLA General Hospital, Beijing, China (mainland)
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Yang F, Shi W, Shi J, Zhang Y, Yin Y, Shi H, Chen D. Assessment of cerebrovascular reserve in unilateral middle cerebral artery stenosis using perfusion CT and CO 2 inhalation tests. Int J Neurosci 2016; 127:320-325. [PMID: 27619639 DOI: 10.1080/00207454.2016.1235044] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Purpose/Aim of the study: Cerebrovascular reactivity (CVR) is an important marker for assessing cerebrovascular disease. This study assessed the CVR by perfusion computed tomography (CT) and CO2 inhalation tests in patients with unilateral middle cerebral artery (MCA) stenosis disease. MATERIALS AND METHODS Thirty-one patients with unilateral MCA stenosis disease diagnosed by digital subtraction angiography were studied. Patients were divided into two groups according to the degree of stenosis: severe and moderate. The regional cerebral blood flow (CBF) before and after CO2 inhalation was determined by perfusion CT. Regional CVR values were obtained by the following formula: increase (%) = (post-CBF) - (pre-CBF)/(pre-CBF) × 100%. RESULTS No significant differences in the mean CBF in the MCA stenosis region were found between the affected and contralateral sides before the CO2 inhalation test; after the test, CBF was more significantly decreased on the affected side than on the contralateral side. The changes in CBF on the affected side were categorized into three types: increased CBF (17 cases), decreased CBF (12 cases) and no change in CBF (2 cases). The rate of CVR impairment among severe stenosis patients (13/19) was higher than that among moderate stenosis patients (3/12). CVR was significantly correlated with the degree of stenosis (r = 0.423, P = 0.018). CONCLUSION CVR impairment was found in approximately half of patients with unilateral MCA stenosis. Along with an increase in the degree of stenosis, patients with unilateral MCA stenosis were more likely to exhibit CVR impairment. It is important to assess the CVR in patients with unilateral MCA stenosis, especially those with severe stenosis.
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Affiliation(s)
- Fen Yang
- a Department of Neurology , Air Force General Hospital of the Chinese PLA , Beijing , China
| | - Wenqian Shi
- a Department of Neurology , Air Force General Hospital of the Chinese PLA , Beijing , China
| | - Jin Shi
- a Department of Neurology , Air Force General Hospital of the Chinese PLA , Beijing , China
| | - Yingqian Zhang
- a Department of Neurology , Air Force General Hospital of the Chinese PLA , Beijing , China
| | - Yanwei Yin
- a Department of Neurology , Air Force General Hospital of the Chinese PLA , Beijing , China
| | - Huiping Shi
- b Department of CT and MRI , Air Force General Hospital of the Chinese PLA , Beijing , China
| | - Dawei Chen
- a Department of Neurology , Air Force General Hospital of the Chinese PLA , Beijing , China
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Zhang J, Wang J, Geng D, Li Y, Song D, Gu Y. Whole-brain CT perfusion and CT angiography assessment of Moyamoya disease before and after surgical revascularization: preliminary study with 256-slice CT. PLoS One 2013; 8:e57595. [PMID: 23451248 PMCID: PMC3579776 DOI: 10.1371/journal.pone.0057595] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2012] [Accepted: 01/24/2013] [Indexed: 11/18/2022] Open
Abstract
Background/Aims The 256-slice CT enables the entire brain to be scanned in a single examination. We evaluated the application of 256-slice whole-brain CT perfusion (CTP) in determining graft patency as well as investigating cerebral hemodynamic changes in Moyamoya disease before and after surgical revascularization. Methods Thirty-nine cases of Moyamoya disease were evaluated before and after surgical revascularization with 256-slice CT. Whole-brain perfusion images and dynamic 3D CT angiographic images generated from perfusion source data were obtained in all patients. Cerebral blood flow (CBF), cerebral blood volume (CBV), time to peak (TTP) and mean transit time (MTT) of one hemisphere in the region of middle cerebral artery (MCA) distribution and contralateral mirroring areas were measured. Relative CTP values (rCBF, rCBV, rTTP, rMTT) were also obtained. Differences in pre- and post- operation perfusion CT values were assessed with paired t test or matched-pairs signed-ranks test. Results Preoperative CBF, MTT and TTP of potential surgical side were significantly different from those of contralateral side (P<0.01 for all). All graft patencies were displayed using the 3D-CTA images. Postoperative CBF, rCBF and rCBV values of surgical side in the region of MCA were significantly higher than those before operation (P<0.01 for all). Postoperative MTT, TTP, rMTT and rTTP values of the surgical side in the region of MCA were significantly lower than those before operation (P<0.05 for all). Conclusion The 256-slice whole-brain CTP can be used to evaluate cerebral hemodynamic changes in Moyamoya disease before and after surgery and the 3D-CTA is useful for assessing the abnormalities of intracranial arteries and graft patencies.
