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Jiang Y, Jiang J, Li J, Hui Q, Tang J, Wang G, Zhang Y, Ma C. Enhancing acute stroke assessment: evaluating the clinical utility of the "Real" one-stop-shop scan protocol combining brain computed tomography perfusion and head-and-neck computed tomography angiography using a 512-slice detector computed tomography scanner. Clin Radiol 2024:S0009-9260(24)00413-6. [PMID: 39198108 DOI: 10.1016/j.crad.2024.07.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Revised: 07/26/2024] [Accepted: 07/30/2024] [Indexed: 09/01/2024]
Abstract
AIM To assess the efficiency and diagnostic value of the "real" one-stop-shop protocol integrating the computed tomography angiography (CTA) sequence of the head and neck into the computed tomography perfusion (CTP) acquisition using a 512-slice detector CT scanner in patients who suffered from acute ischemic stroke. MATERIALS AND METHODS This prospective study included 100 patients suspected of acute ischemic stroke. The patients were randomly divided into two groups: the control group (n=50) who underwent the traditional protocol (brain CTP and head-and-neck CTA examination separately) and the experimental group (n=50) who underwent a one-stop-shop protocol (combined brain CT perfusion and head-and-neck CTA, the CTA triggering time determined by a low-dose test bolus injection). The examination time, contrast-agent dosage, radiation dose, postprocessing time, and image quality were compared between the two groups. RESULTS Compared to the control group, the experimental group had a significantly lower total iodine contrast-agent dosage (80 vs. 100 ml, P<0.001) and shorter scan time (3.23 [3.13, 3.35] vs. 2.32 [2.17, 2.45] min, P<0.001). Additionally, the radiation dose exposure was lower in the experimental group than in the control group (5129.00 [5173, 5232] vs. 4681.35 [4555.12, 4822.95] mGy-cm, P<0.001). No statistically significant differences were observed between the two groups in terms of postprocessing time, head-and-neck CTA, and CTP imaging quality. CONCLUSION The one-stop-shop protocol enables effective detection of lesions, providing clear visualization of the location and degree of stenosis in the head-and-neck vessels. It achieves this with lower costs in scan time, contrast-agent dosage, and radiation dose compared to the traditional protocol and is thus worth considering as the first examination for patients who suffer from acute ischemic stroke.
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Affiliation(s)
- Y Jiang
- Department of Radiology, Deyang People's Hospital, 173# Taishan Bei Road, Jingyang District, Deyang, 618000, Sichuan, China
| | - J Jiang
- Department of Radiology, Deyang People's Hospital, 173# Taishan Bei Road, Jingyang District, Deyang, 618000, Sichuan, China
| | - J Li
- Department of Thyroid and Breast Surgery, General Hospital of Western Theater Command of Chinese People's Liberation Army, Chengdu, Sichuan, China
| | - Q Hui
- Department of Radiology, Deyang People's Hospital, 173# Taishan Bei Road, Jingyang District, Deyang, 618000, Sichuan, China
| | - J Tang
- Department of Radiology, Deyang People's Hospital, 173# Taishan Bei Road, Jingyang District, Deyang, 618000, Sichuan, China
| | - G Wang
- CT Business Unit, Neusoft Medical System Company, Shenyang, China
| | - Y Zhang
- Department of Radiology, Deyang People's Hospital, 173# Taishan Bei Road, Jingyang District, Deyang, 618000, Sichuan, China
| | - C Ma
- Department of Radiology, Deyang People's Hospital, 173# Taishan Bei Road, Jingyang District, Deyang, 618000, Sichuan, China.
