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Zaid Al-Kaylani AHA, Schuurmann RCL, Maathuis WD, Slart RHJA, de Vries JPPM, Bokkers RPH. Clinical Applications of Conebeam CTP Imaging in Cerebral Disease: A Systematic Review. AJNR Am J Neuroradiol 2023; 44:922-927. [PMID: 37414451 PMCID: PMC10411850 DOI: 10.3174/ajnr.a7930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Accepted: 06/11/2023] [Indexed: 07/08/2023]
Abstract
BACKGROUND Perfusion imaging with multidetector CT is integral to the evaluation of patients presenting with ischemic stroke due to large-vessel occlusion. Using conebeam CT perfusion in a direct-to-angio approach could reduce workflow times and improve functional outcome. PURPOSE Our aim was to provide an overview of conebeam CT techniques for quantifying cerebral perfusion, their clinical applications, and validation. DATA SOURCES A systematic search was performed for articles published between January 2000 and October 2022 in which a conebeam CT imaging technique for quantifying cerebral perfusion in human subjects was compared against a reference technique. STUDY SELECTION Eleven articles were retrieved describing 2 techniques: dual-phase (n = 6) and multiphase (n = 5) conebeam CTP. DATA ANALYSIS Descriptions of the conebeam CT techniques and the correlations between them and the reference techniques were retrieved. DATA SYNTHESIS Appraisal of the quality and risk of bias of the included studies revealed little concern about bias and applicability. Good correlations were reported for dual-phase conebeam CTP; however, the comprehensiveness of its parameter is unclear. Multiphase conebeam CTP demonstrated the potential for clinical implementation due to its ability to produce conventional stroke protocols. However, it did not consistently correlate with the reference techniques. LIMITATIONS The heterogeneity within the available literature made it impossible to apply meta-analysis to the data. CONCLUSIONS The reviewed techniques show promise for clinical use. Beyond evaluating their diagnostic accuracy, future studies should address the practical challenges associated with implementing these techniques and the potential benefits for different ischemic diseases.
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Affiliation(s)
- A H A Zaid Al-Kaylani
- Department of Radiology (A.H.A.Z.A., R.H.J.A.S., R.P.H.B.), Medical Imaging Center
- Department of Surgery (A.H.A.Z.A., R.C.L.S., J.-P.M.P.d.V.), Division of Vascular Surgery
| | - R C L Schuurmann
- Department of Surgery (A.H.A.Z.A., R.C.L.S., J.-P.M.P.d.V.), Division of Vascular Surgery
| | - W D Maathuis
- Department of Biomedical Photonic Imaging (W.D.M., R.H.J.A.S.), Faculty of Science and Technology, University of Twente, Enschede, the Netherlands
| | - R H J A Slart
- Department of Radiology (A.H.A.Z.A., R.H.J.A.S., R.P.H.B.), Medical Imaging Center
- Department of Nuclear Medicine and Molecular Imaging (R.H.J.A.S.), University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
- Department of Biomedical Photonic Imaging (W.D.M., R.H.J.A.S.), Faculty of Science and Technology, University of Twente, Enschede, the Netherlands
| | - J-P P M de Vries
- Department of Surgery (A.H.A.Z.A., R.C.L.S., J.-P.M.P.d.V.), Division of Vascular Surgery
| | - R P H Bokkers
- Department of Radiology (A.H.A.Z.A., R.H.J.A.S., R.P.H.B.), Medical Imaging Center
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van der Zijden T, Mondelaers A, Loos C, Voormolen M, Franck C, Niekel M, Jardinet T, Van Thielen T, d'Archambeau O, Menovsky T, Parizel PM. Can angiographic Flat Detector Computed Tomography blood volume measurement be used to predict final infarct size in acute ischemic stroke? Eur J Radiol 2023; 158:110650. [PMID: 36549171 DOI: 10.1016/j.ejrad.2022.110650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 10/30/2022] [Accepted: 12/10/2022] [Indexed: 12/15/2022]
Abstract
INTRODUCTION AND PURPOSE Flat detector computed tomography (FD-CT) technology is becoming more widely available in the angiography suites of comprehensive stroke centers. In patients with acute ischemic stroke (AIS), who are referred for endovascular therapy (EVT), FD-CT generates cerebral pooled blood volume (PBV) maps, which might help in predicting the final infarct area. We retrospectively analyzed pre- and post-recanalization therapy quantitative PBV measurements in both the infarcted and hypoperfused brain areas of AIS patients referred for EVT. MATERIALS AND METHODS We included AIS patients with large vessel occlusion in the anterior circulation referred for EVT from primary stroke centers to our comprehensive stroke center. The pre- and post-recanalization FD-CT regional relative PBV (rPBV) values were measured between ipsilateral lesional and