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Affiliation(s)
- Jun Zhang
- Department of Radiology, Huashan Hospital, Fudan University, Shanghai, China
| | - Jianhong Wang
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China
| | - Daoying Geng
- Department of Radiology, Huashan Hospital, Fudan University, Shanghai, China
- * E-mail:
| | - Yuxin Li
- Department of Radiology, Huashan Hospital, Fudan University, Shanghai, China
| | - Donglei Song
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Yuxiang Gu
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, China
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Optimisation of vascular input and output functions in CT-perfusion imaging using 256(or more)-slice multidetector CT. Eur Radiol 2012. [PMID: 23192376 DOI: 10.1007/s00330-012-2731-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVES To evaluate the accuracy and reproducibility of CT-perfusion (CTP) by finding the optimal artery for the arterial input function (AIF) and re-evaluating the necessity of the venous output function (VOF). METHODS Forty-four acute ischaemic stroke patients who underwent non-enhanced CT, CTP and CT-angiography using 256-slice multidetector computed tomography (MDCT) were evaluated. The anterior cerebral artery (ACA), middle cerebral artery (MCA), internal carotid artery (ICA) and basilar artery were selected as the AIF. Subsequently the resulting area under the time-enhancement curve of the AIF (AUCAIF) and quantitative perfusion measurements were analysed by repeated measures ANOVA and subsequently the paired t test. To evaluate reproducibility we examined if the VOF could be deleted by comparing the perfusion measurements using versus not using the VOF (paired t test). RESULTS The AUCAIF and perfusion measurements resulting from the different AIFs showed significant group differences (all P < 0.0001). The ICA had the largest AUCAIF and resulted in the highest mean transient time (MTT) and lowest cerebral blood flow (CBF), whereas the basilar artery showed the lowest cerebral blood volume (CBV). Not using the VOF showed significantly higher CBV and CBF in 66 % of patients on the ipsilateral (P < 0.0001 and P = 0.007, respectively) and contralateral hemisphere (P < 0.0001 and P = 0.019, respectively). CONCLUSION Selecting the ICA as the AIF and continuing the use of the VOF would improve the accuracy of CTP. KEY POINTS • Perfusion imaging is an increasingly important aspect of multidetector computed tomography (MDCT). • Vascular input functions were evaluated for CT-perfusion using 256-slice MDCT. • Selecting different arterial input functions (AIFs) leads to variation in quantitative values. • Using the internal carotid artery for AIF provides optimal perfusion values. • Deleting the venous output function would be detrimental for validity.