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Stein T, Kellner E, Mueller-Peltzer K, Elsheikh S, Reisert M, Hosp JA, Bamberg F, Urbach H, Rau A. Assessing bolus peak position in CT perfusion: High variance persisting despite age-dependency in a large cohort. Eur J Radiol 2024; 177:111595. [PMID: 38970994 DOI: 10.1016/j.ejrad.2024.111595] [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: 03/09/2024] [Revised: 06/12/2024] [Accepted: 06/28/2024] [Indexed: 07/08/2024]
Abstract
PURPOSE CT perfusion (CTP) is a valuable tool in suspected acute ischemic stroke. A substantial variability of the delay between contrast injection and bolus arrival in the brain is conceivable. We investigated the distribution of the peak positions of the concentration time curves measured in an artery (arterial input function, AIF) and - in cases with ischemia - also measured in the penumbra. METHODS We report on 2624 perfusion scans (52 % female, mean age 72.2 ± 14.4 years) with stroke present in 1636 cases. From the attenuation time curves of the AIF and the penumbra, we calculated the respective bolus peak positions and investigated the distribution of the peak positions. Further, we analyzed the bolus peak positions for associations with age. RESULTS The bolus peaked significantly later in older patients, both in the AIF and in the penumbra (all p < 0.001). In the whole cohort, we found a significant association of age with the bolus peak position of the AIF (ρ = 0.334; p < 0.001). In patients with stroke, age was also associated to the peak position of the AIF (ρ = 0.305; p < 0.001), and the penumbra (ρ = 0.246, p < 0.001). However, a substantial range of peak positions of the AIF and penumbra was noted across all age ranges. CONCLUSIONS This study revealed a strong age-dependency of the contrast bolus arrival in both healthy and ischemic tissue. This variability makes non-uniform sampling schemes, which have been suggested to reduce radiation dose, problematic, as they might not always optimally capture the bolus in all cases.
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Affiliation(s)
- Thomas Stein
- Department of Diagnostic and Interventional Radiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Elias Kellner
- Medical Physics, Department of Diagnostic and Interventional Radiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Katharina Mueller-Peltzer
- Department of Diagnostic and Interventional Radiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Samer Elsheikh
- Department of Neuroradiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Marco Reisert
- Medical Physics, Department of Diagnostic and Interventional Radiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany; Department of Stereotactic and Functional Neurosurgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Jonas A Hosp
- Department of Neurology and Clinical Neuroscience, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Fabian Bamberg
- Department of Diagnostic and Interventional Radiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Horst Urbach
- Department of Neuroradiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Alexander Rau
- Department of Neuroradiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
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Mo X, Cui Y, Yuan J, Hang Z, Jiang X, Duan G, Liang L, Huang Z, Li S, Sun P, Chen W, Wei L, Guo Y, Deng D. Study on a new "One-stop-shop" scan protocol combining brain CT perfusion and head-and-neck CT angiography by using 256-detector CT for stroke patients. Eur J Radiol 2022; 154:110426. [PMID: 35797790 DOI: 10.1016/j.ejrad.2022.110426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Revised: 03/20/2022] [Accepted: 06/24/2022] [Indexed: 12/30/2022]
Abstract
PURPOSE We sought to evaluate the performance of a new "one-stop-shop" scan protocol combining brain computed tomography perfusion (CTP) and head-and-neck CT angiography (CTA) imaging for acute stroke patients using a 256-detector CT scanner. METHOD From March to August 2020, 60 patients (30 men and 30 women) aged 22-88 years with suspected acute stroke were enrolled and randomly divided into 2 groups to undergo brain CTP and head-and-neck CTA with a 256-detector CT system. Group A used traditional scan protocol with a separate brain CTP and head-and-neck CT examination that included non-contrast-enhanced and contrast-enhanced acquisitions; group B used the new "one-stop-shop" scan protocol with head-and-neck CTA data inserted into brain CTP scans at the peak time (PT) of the arterial phase. The insertion point of the head-and-neck CTA data was determined by a test bolus. The examination time, contrast dose, radiation dose, and image quality were compared between the groups. RESULTS The total contrast dose was reduced by 40% in group B compared to group A (60 mL vs. 100 mL). The imaging time was 52.5 ± 2.6 s in group B and 74.9 ± 3.3 s in group A, showing a reduction of approximately 43% in group B. There was no significant difference in image quality both quantitatively and qualitatively between the groups (all P > 0.05). Group B had a slight reduction in dose length product (1139.0 ± 45.3 vs. 1211.6 ± 31.9 mGy·cm, P < 0.001). CONCLUSIONS The proposed "one-stop-shop" scan protocol combining brain CTP and head-and-neck CTA on a 256-detector CT system can reduce imaging time and contrast dose, without affecting image quality or perfusion results, compared to the traditional protocol of separating the examinations.