contralateral non-lesional areas based on final infarct area on post EVT follow-up cross-sectional imaging. Statistical analysis was performed to identify differences in PBV values between infarcted and non-infarcted, recanalized brain areas. RESULTS We included 20 AIS patients. Mean age was 63 years (ranging from 36 to 86 years). The mean pre- EVT rPBV value was 0.57 (±0.40) for infarcted areas and 0.75 (±0.43) for hypoperfusion areas. The mean differences (Δ) between pre- and post-EVT rPBV values for infarcted and hypoperfused areas were respectively 0.69 (±0.59) and 0.69 (±0.90). We found no significant differences (p > 0.05) between pre-EVT rPBV and ΔrPBV values of infarct areas and hypoperfusion areas. CONCLUSION Angiographic PBV mapping is useful for the detection of cerebral perfusion deficits, especially in combination with the fill run images. However, we were not able to distinguish irreversibly infarcted tissue from potentially salvageable, hypoperfused brain tissue based on quantitative PBV measurement in AIS patients.
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Affiliation(s)
- Thijs van der Zijden
- Department of Radiology, Antwerp University Hospital (UZA), 2650 Edegem, Belgium; Department of Medical Imaging, AZ KLINA, 2930 Brasschaat, Belgium.
| | - Annelies Mondelaers
- Department of Radiology, Antwerp University Hospital (UZA), 2650 Edegem, Belgium; Research Group mVision, Faculty of Medicine and Health Sciences, University of Antwerp (UA), 2610 Wilrijk, Belgium
| | - Caroline Loos
- Department of Neurology, Antwerp University Hospital (UZA), 2650 Edegem, Belgium; Research Group Translational Neurosciences, Faculty of Medicine and Health Sciences, University of Antwerp, (UA), 2610 Wilrijk, Belgium
| | - Maurits Voormolen
- Department of Radiology, Antwerp University Hospital (UZA), 2650 Edegem, Belgium; Research Group mVision, Faculty of Medicine and Health Sciences, University of Antwerp (UA), 2610 Wilrijk, Belgium
| | - Caro Franck
- Department of Radiology, Antwerp University Hospital (UZA), 2650 Edegem, Belgium; Research Group mVision, Faculty of Medicine and Health Sciences, University of Antwerp (UA), 2610 Wilrijk, Belgium
| | - Maarten Niekel
- Department of Radiology, Antwerp University Hospital (UZA), 2650 Edegem, Belgium
| | - Thomas Jardinet
- Department of Radiology, Antwerp University Hospital (UZA), 2650 Edegem, Belgium
| | - Thomas Van Thielen
- Department of Radiology, Antwerp University Hospital (UZA), 2650 Edegem, Belgium; Department of Medical Imaging, AZ KLINA, 2930 Brasschaat, Belgium
| | - Olivier d'Archambeau
- Department of Radiology, Antwerp University Hospital (UZA), 2650 Edegem, Belgium
| | - Tomas Menovsky
- Research Group Translational Neurosciences, Faculty of Medicine and Health Sciences, University of Antwerp, (UA), 2610 Wilrijk, Belgium; Department of Neurosurgery, Antwerp University Hospital (UZA), 2650 Edegem, Belgium
| | - Paul M Parizel
- Research Group mVision, Faculty of Medicine and Health Sciences, University of Antwerp (UA), 2610 Wilrijk, Belgium; Department of Radiology, Royal Perth Hospital and University of Western Australia Medical School, Perth, WA, Australia; Director, Western Australia National Imaging Facility (WA NIF) Node, Perth, WA, Australia
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Flat Detector CT with Cerebral Pooled Blood Volume Perfusion in the Angiography Suite: From Diagnostics to Treatment Monitoring. Diagnostics (Basel) 2022; 12:diagnostics12081962. [PMID: 36010312 PMCID: PMC9406673 DOI: 10.3390/diagnostics12081962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 08/09/2022] [Accepted: 08/12/2022] [Indexed: 11/17/2022] Open
Abstract
C-arm flat-panel detector computed tomographic (CT) imaging in the angiography suite increasingly plays an important part during interventional neuroradiological procedures. In addition to conventional angiographic imaging of blood vessels, flat detector CT (FD CT) imaging allows simultaneous 3D visualization of parenchymal and vascular structures of the brain. Next to imaging of anatomical structures, it is also possible to perform FD CT perfusion imaging of the brain by means of cerebral blood volume (CBV) or pooled blood volume (PBV) mapping during steady state contrast administration. This enables more adequate decision making during interventional neuroradiological procedures, based on real-time insights into brain perfusion on the spot, obviating time consuming and often difficult transportation of the (anesthetized) patient to conventional cross-sectional imaging modalities. In this paper we review the literature about the nature of FD CT PBV mapping in patients and demonstrate its current use for diagnosis and treatment monitoring in interventional neuroradiology.