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Chin SC, Chang CH, Chang TY, Huang KL, Wu TC, Lin JR, Chang YJ, Lee TH. Brain computed tomography perfusion may help to detect hemodynamic reconstitution and predict intracerebral hemorrhage after carotid stenting. J Vasc Surg 2012; 56:1281-90. [DOI: 10.1016/j.jvs.2012.04.038] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2012] [Revised: 04/16/2012] [Accepted: 04/17/2012] [Indexed: 10/28/2022]
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Yang B, Chen W, Yang Y, Lin Y, Duan Y, Li J, Wang H, Fu F, Zhuge Q, Chen X. Short- and long-term hemodynamic and clinical effects of carotid artery stenting. AJNR Am J Neuroradiol 2012; 33:1170-6. [PMID: 22268082 DOI: 10.3174/ajnr.a2930] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Stenosis of the carotid artery may cause reduced hemodynamic and neural function that may be ameliorated with CAS. The goal of this study was to evaluate short- and long-term hemodynamic and clinical effects after CAS. MATERIALS AND METHODS Hemodynamic parameters were acquired by PCT within 1 week before CAS and at 1 week and 1 year (10-13 months) after CAS. In ACA territory, MCA territory, PCA territory, basal ganglia, anterior and posterior CWS and IWS, the rCBF, rCBV, and rMTT were determined in 20 patients with unilateral carotid artery stenosis who underwent CAS. MR and noncontrast CT were performed within 1 week before CAS. Noncontrast CT and carotid arteriography were performed immediately after CAS. Carotid arteriography was performed 1 year after CAS. MRS was performed in 3 measurements. The variance analysis was performed to determine whether there were significant differences among the 3 measurements. RESULTS No significant differences were found among rCBV in any territory (P > .05). In the non-PCA territories, rMTT decreased and rCBF increased at 1 week after CAS (P < .01), but there was no significant difference between 1-week and 1-year effects (P > .05). For MR spectroscopy, no significant differences were found between 1 week after CAS and pretreatment (P > .05); the 1-year scores improved significantly (P < .01). CONCLUSIONS The long-term hemodynamic and clinical results after treatment validated that CAS is a durable procedure. The 1-week hemodynamic effects can predict long-term effects.
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Affiliation(s)
- B Yang
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical College, WenzhouCity, ZheJiang Province, China
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The relative effect of vendor variability in CT perfusion results: a method comparison study. AJR Am J Roentgenol 2011; 197:468-73. [PMID: 21785096 DOI: 10.2214/ajr.10.6058] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE There are known interoperator, intraoperator, and intervendor software differences that can influence the reproducibility of quantitative CT perfusion values. The purpose of this study was to determine the relative impact of operator and software differences in CT perfusion variability. MATERIALS AND METHODS CT perfusion imaging data were selected for 11 patients evaluated for suspected ischemic stroke. Three radiologists each independently postprocessed the source data twice, using four different vendor software applications. Results for cerebral blood volume (CBV), cerebral blood flow (CBF), and mean transit time (MTT) were recorded for the lentiform nuclei in both hemispheres. Repeated variables multivariate analysis of variance was used to assess differences in the means of CBV, CBF, and MTT. Bland-Altman analysis was used to assess agreement between pairs of vendors, readers, and read times. RESULTS Choice of vendor software, but not interoperator or intraoperator disagreement, was associated with significant variability (p < 0.001) in CBV, CBF, and MTT. The mean difference in CT perfusion values was greater for pairs of vendors than for pairs of operators. CONCLUSION Different vendor software applications do not generate quantitative perfusion results equivalently. Intervendor difference is, by far, the largest cause of variability in perfusion results relative to interoperator and intraoperator difference. Caution should be exercised when interpreting quantitative CT perfusion results because these values may vary considerably depending on the postprocessing software.
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Zussman B, Jabbour P, Talekar K, Gorniak R, Flanders AE. Sources of variability in computed tomography perfusion: implications for acute stroke management. Neurosurg Focus 2011; 30:E8. [DOI: 10.3171/2011.3.focus1136] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object
Although dynamic, first-pass cerebral CT perfusion is used in the evaluation of acute ischemic stroke, a lack of standardization restricts the value of this imaging modality in clinical decision-making. The purpose of this study was to comprehensively review the reported sources of variability and error in cerebral CT perfusion results.