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Affiliation(s)
- Xiaping Mo
- Department of Radiology, First Affiliated Hospital, Guangxi University of Chinese Medicine, Nanning 530023, Guangxi, China
| | - Yu Cui
- Department of Radiology, First Affiliated Hospital, Guangxi University of Chinese Medicine, Nanning 530023, Guangxi, China
| | - Jie Yuan
- Department of Radiology, First Affiliated Hospital, Guangxi University of Chinese Medicine, Nanning 530023, Guangxi, China
| | - Zufei Hang
- Department of Radiology, First Affiliated Hospital, Guangxi University of Chinese Medicine, Nanning 530023, Guangxi, China
| | - Xueyuan Jiang
- Department of Radiology, First Affiliated Hospital, Guangxi University of Chinese Medicine, Nanning 530023, Guangxi, China
| | - Gaoxiong Duan
- Department of Radiology, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning 530021, Guangxi, China
| | - Lingyan Liang
- Department of Radiology, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning 530021, Guangxi, China
| | - Zengchao Huang
- Department of Radiology, First Affiliated Hospital, Guangxi University of Chinese Medicine, Nanning 530023, Guangxi, China
| | - Shasha Li
- Department of Radiology, First Affiliated Hospital, Guangxi University of Chinese Medicine, Nanning 530023, Guangxi, China
| | - Peiyi Sun
- Department of Radiology, First Affiliated Hospital, Guangxi University of Chinese Medicine, Nanning 530023, Guangxi, China
| | - Wei Chen
- Department of Neurology, First Affiliated Hospital, Guangxi University of Chinese Medicine, Nanning 530023, Guangxi, China
| | - Lanzhen Wei
- Department of Radiology, First Affiliated Hospital, Guangxi University of Chinese Medicine, Nanning 530023, Guangxi, China
| | - Ying Guo
- GE Healthcare, Computed Tomography Research Center, Beijing 100176, China
| | - Demao Deng
- Department of Radiology, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning 530021, Guangxi, China.
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Li J, Zhang Y, Yin D, Shang H, Li K, Jiao T, Fang C, Cui Y, Liu M, Pan J, Zeng Q. CT perfusion-based delta-radiomics models to identify collateral vessel formation after revascularization in patients with moyamoya disease. Front Neurosci 2022; 16:974096. [PMID: 36033623 PMCID: PMC9403315 DOI: 10.3389/fnins.2022.974096] [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: 06/20/2022] [Accepted: 07/20/2022] [Indexed: 11/15/2022] Open
Abstract
Purpose To build CT perfusion (CTP)-based delta-radiomics models to identify collateral vessel formation after revascularization in patients with moyamoya disease (MMD). Methods Fifty-three MMD patients who underwent CTP and digital subtraction angiography (DSA) examination were retrospectively enrolled. Patients were divided into good and poor groups based on postoperative DSA. CTP parameters, such as mean transit time (MTT), time to drain (TTD), time to maximal plasma concentration (Tmax), and flow extraction product (FE), were obtained. CTP efficacy in evaluating surgical treatment were compared between the good and poor groups. The changes in the relative CTP parameters (ΔrMTT, ΔrTTD, ΔrTmax, and ΔrFE) were calculated to evaluate the differences between pre- and postoperative CTP values. CTP parameters were selected to build delta-radiomics models for identifying collateral vessel formation. The identification performance of machine learning classifiers was assessed using area under the receiver operating characteristic curve (AUC). Results Of the 53 patients, 36 (67.9%) and 17 (32.1%) were divided into the good and poor groups, respectively. The postoperative changes of ΔrMTT, ΔrTTD, ΔrTmax, and ΔrFE in the good group were significantly better than the poor group (p < 0.05). Among all CTP parameters in the perfusion improvement evaluation, the ΔrTTD had the largest AUC (0.873). Eleven features were selected from the TTD parameter to build the delta-radiomics model. The classifiers of the support vector machine and k-nearest neighbors showed good diagnostic performance with AUC values of 0.933 and 0.867, respectively. Conclusion The TTD-based delta-radiomics model has the potential to identify collateral vessel formation after the operation.
