TENDER: Tensor non-local deconvolution enabled radiation reduction in CT perfusion

Basis and current state of computed tomography perfusion imaging: a review

Computed tomography perfusion (CTP) is a functional imaging that allows for providing capillary-level hemodynamics information of the desired tissue in clinics. In this paper, we aim to offer insight into CTP imaging which covers the basics and current state of CTP imaging, then summarize the technical applications in the CTP imaging as well as the future technological potential. At first, we focus on the fundamentals of CTP imaging including systematically summarized CTP image acquisition and hemodynamic parameter map estimation techniques. A short assessment is presented to outline the clinical applications with CTP imaging, and then a review of radiation dose effect of the CTP imaging on the different applications is presented. We present a categorized methodology review on known and potential solvable challenges of radiation dose reduction in CTP imaging. To evaluate the quality of CTP images, we list various standardized performance metrics. Moreover, we present a review on the determination of infarct and penumbra. Finally, we reveal the popularity and future trend of CTP imaging.

Noise modelling of perfusion CT images for robust hemodynamic parameter estimations

Objective. The radiation dose of cerebral perfusion computed tomography (CPCT) imaging can be reduced by lowering the milliampere-second or kilovoltage peak. However, dose reduction can decrease image quality due to excessive x-ray quanta fluctuation and reduced detector signal relative to system electronic noise, thereby influencing the accuracy of hemodynamic parameters for patients with acute stroke. Existing low-dose CPCT denoising methods, which mainly focus on specific temporal and spatial prior knowledge in low-dose CPCT images, not take the noise distribution characteristics of low-dose CPCT images into consideration. In practice, the noise of low-dose CPCT images can be much more complicated. This study first investigates the noise properties in low-dose CPCT images and proposes a perfusion deconvolution model based on the noise properties. Approach. To characterize the noise distribution in CPCT images properly, we analyze noise properties in low-dose CPCT images and find that the intra-frame noise distribution may vary in the different areas and the inter-frame noise also may vary in low-dose CPCT images. Thus, we attempt the first-ever effort to model CPCT noise with a non-independent and identical distribution (i.i.d.) mixture-of-Gaussians (MoG) model for noise assumption. Furthermore, we integrate the noise modeling strategy into a perfusion deconvolution model and present a novel perfusion deconvolution method by using self-relative structural similarity information and MoG model (named as SR-MoG) to estimate the hemodynamic parameters accurately. In the presented SR-MoG method, the self-relative structural similarity information is obtained from preprocessed low-dose CPCT images. Main results. The results show that the presented SR-MoG method can achieve promising gains over the existing deconvolution approaches. In particular, the average root-mean-square error (RMSE) of cerebral blood flow (CBF), cerebral blood volume, and mean transit time was improved by 40.3%, 69.1%, and 40.8% in the digital phantom study, and the average RMSE of CBF can be improved by 81.0% in the clinical data study, compared with tensor total variation regularization deconvolution method. Significance. The presented SR-MoG method can estimate high-accuracy hemodynamic parameters andachieve promising gains over the existing deconvolution approaches.

Iterative reconstruction for low-dose cerebral perfusion computed tomography using prior image induced diffusion tensor

Cerebral perfusion computed tomography (CPCT) can depict the functional status of cerebral circulation at the tissue level; hence, it has been increasingly used to diagnose patients with cerebrovascular disease. However, there is a significant concern that CPCT scanning protocol could expose patients to excessive radiation doses. Although reducing the x-ray tube current when acquiring CPCT projection data is an effective method for reducing radiation dose, this technique usually results in degraded image quality. To enhance the image quality of low-dose CPCT, we present a prior image induced diffusion tensor (PIDT) for statistical iterative reconstruction, based on the penalized weighted least-squares (PWLS) criterion, which we referred to as PWLS-PIDT, for simplicity. Specifically, PIDT utilizes the geometric features of pre-contrast scanned high-quality CT image as a structure prior for PWLS reconstruction; therefore, the low-dose CPCT images are enhanced while preserving important features in the target image. An effective alternating minimization algorithm is developed to solve the associated objective function in the PWLS-PIDT reconstruction. We conduct qualitative and quantitative studies to evaluate the PWLS-PIDT reconstruction with a digital brain perfusion phantom and patient data. With this method, the noise in the reconstructed CPCT images is more substantially reduced than that of other competing methods, without sacrificing structural details significantly. Furthermore, the CPCT sequential images reconstructed via the PWLS-PIDT method can derive more accurate hemodynamic parameter maps than those of other competing methods.

Contrast-Medium Anisotropy-Aware Tensor Total Variation Model for Robust Cerebral Perfusion CT Reconstruction with Low-Dose Scans

Perfusion computed tomography (PCT) is critical in detecting cerebral ischemic lesions. PCT examination with low-dose scans can effectively reduce radiation exposure to patients at the cost of degraded images with severe noise and artifacts. Tensor total variation (TTV) models are powerful tools that can encode the regional continuous structures underlying a PCT object. In a TTV model, the sparsity structures of the contrast-medium concentration (CMC) across PCT frames are assumed to be isotropic with identical and independent distribution. However, this assumption is inconsistent with practical PCT tasks wherein the sparsity has evident variations and correlations. Such modeling deviation hampers the performance of TTV-based PCT reconstructions. To address this issue, we developed a novel contrast-medium anisotropy-aware tensor total variation (CMAA-TTV) model to describe the intrinsic anisotropy sparsity of the CMC in PCT imaging tasks. Instead of directly on the difference matrices, the CMAA-TTV model characterizes sparsity on a low-rank subspace of the difference matrices which are calculated from the input data adaptively, thus naturally encoding the intrinsic variant and correlated anisotropy sparsity structures of the CMC. We further proposed a robust and efficient PCT reconstruction algorithm to improve low-dose PCT reconstruction performance using the CMAA-TTV model. Experimental studies using a digital brain perfusion phantom, patient data with low-dose simulation and clinical patient data were performed to validate the effectiveness of the presented algorithm. The results demonstrate that the CMAA-TTV algorithm can achieve noticeable improvements over state-of-the-art methods in low-dose PCT reconstruction tasks.