Methods
A systematic literature review was conducted, 120 articles were reviewed, and 23 published original research articles were included. Sources of variability and error were thematically categorized and presented within the context of the 3 stages of a typical CT perfusion study: data acquisition, postprocessing, and results interpretation.
Results
Seven factors that caused variability were identified and described in detail: 1) contrast media, the iodinated compound injected intravascularly to permit imaging of the cerebral vessels; 2) data acquisition rate, the number of images obtained by CT scan per unit time; 3) user inputs, the subjective selections that operators make; 4) observer variation, the failure of operators to repeatedly measure a perfusion parameter with precision; 5) software operational mode, manual, semiautomatic, or automatic; 6) software design, the mathematical algorithms used to perform postprocessing; and 7) value type, absolute versus relative values.
Conclusions
Standardization at all 3 stages of the CT perfusion study cycle is warranted. At present, caution should be exercised when interpreting CT perfusion results as these values may vary considerably depending on a variety of factors. Future research is needed to define the role of CT perfusion in clinical decision-making for acute stroke patients and to determine the clinically acceptable limits of variability in CT perfusion results.
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Affiliation(s)
| | | | - Kiran Talekar
- 3Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Richard Gorniak
- 3Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Adam E. Flanders
- 3Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
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Aikawa H, Kazekawa K, Tsutsumi M, Onizuka M, Iko M, Kodama T, Nii K, Hamaguchi S, Etou H, Sakamoto K. Intraprocedural changes in angiographic cerebral circulation time predict cerebral blood flow after carotid artery stenting. Neurol Med Chir (Tokyo) 2010; 50:269-74. [PMID: 20448416 DOI: 10.2176/nmc.50.269] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Changes in the cerebral blood flow (CBF) are important for planning postoperative care in patients treated by carotid artery stenting (CAS). The relationship between intraprocedural changes in the angiographic cerebral circulation time (CCT) and perioperative CBF changes were retrospectively studied in 49 CAS procedures performed in 46 patients with carotid artery stenosis. The CCT, defined as the interval between the timing of maximal opacification at the terminal portion of the internal carotid artery and at the cortical vein, was determined by referring to time-density curves of data obtained from routine intraprocedural digital subtraction angiography. The intraoperative change in CCT (Delta CCT) was calculated for each of the 49 procedures. CBF studies, using dynamic perfusion computed tomography, were performed 10-2 days before and 2-4 days after CAS. Perioperative changes in the ratio of the CBF in the territory of the middle cerebral artery on the affected side to CBF on the contralateral side (%CBF) were calculated by subtracting pre- from postoperative %CBF (Delta%CBF) and the correlation between Delta CCT and Delta%CBF was evaluated. Mean CCT was shortened by 1.1 seconds from 5.3 to 4.2 seconds after CAS. Mean %CBF increased by 11.9% from 91.8% to 103.7% after the procedure. Delta CCT and Delta%CBF showed a significant positive correlation (r = 0.61, p = 0.008). Intraprocedural changes in angiographic CCT are predictive of postoperative CBF in patients with CAS.
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Affiliation(s)
- Hiroshi Aikawa
- Department of Neurosurgery, Fukuoka University Chikushi Hospital, Chikushino, Fukuoka, Japan
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Bae KT. Intravenous contrast medium administration and scan timing at CT: considerations and approaches. Radiology 2010; 256:32-61. [PMID: 20574084 DOI: 10.1148/radiol.10090908] [Citation(s) in RCA: 658] [Impact Index Per Article: 47.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The continuing advances in computed tomographic (CT) technology in the past decades have provided ongoing opportunities to improve CT image quality and clinical practice and discover new clinical CT imaging applications. New CT technology, however, has introduced new challenges in clinical radiology practice. One of the challenges is with intravenous contrast medium administration and scan timing. In this article, contrast medium pharmacokinetics and patient, contrast medium, and CT scanning factors associated with contrast enhancement and scan timing are presented and discussed. Published data from clinical studies of contrast medium and physiology are reviewed and interpreted. Computer simulation data are analyzed to provide an in-depth analysis of various factors associated with contrast enhancement and scan timing. On the basis of basic principles and analysis of the factors, clinical considerations and modifications to protocol design that are necessary to optimize contrast enhancement for common clinical CT applications are proposed.