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Affiliation(s)
- Jizhen Li
- Department of Radiology, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, China
- Department of Radiology, Shandong Mental Health Center Affiliated to Shandong University, Jinan, China
| | - Yan Zhang
- Department of Radiology, Shandong Mental Health Center Affiliated to Shandong University, Jinan, China
| | - Di Yin
- Department of Radiology, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, China
| | - Hui Shang
- Department of Radiology, The First Affiliated Hospital of Shandong First Medical University, Shandong Provincial Qianfoshan Hospital, Jinan, China
| | - Kejian Li
- Department of Radiology, The First Affiliated Hospital of Shandong First Medical University, Shandong Provincial Qianfoshan Hospital, Jinan, China
| | - Tianyu Jiao
- Department of Radiology, The First Affiliated Hospital of Shandong First Medical University, Shandong Provincial Qianfoshan Hospital, Jinan, China
| | - Caiyun Fang
- Department of Radiology, The First Affiliated Hospital of Shandong First Medical University, Shandong Provincial Qianfoshan Hospital, Jinan, China
| | - Yi Cui
- Department of Radiology, Qilu Hospital of Shandong University, Jinan, China
| | - Ming Liu
- Department of Neurosurgery, Qilu Hospital of Shandong University, Jinan, China
| | - Jun Pan
- Department of Radiology, Shandong Mental Health Center Affiliated to Shandong University, Jinan, China
| | - Qingshi Zeng
- Department of Radiology, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, China
- Department of Radiology, The First Affiliated Hospital of Shandong First Medical University, Shandong Provincial Qianfoshan Hospital, Jinan, China
- *Correspondence: Qingshi Zeng,
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Tang S, Zhang G, Chen Z, Liu X, Fan X, Liu D, He L. Application of multiple injections of contrast agent in head and neck CT arteriovenous angiography in children: Study protocol clinical trial (SPIRIT Compliant). Medicine (Baltimore) 2020; 99:e19773. [PMID: 32282739 PMCID: PMC7220194 DOI: 10.1097/md.0000000000019773] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE To investigate the application value of multiple injections of contrast agent in head and neck CT arteriovenous angiography in children. METHODS A total of 100 children aged 6 to 7 years who needed head and neck CT arteriovenous angiography were prospectively selected. They were randomly divided into a control group and a research group, with 50 children in each group. The same scanning parameters and reconstruction methods were used. The right median cubital vein was injected intravenously with the contrast agent Omnipaque (350 mg I/ml). For children in the control group, a bolus of undiluted contrast agent (dose was 2 ml/kg, upper limit was 50 ml) was injected 1 time. The arterial phase and vein phase of the head and neck vessels were scanned. For children in the research group, a contrast agent bolus diluted with saline to a concentration of 20% was first injected (dose was 1 ml/kg, upper limit was 25 ml), and then an undiluted contrast agent bolus (dose was 1 ml/kg, upper limit was 25 ml) was injected. Thresholds were used to trigger the scanning of the head and neck arterial phases. The CT image quality of the head and neck arteries and veins, radiation dose and contrast agent dose were compared between the 2 groups. RESULTS Subjective evaluation of CT image quality of arteries: there were 47 cases of 4 points and 3 cases of 3 points in the control group and 34 cases of 4 points and 16 cases of 3 points in the research group. Subjective evaluation of CT image quality of veins: there were 47 cases of 4 points and 3 cases of 3 points in the control group and 5 cases of 4 points, 42 cases of 3 points and 3 cases of 2 points in the research group. The CT value of brain arterial vessel enhancement was higher in the control group than the research group, and the difference was statistically significant (P < .05). The CT value of vein enhancement was higher in the control group than the research group, and the difference was statistically significant (P < .05). The X-ray dose in the research group was 51% lower than that in the control group; the contrast agent dose in the research group was 44% lower than that in the control group. CONCLUSION For the head and neck enhanced CT examination of children, the method of first bolus injection of 20% diluted contrast agent and later bolus injection of undiluted contrast agent can clearly demonstrate the head and neck arteries and veins one time, reducing the X-ray dose and contrast agent dose, which has clinical practical value in the enhanced CT examination of children with head and neck disease.