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Wen L, Zhou L, Wu Q, Zhou X, Zhang X. Feasibility of FDCT Early Brain Parenchymal Blood Volume Maps in Predicting Short-Term Prognosis in Patients With Aneurysmal Subarachnoid Hemorrhage. Front Neurol 2022; 13:888369. [PMID: 35911895 PMCID: PMC9329812 DOI: 10.3389/fneur.2022.888369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 06/16/2022] [Indexed: 11/13/2022] Open
Abstract
Purpose Aneurysmal subarachnoid hemorrhage (SAH) is accompanied by cerebral perfusion changes. We aimed to measure the parenchymal blood volume (PBV) maps acquired by C-arm flat-panel detector CT (FDCT) to assess the cerebral blood volume at an early stage in aneurysmal SAH and to explore the correlation with the outcomes at discharge. Methods Data of 66 patients with aneurysmal SAH who underwent FDCT PBV examination were retrospectively analyzed. The PBV of regions of interest, including the cortices of the bilateral frontal lobe, the parietal lobe, the occipital lobe, and the cerebral hemisphere, as well as the basal ganglia, were measured and quantitatively analyzed. The clinical and imaging data of the patients were also collected, and logistic regression analysis was performed to explore the correlation between the perfusion parameters and outcomes at discharge. Results The favorable and poor outcomes at discharge were found in 37 (56.06%) and 29 (43.94%) patients, respectively. The whole-brain PBV was significantly correlated with the Hunt-Hess grades (p < 0.005) and the WFNSS grades (p < 0.005). The whole-brain PBV of the poor prognosis was significantly higher than that of the favorable prognosis (35.17 ± 7.66 vs. 29.78 ± 5.54, p < 0.005). The logistic regression analysis showed that the PBV of the parietal lobe at the bleeding side (OR = 1.10, 95%CI: 1.00-1.20, p = 0.04) was an independent risk factor predicting the short-term prognosis. Conclusions Parenchymal blood volume (PBV) maps could reflect the cerebral blood volume throughout the brain to characterize its perfusion status at an early stage in aneurysmal SAH. It enables a one-stop imaging evaluation and treatment in the same angio-suite and may serve as a reliable technique in clinical assessment of aneurysmal SAH.