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Affiliation(s)
- Kyongtae T Bae
- Department of Radiology, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA.
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Lui YW, Tang ER, Allmendinger AM, Spektor V. Evaluation of CT perfusion in the setting of cerebral ischemia: patterns and pitfalls. AJNR Am J Neuroradiol 2010; 31:1552-63. [PMID: 20190208 DOI: 10.3174/ajnr.a2026] [Citation(s) in RCA: 81] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
CTP has a growing role in evaluating stroke. It can be performed immediately following NCCT and has advantages of accessibility and speed. Differentiation of salvageable ischemic penumbra from unsalvageable core infarct may help identify patients most likely to benefit from thrombectomy or thrombolysis. Still, CTP interpretation can be complex. We review normal and ischemic perfusion patterns followed by an illustrative series of technical/diagnostic challenges of CTP interpretation in the setting of acute stroke syndromes.
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Affiliation(s)
- Y W Lui
- Department of Radiology, Albert Einstein College of Medicine, Montefiore Medical Center, 111 East 210th St., Bronx, NY 10467, USA.
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Ahmed AS, Zellerhoff M, Strother CM, Pulfer KA, Redel T, Deuerling-Zheng Y, Royalty K, Consigny D, Niemann DB. C-arm CT measurement of cerebral blood volume: an experimental study in canines. AJNR Am J Neuroradiol 2009; 30:917-22. [PMID: 19299488 DOI: 10.3174/ajnr.a1513] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Cerebral blood volume (CBV) is an important parameter in estimating the viability of brain tissue following an ischemic event. We tested the hypothesis that C-arm CT measurements of CBV would correlate well with those made with perfusion CT (PCT). MATERIALS AND METHODS CBV was measured in 12 canines by using PCT and C-arm CT. Two measurements with each technique were made on each animal; a different injection protocol was used for each of these techniques. PCT was performed by using a 64-section V-scanner. C-arm CT was performed by using a biplane Artis dBA system. PCT images were transferred to a commercially available workstation for postprocessing and analysis; C-arm CT images were transferred to a commercially available workstation for postprocessing and analysis by using prototype software. From each animal, 2 sections from each technique were selected for analysis. RESULTS There was good agreement of both the color maps and absolute numbers between the 2 techniques. The maximum and mean deviations of values between the 2 techniques for the first 5 animals were 30.20% and 7.82%; for the second 7 animals, these values were 26.79% and 7.40%. The maximum and mean deviations between the 2 C-arm CT studies performed on the first 5 animals were 33.15% and 12.24%; for the second 7 animals, these values were 41.15% and 10.89%. CONCLUSIONS In these healthy animals, measurement of CBV with C-arm CT compared well with measurements made with PCT.