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Affiliation(s)
| | - Guanping Zhang
- National Clinical Research Center for Child Health and Disorders
| | - Zhuo Chen
- Department of Radiology
- Chongqing Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Xianfan Liu
- Ministry of Education Key Laboratory of Child Development and Disorders
| | - Xiao Fan
- China International Science and Technology Cooperation base of Child development and Critical Disorders
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Proposed achievable levels of dose and impact of dose-reduction systems for thrombectomy in acute ischemic stroke: an international, multicentric, retrospective study in 1096 patients. Eur Radiol 2019; 29:3506-3515. [DOI: 10.1007/s00330-019-06062-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Revised: 01/08/2019] [Accepted: 02/01/2019] [Indexed: 10/27/2022]
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Evaluating the Prognosis of Ischemic Stroke Using Low-Dose Multimodal Computed Tomography Parameters in Hyperacute Phase. J Comput Assist Tomogr 2019; 43:22-28. [PMID: 30188358 DOI: 10.1097/rct.0000000000000783] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
PURPOSE The aim of this study was to evaluate the potential value of low-dose multimodal computed tomography (CT) in predicting prognosis of acute ischemic stroke (AIS) within 6 hours. METHODS The admission "one-stop-shop" multimodal CT examination, including noncontrast CT (NCCT), low-dose CT perfusion, and CT angiography (CTA), was performed in patients with symptoms of stroke within 6 hours. Noncontrast CT, CTA source image (CTA-SI), cerebral blood flow (CBF), cerebral blood volume (CBV), time to peak (TTP), and mean transit time (MTT) maps were studied using Alberta Stroke Program Early CT Score (ASPECTS). The regional leptomeningeal collateral (rLMC) score (0-20) was dichotomized into 2 groups: good (11-20) and poor (0-10) rLMC. Poor functional outcomes were defined by a modified Rankin scale score of 3 to 6. RESULTS One hundred forty-four patients were ultimately selected; 43.8% of them showed poor functional outcomes. They had lower ASPECTSs on NCCT, CTA-SI, CBV, CBF, TTP, and MTT, and poor rLMC was more frequently associated with poor functional outcomes (all P < 0.001). In the multivariate analysis for AIS patients with conservative treatment, CTA-SI-ASPECTS 6 or less (odds ratio [OR], 5.9; 95% confidence interval [95% CI], 1.9-18.4; P = 0.002) and poor collaterals (OR, 5.0; 95% CI, 1.3-15.4; P = 0.017), CBV-ASPECTS 6 or less (OR, 8.0; 95% CI, 2.7-24.0; P < 0.001), CBF-ASPECTS 4 or less (OR, 8.0; 95% CI, 2.0-31.5; P = 0.003), MTT-ASPECTS≤3 (OR, 5.8; 95% CI, 1.8-18.1; P = 0.003), TTP-ASPECTS 4 or less (OR, 5.0; 95% CI, 1.6-15.1; P = 0.005), and NCCT-ASPECTS 8 or less (OR, 5.9; 95% CI, 1.7-20.4; P = 0.005) were significantly associated with poor functional outcome. In the multivariate analysis for AIS patients with thrombolysis, CTA-SI-ASPECTS 6 or less (OR, 27.5; 95% CI, 2.9-262.3; P = 0.004), poor collaterals (OR, 28.0; 95% CI, 2.8-283.0; P < 0.028), and CBV-ASPECTS 6 or less (OR, 18.0; 95% CI, 3.0-107.7; P = 0.002) were associated with poor functional outcomes. Furthermore, the area under the curve (AUC) of the combination of CTA-SI-ASPECTS 6 or less, poor collaterals, and CBV-ASPECTS 6 or less (AUC, 0.87) was greater than that for any single parameter alone: CTA-SI-ASPECTS 6 or less (AUC, 0.80; P < 0.001), poor collaterals (AUC, 0.76; P < 0.001), and CBV-ASPECTS 6 or less (AUC, 0.81; P = 0.002). CONCLUSIONS The combination of CTA-SI-ASPECTS, collaterals, and CBV-ASPECTS may improve predictive power compared with a single parameter alone.