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Affiliation(s)
- Lili Wen
- Department of Neurosurgery, Sir Run Run Hospital, Nanjing Medical University, Nanjing, China
| | - Longjiang Zhou
- Medical Imaging Center, The Affiliated Hospital of Yangzhou University, Yangzhou, China
| | - Qi Wu
- Department of Neurosurgery, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
| | - Xiaoming Zhou
- Department of Neurosurgery, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
| | - Xin Zhang
- Department of Neurosurgery, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
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van der Zijden T, Mondelaers A, Franck C, Voormolen M, Menovsky T. Selective Angiographic Flat Detector Computer Tomography Blood Volume Imaging in Pre-Operative Vascular Mapping and Embolization of Hypervascular Intracranial Tumors-Preliminary Clinical Experience. Diagnostics (Basel) 2022; 12:1185. [PMID: 35626340 PMCID: PMC9139786 DOI: 10.3390/diagnostics12051185] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 05/07/2022] [Accepted: 05/09/2022] [Indexed: 02/04/2023] Open
Abstract
Pre-operative embolization of hypervascular intracranial tumors can be performed to reduce bleeding complications during resection. Accurate vascular mapping of the tumor is necessary for both the correct indication setting for embolization and for the evaluation of the performed embolization. We prospectively examined the role of whole brain and selective parenchymal blood volume (PBV) flat detector computer tomography perfusion (FD CTP) imaging in pre-operative angiographic mapping and embolization of patients with hypervascular intracranial tumors. Whole brain FD CTP imaging with a contrast injection from the aortic root and selective contrast injection in the dural feeding arteries was performed in five patients referred for tumor resection. Regional relative PBV values were obtained pre- and post-embolization. Total tumor volumes with selective external carotid artery (ECA) supply volumes and post-embolization devascularized tumor volumes were determined as well. In all patients, including four females and one male, with a mean age of 54.2 years (range 44-64 years), the PBV scans were performed without adverse events. The average ECA supply was 54% (range 31.5-91%). The mean embolized tumor volume was 56.5% (range 25-94%). Relative PBV values decreased from 5.75 ± 1.55 before embolization to 2.43 ± 1.70 post-embolization. In one patient, embolization was not performed because of being considered not beneficial for the resection. Angiographic FD CTP imaging of the brain tumor allows 3D identification and quantification of individual tumor feeder arteries. Furthermore, the technique enables monitoring of the efficacy of pre-operative endovascular tumor embolization.
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Affiliation(s)
- Thijs van der Zijden
- Department of Radiology, Antwerp University Hospital (UZA), 2650 Edegem, Belgium; (C.F.); (M.V.)
- Department of Medical Imaging, AZ Klina, 2930 Brasschaat, Belgium
| | - Annelies Mondelaers
- Department of Radiology, Antwerp University Hospital (UZA), 2650 Edegem, Belgium; (C.F.); (M.V.)
- Research Group mVision, Faculty of Medicine and Health Sciences, University of Antwerp (UA), 2610 Antwerp, Belgium
| | - Caro Franck
- Department of Radiology, Antwerp University Hospital (UZA), 2650 Edegem, Belgium; (C.F.); (M.V.)
- Research Group mVision, Faculty of Medicine and Health Sciences, University of Antwerp (UA), 2610 Antwerp, Belgium
| | - Maurits Voormolen
- Department of Radiology, Antwerp University Hospital (UZA), 2650 Edegem, Belgium; (C.F.); (M.V.)
- Research Group mVision, Faculty of Medicine and Health Sciences, University of Antwerp (UA), 2610 Antwerp, Belgium
| | - Tomas Menovsky
- Department of Neurosurgery, Antwerp University Hospital (UZA), 2650 Edegem, Belgium;
- Research Group Translational Neurosciences, Faculty of Medicine and Health Sciences, University of Antwerp (UA), 2610 Antwerp, Belgium
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Diagnostic accuracy of flat-panel computed tomography in assessing cerebral perfusion in comparison with perfusion computed tomography and perfusion magnetic resonance: a systematic review. Neuroradiology 2019; 61:1457-1468. [PMID: 31523757 PMCID: PMC6848034 DOI: 10.1007/s00234-019-02285-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Accepted: 08/26/2019] [Indexed: 12/09/2022]
Abstract
Purpose Flat-panel computed tomography (FP-CT) is increasingly available in angiographic rooms and hybrid OR’s. Considering its easy access, cerebral imaging using FP-CT is an appealing modality for intra-procedural applications. The purpose of this systematic review is to assess the diagnostic accuracy of FP-CT compared with perfusion computed tomography (CTP) and perfusion magnetic resonance (MRP) in cerebral perfusion imaging. Methods We performed a systematic literature search in the Cochrane Library, MEDLINE, Embase, and Web of Science up to June 2019 for studies directly comparing FP-CT with either CTP or MRP in vivo. Methodological quality was assessed using the QUADAS-2 tool. Data on diagnostic accuracy was extracted and pooled if possible. Results We found 11 studies comparing FP-CT with CTP and 5 studies comparing FP-CT with MRP. Most articles were pilot or feasibility studies, focusing on scanning and contrast protocols. All patients studied showed signs of cerebrovascular disease. Half of the studies were animal trials. Quality assessment showed unclear to high risks of bias and low concerns regarding applicability. Five studies reported on diagnostic accuracy; FP-CT shows good sensitivity (range 0.84–1.00) and moderate specificity (range 0.63–0.88) in detecting cerebral blood volume (CBV) lesions. Conclusions Even though FP-CT provides similar CBV values and reconstructed blood volume maps as CTP in cerebrovascular disease, additional studies are required in order to reliably compare its diagnostic accuracy with cerebral perfusion imaging. Electronic supplementary material The online version of this article (10.1007/s00234-019-02285-y) contains supplementary material, which is available to authorized users.