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Affiliation(s)
- A S Ahmed
- University of Wisconsin Hospitals and Clinics, Madison, Wis., USA
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Petralia G, Preda L, Raimondi S, D'Andrea G, Summers P, Giugliano G, Chiesa F, Bellomi M. Intra- and interobserver agreement and impact of arterial input selection in perfusion CT measurements performed in squamous cell carcinoma of the upper aerodigestive tract. AJNR Am J Neuroradiol 2009; 30:1107-15. [PMID: 19342547 DOI: 10.3174/ajnr.a1540] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND AND PURPOSE CT Perfusion (CTP) has shown potential for assessing head and neck tumors. Our purposes were to assess the inter- and intraobserver agreement of CTP measurements and to investigate whether the selection of arterial input, ipsilateral versus contralateral to the tumor or left-versus-right external carotid artery (ECA), may affect CTP measurements in patients with squamous cell carcinoma (SCCA) of the upper aerodigestive tract. MATERIALS AND METHODS Twenty-six patients with SCCA were enrolled in this prospective study and underwent CTP. Data were analyzed by 2 expert readers and by an inexperienced reader for interobserver agreement and by the 2 expert readers for intraobserver agreement assessment, by using the ECA ipsilateral to tumor site as arterial input. All 3 readers repeated their analysis by using the ECA contralateral to tumor site as arterial input. Inter- and intraobserver agreement was assessed by using the Bland-Altman approach; CTP measurements by using ipsilateral-versus-contralateral or left-versus-right ECA were compared by using the Wilcoxon signed rank test. RESULTS The geometric mean of the ratios (95% limits of agreement) for inter- and intraobserver agreement ranged from 0.96 (0.75-1.23) to 1.00 (0.92-1.10) for blood flow (BF), from 0.88 (0.63-1.21) to 1.00 (0.88-1.14) for blood volume (BV), from 0.96 (0.64-1.44) to 0.98 (0.76-1.27) for mean transit time (MTT), and from 0.85 (0.41-1.76) to 1.14 (0.70-1.86) for permeability surface area product (PS). Significantly higher tumor PS and MTT for 2 readers and lower tumor BF for 1 of 3 readers were observed when the arterial input was placed in the left ECA. CONCLUSIONS BF, BV, and MTT demonstrated higher inter- and intraobserver agreement than PS. The selection of arterial input, right-versus-left ECA, may determine changes in CTP measurements in patients with SCCA of the upper aerodigestive tract.
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Affiliation(s)
- G Petralia
- Department of Radiology, European Institute of Oncology, Milan, Italy.
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Decaminada N, Pernter P, Imondi A, Tomassini A. CT Perfusion Evaluation of Cerebral Haemodynamics before and after Cranioplasty. Neuroradiol J 2008; 21:459-71. [PMID: 24256951 DOI: 10.1177/197140090802100402] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2008] [Accepted: 05/13/2008] [Indexed: 11/16/2022] Open
Abstract
CT Perfusion imaging is usually applied to assess perfusion abnormalities in acute stroke. This prospective study applied the technique to monitor cerebral haemodynamics before and after cranioplasty. Cranioplasty is the surgical correction of a skull defect using autologous or heterologous material to obtain cosmetic repair, restoration of brain protection and neurological improvement (1). As far as we know the effect of cranioplasty on cerebral haemodynamics flow has been analysed by CT perfusion only in one article (2). We tested the examination as method of monitoring intracranial haemodynamics in a larger number of patients evaluating its reliability and efficacy. We prospectively examined cerebral haemodynamics with Perfusion CT before and after (two weeks, three and six months) cranioplasty in ten patients. The data evaluation of dynamic CT was done by an application software package on a workstation (Leonardo) permitting the use of visual assessment combined with quantitative analysis with ROIs. There was a comparison of CBF, CBV and TTP values between the regions of interest and mirror-image control regions, and in the three different examinations for each patient. After cranioplasty there was clearly an improvement in neurological symptoms and CT perfusion in the majority of cases showed a slight increase in CBF, CBV and decrease of TTP in the cerebral parenchyma close to the cranioplasty, not only on the symptomatic side but also on the opposite side. Even though there was neurological improvement and improved cranial perfusion from the first to the last examinations, our data were not statistically significant. The method is easily reproducible, well tolerated by all patients but has several limitations related to data processing and radiation exposure.
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Affiliation(s)
- N Decaminada
- Radiology Department, Bolzano Central Hospital; Bolzano, Italy -
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15
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Wintermark M, Lau BC, Chien J, Arora S. The anterior cerebral artery is an appropriate arterial input function for perfusion-CT processing in patients with acute stroke. Neuroradiology 2007; 50:227-36. [DOI: 10.1007/s00234-007-0336-8] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2007] [Accepted: 10/18/2007] [Indexed: 10/22/2022]
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