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Messaris GAT, Georgakopoulos DN, Zampakis P, Kalogeropoulou CP, Petsas TG, Panayiotakis GS. Patient dose in brain perfusion imaging using an 80-slice CT system. J Neuroradiol 2018; 46:243-247. [PMID: 30030061 DOI: 10.1016/j.neurad.2018.06.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Revised: 06/04/2018] [Accepted: 06/23/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND PURPOSE Brain CT Perfusion (CTP) is an X-ray imaging technique for the assessment of brain tissue perfusion, which can be used in several different entities. The aim of this study is the evaluation of the radiation dose to patients during a comprehensive brain CT prescription protocol (CPP) consisting of an unenhanced brain CT, a brain CT angiography and a CTP scan. MATERIALS AND METHODS Eighteen patients were studied using an 80-slice CT system, with an iterative reconstruction algorithm. The volume Computed Tomography Dose Index (CTDIvol) and dose length product (DLP) were recorded from the dose report of the system. The calculation of effective dose (ED) was accomplished using the DLP values. RESULTS For the CTP examinations, the CTDIvol ranged from 116.0 to 134.8mGy, with the mean value 119.5mGy. The DLP ranged from 463.9 to 539.2mGy·cm, with the mean value 478mGy·cm. For the CPP, the total ED ranged from 3.31 to 5.07mSv, with the mean value 4.37mSv. CONCLUSIONS These values are lower than the values reported in corresponding studies, including studies utilizing CT systems with more slices.
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Affiliation(s)
- Gerasimos A T Messaris
- Department of Medical Physics, School of Medicine, University of Patras, 26504 Patras, Greece
| | | | - Petros Zampakis
- Department of Radiology, School of Medicine, University of Patras, 26504 Patras, Greece
| | | | - Theodoros G Petsas
- Department of Radiology, School of Medicine, University of Patras, 26504 Patras, Greece
| | - George S Panayiotakis
- Department of Medical Physics, School of Medicine, University of Patras, 26504 Patras, Greece.
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Drocton GT, Luttrull MD, Ajam AA, Nguyen XV. Emerging Trends in Emergent Stroke Neuroimaging. CURRENT RADIOLOGY REPORTS 2018. [DOI: 10.1007/s40134-018-0282-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Hajdu SD, Daniel RT, Meuli RA, Zerlauth JB, Dunet V. Impact of model-based iterative reconstruction (MBIR) on image quality in cerebral CT angiography before and after intracranial aneurysm treatment. Eur J Radiol 2018; 102:109-114. [PMID: 29685523 DOI: 10.1016/j.ejrad.2018.03.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Revised: 03/04/2018] [Accepted: 03/05/2018] [Indexed: 12/25/2022]
Abstract
PURPOSE To subjectively and objectively assess the impact of model-based iterative reconstruction(MBIR) on image quality in cerebral computed tomography angiography compared to adaptive statistical iterative reconstruction (ASIR). METHODS 107 patients (mean age: 58 ± 14 years) were included prior to (n = 38) and after (n = 69) intracranial aneurysm treatment. Images were acquired using a routine protocol and reconstructed with MBIR and ASIR. Image noise, signal-to-noise (SNR) and contrast-to-noise (CNR) ratios in the internal carotid and middle cerebral arteries were compared between MBIR and ASIR using the Wilcoxon signed-rank test. Additionally, two neuroradiologists subjectively assessed noise, artefacts, vessel sharpness and overall quality using a semi-quantitative assessment scale. RESULTS Objective assessment revealed that MBIR reduced noise (p < 0.0001) and additionally improved SNR (p < 0.0001) and CNR (p < 0.0001) compared to ASIR in untreated and treated patients. Subjective assessment revealed that in untreated patients, MBIR improved noise reduction, artefacts, vessel sharpness and overall quality relative to ASIR (p < 0.0001). In the treated groups, noise and vessel sharpness were improved (p < 0.0001) with no change in artefacts on images reconstructed with MBIR compared to ASIR. CONCLUSION MBIR significantly improves noise, SNR, CNR and vessel sharpness in untreated and treated patients with intracranial aneurysms. MBIR does not reduce artefacts generated by metallic devices following intracranial aneurysm treatment.