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Asai K, Nakamura H, Watabe T, Nishida T, Sakaguchi M, Hatazawa J, Yoshimine T, Kishima H. X-ray angiography perfusion imaging with an intra-arterial injection: comparative study with 15O-gas/water positron emission tomography. J Neurointerv Surg 2017; 10:780-783. [DOI: 10.1136/neurintsurg-2017-013487] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2017] [Revised: 11/12/2017] [Accepted: 11/14/2017] [Indexed: 11/03/2022]
Abstract
BackgroundX-ray angiography perfusion (XAP) is a perfusion imaging technique based on conventional DSA.ObjectiveIn this study, we aimed to validate parameters derived from XAP by comparing them with 15O-gas/water positron emission tomography (PET), using data from patients with chronic ischemic cerebrovascular disease.Methods18 consecutive patients were included. XAP was performed with intra-arterial infusion of contrast media, and a time–density curve was constructed for each cerebral hemisphere. From the curves, the relative values of mean transit time (rMTT) and wash-in rate (rWiR) were obtained by dividing the values of the right hemisphere by those of the left hemisphere. These were then compared with the relative values of cerebral blood flow (rCBF) and rMTT calculated from the PET data.ResultsXAP rWiR correlated strongly with PET rCBF (r=0.86, P<0.0001). rMTT measurements from the two modalities were also strongly correlated (r=0.85, P<0.0001). Bland–Altman analysis revealed a bias of 0.14±0.18 (95% limits of agreement −0.22 to 0.51) for PET rCBF versus XAP rWiR, and 0.016±0.093 (95% limits of agreement −0.17 to 0.20) for rMTT between the two modalities.ConclusionsThe relative values obtained from XAP were validated across a population of patients with chronic ischemic cerebrovascular disease.
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Garcia M, Okell TW, Gloor M, Chappell MA, Jezzard P, Bieri O, Byrne JV. Feasibility of Flat Panel Detector CT in Perfusion Assessment of Brain Arteriovenous Malformations: Initial Clinical Experience. AJNR Am J Neuroradiol 2017; 38:735-739. [PMID: 28209577 DOI: 10.3174/ajnr.a5091] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2016] [Accepted: 12/01/2016] [Indexed: 11/07/2022]
Abstract
The different results from flat panel detector CT in various pathologies have provoked some discussion. Our aim was to assess the role of flat panel detector CT in brain arteriovenous malformations, which has not yet been assessed. Five patients with brain arteriovenous malformations were studied with flat panel detector CT, DSC-MR imaging, and vessel-encoded pseudocontinuous arterial spin-labeling. In glomerular brain arteriovenous malformations, perfusion was highest next to the brain arteriovenous malformation with decreasing values with increasing distance from the lesion. An inverse tendency was observed in the proliferative brain arteriovenous malformation. Flat panel detector CT, originally thought to measure blood volume, correlated more closely with arterial spin-labeling-CBF and DSC-CBF than with DSC-CBV. We conclude that flat panel detector CT perfusion depends on the time point chosen for data collection, which is triggered too early in these patients (ie, when contrast agent appears in the superior sagittal sinus after rapid shunting through the brain arteriovenous malformation). This finding, in combination with high data variability, makes flat panel detector CT inappropriate for perfusion assessment in brain arteriovenous malformations.
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Affiliation(s)
- M Garcia
- From the Division of Diagnostic and Interventional Neuroradiology (M. Garcia) .,Nuffield Department of Surgical Sciences and Department of Neuroradiology (M. Garcia, J.V.B.)
| | - T W Okell
- Centre for Functional Magnetic Resonance Imaging of the Brain (FMRIB Centre) (T.W.O., M.A.C., P.J.), Nuffield Department of Neurosciences
| | - M Gloor
- Division of Radiological Physics (M. Gloor, O.B.), Department of Radiology Clinic for Radiology and Nuclear Medicine, University of Basel Hospital, Basel, Switzerland
| | - M A Chappell
- Centre for Functional Magnetic Resonance Imaging of the Brain (FMRIB Centre) (T.W.O., M.A.C., P.J.), Nuffield Department of Neurosciences.,Institute of Biomedical Engineering (M.A.C.), Department of Engineering, University of Oxford, Oxford, United Kingdom
| | - P Jezzard
- Centre for Functional Magnetic Resonance Imaging of the Brain (FMRIB Centre) (T.W.O., M.A.C., P.J.), Nuffield Department of Neurosciences
| | - O Bieri
- Division of Radiological Physics (M. Gloor, O.B.), Department of Radiology Clinic for Radiology and Nuclear Medicine, University of Basel Hospital, Basel, Switzerland
| | - J V Byrne
- Nuffield Department of Surgical Sciences and Department of Neuroradiology (M. Garcia, J.V.B.)
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Wen LL, Zhang X, Zhang QR, Wu Q, Chen SJ, Deng JL, Huang K, Wang HD. Flat-detector computed tomography PBV map in the evaluation of presurgical embolization for hypervascular brain tumors. J Neurointerv Surg 2016; 9:1139-1144. [PMID: 27856651 DOI: 10.1136/neurintsurg-2016-012658] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2016] [Revised: 10/22/2016] [Accepted: 10/27/2016] [Indexed: 11/04/2022]
Abstract
BACKGROUND Preoperative embolization of hypervascular brain tumors is frequently used to minimize intraoperative bleeding. OBJECTIVE To explore the efficacy of embolization using flat-detector CT (FDCT) parenchymal blood volume (PBV) maps before and after the intervention. MATERIALS AND METHODS Twenty-five patients with hypervascular brain tumors prospectively received pre- and postprocedural FDCT PBV scans using a biplane system under a protocol approved by the institutional research ethics committee. Semiquantitative analysis, based on region of interest measurements of the pre- and post-embolization PBV maps, operating time, and blood loss, was performed to assess the feasibility of PBV maps in detecting the perfusion deficit and to evaluate the efficacy of embolization. RESULTS Preoperative embolization was successful in 18 patients. The relative PBV decreased significantly from 3.98±1.41 before embolization to 2.10±2.00 after embolization. Seventeen patients underwent surgical removal of tumors 24 hours after embolization. The post-embolic tumor perfusion index correlated significantly with blood loss (ρ=0.55) and operating time (ρ=0.60). CONCLUSIONS FDCT PBV mapping is a useful method for evaluating the perfusion of hypervascular brain tumors and the efficacy of embolization. It can be used as a supplement to CT perfusion, MRI, and DSA in the evaluation of tumor embolization.
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Affiliation(s)
- Li-Li Wen
- Department of Neurosurgery, Jinling Hospital, Jinling School of Clinical Medicine, Nanjing Medical University, Nanjing, PR China
| | - Xin Zhang
- Department of Neurosurgery, Jinling Hospital, Nanjing University School of Medicine, Nanjing, PR China
| | - Qing-Rong Zhang
- Department of Neurosurgery, Jinling Hospital, Nanjing University School of Medicine, Nanjing, PR China
| | - Qi Wu
- Department of Neurosurgery, Jinling Hospital, Nanjing University School of Medicine, Nanjing, PR China
| | - Shu-Juan Chen
- Department of Neurosurgery, Jinling Hospital, Nanjing University School of Medicine, Nanjing, PR China
| | - Jin-Long Deng
- Department of Neurosurgery, Jinling Hospital, Nanjing University School of Medicine, Nanjing, PR China
| | | | - Han-Dong Wang
- Department of Neurosurgery, Jinling Hospital, Jinling School of Clinical Medicine, Nanjing Medical University, Nanjing, PR China
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Kamran M, Byrne JV. Time density curve analysis for C-arm FDCT PBV imaging. Interv Neuroradiol 2016; 22:176-86. [PMID: 26769736 DOI: 10.1177/1591019915622169] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2015] [Accepted: 11/22/2015] [Indexed: 01/04/2023] Open
Abstract