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Affiliation(s)
- Steven David Hajdu
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital, Lausanne, Switzerland.
| | - Roy Thomas Daniel
- Department of Neurosurgery, Lausanne University Hospital, Lausanne, Switzerland
| | - Reto Antoine Meuli
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital, Lausanne, Switzerland
| | - Jean-Baptiste Zerlauth
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital, Lausanne, Switzerland
| | - Vincent Dunet
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital, Lausanne, Switzerland
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Chen Y, Zhang X, Xue H, Zhu Y, Wang Y, Li Y, Zhang Z, Jin Z. Head and neck angiography at 70 kVp with a third-generation dual-source CT system in patients: comparison with 100 kVp. Neuroradiology 2017; 59:1071-1081. [DOI: 10.1007/s00234-017-1901-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Accepted: 08/01/2017] [Indexed: 11/30/2022]
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Yang ZL, Ni QQ, Schoepf UJ, De Cecco CN, Lin H, Duguay TM, Zhou CS, Zhao YE, Lu GM, Zhang LJ. Small Intracranial Aneurysms: Diagnostic Accuracy of CT Angiography. Radiology 2017; 285:941-952. [PMID: 28654338 DOI: 10.1148/radiol.2017162290] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Purpose To assess the accuracy of computed tomographic (CT) angiography for diagnosis of cerebral aneurysms 5 mm or smaller, with digital subtraction angiography (DSA) as the reference standard, in a large patient cohort Materials and Methods This retrospective study was approved by the local institutional review board with a waiver of written informed consent. A total of 1366 patients who underwent cerebral CT angiography followed by DSA were included. The performance of CT angiography for depiction of aneurysms was evaluated by two readers on a per-patient and per-aneurysm basis and based on size of aneurysm, location, and status of rupture. The performance of CT angiography for diagnosis of aneurysms of different size, location, and rupture status was compared by using χ2 test. κ statistic was used to assess interreader agreement for diagnosis of aneurysms. Results Of 1366 patients, 579 patients had 711 small aneurysms at DSA. By using DSA as the reference standard, the respective sensitivity, specificity, and accuracy of CT angiography for readers 1 and 2 for detection of small aneurysms on a per-patient basis were 97.1% (562 of 579) and 97.4% (564 of 579), 98.5% (451 of 458) and 99.1% (454 of 458), and 97.7% (1013 of 1037) and 98.2% (1018 of 1037) and those on a per-aneurysm basis were 95.2% (677 of 711) and 95.4% (678 of 711), 96.6% (451 of 467) and 97.0% (454 of 468), and 95.8% (1128 of 1178) and 96.0% (1132 of 1179). The sensitivities of CT angiography were lower for detection of aneurysms smaller than 3 mm and unruptured compared with aneurysms that were 3-5 mm and ruptured (P < .001). No difference existed for the sensitivities of CT angiography for diagnosis of aneurysms in the anterior versus posterior circulation (P > .0167). Excellent or good interreader agreement was found for detection of intracranial aneurysms on a per-patient (κ = 0.982) and per-aneurysm (κ = 0.748) basis. Conclusion This large cohort study demonstrated that CT angiography had high accuracy for detection of small cerebral aneurysms, including those smaller than 3 mm. © RSNA, 2017 Online supplemental material is available for this article.