INTRODUCTION Parenchymal blood volume (PBV) estimation using C-arm flat detector computed tomography (FDCT) assumes a steady-state contrast concentration in cerebral vasculature for the scan duration. Using time density curve (TDC) analysis, we explored if the steady-state assumption is met for C-arm CT PBV scans, and how consistent the contrast-material dynamics in cerebral vasculature are across patients. METHODS Thirty C-arm FDCT datasets of 26 patients with aneurysmal-SAH, acquired as part of a prospective study comparing C-arm CT PBV with MR-PWI, were analysed. TDCs were extracted from the 2D rotational projections. Goodness-of-fit of TDCs to a steady-state horizontal-line-model and the statistical similarity among the individual TDCs were tested. Influence of the differences in TDC characteristics on the agreement of resulting PBV measurements with MR-CBV was calculated. RESULTS Despite identical scan parameters and contrast-injection-protocol, the individual TDCs were statistically non-identical (p < 0.01). Using Dunn's multiple comparisons test, of the total 435 individual comparisons among the 30 TDCs, 330 comparisons (62%) reached statistical significance for difference. All TDCs deviated significantly (p < 0.01) from the steady-state horizontal-line-model. PBV values of those datasets for which the TDCs showed largest deviations from the steady-state model demonstrated poor agreement and correlation with MR-CBV, compared with the PBV values of those datasets for which the TDCs were closer to steady-state. CONCLUSION For clinical C-arm CT PBV examinations, the administered contrast material does not reach the assumed 'ideal steady-state' for the duration of scan. Using a prolonged injection protocol, the degree to which the TDCs approximate the ideal steady-state influences the agreement of resulting PBV measurements with MR-CBV.
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Affiliation(s)
- Mudassar Kamran
- Nuffield Department of Surgical Sciences, University of Oxford, UK
| | - James V Byrne
- Nuffield Department of Surgical Sciences, University of Oxford, UK
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Kamran M, Byrne JV. Whole brain C-arm computed tomography parenchymal blood volume measurements. Interv Neuroradiol 2016; 22:165-75. [PMID: 26769737 DOI: 10.1177/1591019915622168] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2015] [Accepted: 11/22/2015] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION C-arm flat detector computed tomography (FDCT) parenchymal blood volume (PBV) imaging in the neuro-interventional suite is a new technique for which detailed whole brain measurements have not been previously reported. This study aims to create a catalogue of PBV measurements for various anatomical regions encompassing the whole brain, using a three-dimensional volume-of-interest (3D-VOI) analysis. METHODS We acquired and analysed 30 C-arm FDCT datasets from 26 patients with aneurysmal subarachnoid haemorrhage (SAH), as part of a prospective study comparing C-arm computed tomography (CT) PBV with magnetic resonance perfusion-weighted imaging (MR-PWI). We calculated the PBV values for various brain regions with an automated analysis, using 58 pre-defined atlas-based 3D-VOIs encompassing the whole brain. VOIs partially or completely overlapping regions of magnetic resonance diffusion weighted imaging (MR-DWI) abnormality or magnetic resonance cerebral blood flow (MR-CBF) asymmetry were excluded from the analysis. RESULTS Of the 30 C-arm CT PBV datasets, 14 (54%; 12 patients) had areas of restricted diffusion, the majority of which were focal. The PBV values for the cerebral cortex and cerebral white matter were 4.01 ± 0.47 (mean ± SD) and 3.01 ± 0.39 ml per 100 ml. Lobar PBV values were: frontal lobe 4.2 ± 0.8, temporal lobe 4.2 ± 0.9, parietal lobe 3.9 ± 0.7 and occipital lobe 4.3 ± 0.8 ml/100 ml. The basal ganglia and brainstem PBV values were 3.4 ± 0.7 and 4.6 ± 0.6 ml/100 ml, respectively. CONCLUSIONS Compared with the typical reference cerebral blood volume (CBV) values reported in the literature for Positron Emission Tomography (PET), the PBV values were relatively high for the white matter and relatively low for the cortical grey matter. The reported catalogue of PBV values for various brain regions would be useful to inform future studies and could be used in clinical practice, when interpreting PBV maps.
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Affiliation(s)
- Mudassar Kamran
- Nuffield Department of Surgical Sciences, University of Oxford, Headington, Oxford, UK
| | - James V Byrne
- Nuffield Department of Surgical Sciences, University of Oxford, Headington, Oxford, UK
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