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Affiliation(s)
- Zhen Lu Yang
- From the Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu 210002, China (Z.L.Y., Q.Q.N., U.J.S., C.S.Z., Y.E.Z., G.M.L., L.J.Z.); and Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC (U.J.S., C.N.D.C., H.L., T.M.D.)
| | - Qian Qian Ni
- From the Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu 210002, China (Z.L.Y., Q.Q.N., U.J.S., C.S.Z., Y.E.Z., G.M.L., L.J.Z.); and Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC (U.J.S., C.N.D.C., H.L., T.M.D.)
| | - U Joseph Schoepf
- From the Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu 210002, China (Z.L.Y., Q.Q.N., U.J.S., C.S.Z., Y.E.Z., G.M.L., L.J.Z.); and Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC (U.J.S., C.N.D.C., H.L., T.M.D.)
| | - Carlo N De Cecco
- From the Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu 210002, China (Z.L.Y., Q.Q.N., U.J.S., C.S.Z., Y.E.Z., G.M.L., L.J.Z.); and Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC (U.J.S., C.N.D.C., H.L., T.M.D.)
| | - Han Lin
- From the Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu 210002, China (Z.L.Y., Q.Q.N., U.J.S., C.S.Z., Y.E.Z., G.M.L., L.J.Z.); and Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC (U.J.S., C.N.D.C., H.L., T.M.D.)
| | - Taylor M Duguay
- From the Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu 210002, China (Z.L.Y., Q.Q.N., U.J.S., C.S.Z., Y.E.Z., G.M.L., L.J.Z.); and Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC (U.J.S., C.N.D.C., H.L., T.M.D.)
| | - Chang Sheng Zhou
- From the Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu 210002, China (Z.L.Y., Q.Q.N., U.J.S., C.S.Z., Y.E.Z., G.M.L., L.J.Z.); and Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC (U.J.S., C.N.D.C., H.L., T.M.D.)
| | - Yan E Zhao
- From the Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu 210002, China (Z.L.Y., Q.Q.N., U.J.S., C.S.Z., Y.E.Z., G.M.L., L.J.Z.); and Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC (U.J.S., C.N.D.C., H.L., T.M.D.)
| | - Guang Ming Lu
- From the Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu 210002, China (Z.L.Y., Q.Q.N., U.J.S., C.S.Z., Y.E.Z., G.M.L., L.J.Z.); and Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC (U.J.S., C.N.D.C., H.L., T.M.D.)
| | - Long Jiang Zhang
- From the Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu 210002, China (Z.L.Y., Q.Q.N., U.J.S., C.S.Z., Y.E.Z., G.M.L., L.J.Z.); and Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC (U.J.S., C.N.D.C., H.L., T.M.D.)
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Abstract
Recent rapid advances in endovascular treatment for acute ischemic stroke highlight the crucial role of neuroimaging especially multimodal computed tomography (CT) including CT perfusion in stroke triage and management decisions. With an increasing focus on changes in cerebral physiology along with time-based matrices in clinical decisions for acute ischemic stroke, CT perfusion provides a rapid and practical modality for assessment and identification of salvageable tissue at risk and infarct core and provides a better understanding of the changes in cerebral physiology. Although there are challenges with the lack of standardization and accuracy of quantitative assessment, CT perfusion is evolving as a cornerstone for imaging-based strategies in the rapid management of acute ischemic stroke.
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Affiliation(s)
- Pradeep Krishnan
- *Division of Neuroradiology, Department of Medical Imaging, University of Toronto and Sunnybrook Health Sciences Centre †Diagnostic Imaging, The Hospital for Sick Children ‡Division of Neuroradiology, Department of Medical Imaging, University of Toronto and Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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