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Smith CJ, Rossitto CP, Manhart M, Fuhrmann I, DiNitto J, Baker T, Ali M, Sarmiento M, Mocco J, Kellner CP. Minimally Invasive Intracerebral Hemorrhage Evacuation Improves Pericavity Cerebral Blood Volume. Transl Stroke Res 2024; 15:599-605. [PMID: 37195548 DOI: 10.1007/s12975-023-01155-3] [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: 01/29/2023] [Revised: 04/18/2023] [Accepted: 05/02/2023] [Indexed: 05/18/2023]
Abstract
Cerebral blood volume mapping can characterize hemodynamic changes within brain tissue, particularly after stroke. This study aims to quantify blood volume changes in the perihematomal parenchyma and pericavity parenchyma after minimally invasive intracerebral hemorrhage evacuation (MIS for ICH). Thirty-two patients underwent MIS for ICH with pre- and post-operative CT imaging and intraoperative perfusion imaging (DynaCT PBV Neuro, Artis Q, Siemens). The pre-operative and post-operative CT scans were segmented using ITK-SNAP software to calculate hematoma volumes and to delineate the pericavity tissue. Helical CT segmentations were registered to cone beam CT data using elastix software. Mean blood volumes were computed inside subvolumes by dilating the segmentations at increasing distances from the lesion. Pre-operative perihematomal blood volumes and post-operative pericavity blood volumes (PBV) were compared. In 27 patients with complete imaging, post-operative PBV significantly increased within the 6-mm pericavity region after MIS for ICH. The mean relative PBV increased by 21.6 and 9.1% at 3 mm and 6 mm, respectively (P = 0.001 and 0.016, respectively). At the 9-mm pericavity region, there was a 2.83% increase in mean relative PBV, though no longer statistically significant. PBV analysis demonstrated a significant increase in pericavity cerebral blood volume after minimally invasive ICH evacuation to a distance of 6 mm from the border of the lesion.
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Affiliation(s)
- Colton J Smith
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Christina P Rossitto
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | | | | | | | - Turner Baker
- Sinai BioDesign, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Muhammad Ali
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | | | - J Mocco
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Christopher P Kellner
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA.
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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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Wen L, Zhou L, Wu Q, Tang X, Ge J, Zhou X, Zhang X. Early Microcirculatory Hemodynamic Changes Are Correlated With Functional Outcomes at Discharge in Patients With Aneurysmal SAH. Front Neurol 2022; 12:793411. [PMID: 35126294 PMCID: PMC8811302 DOI: 10.3389/fneur.2021.793411] [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: 10/12/2021] [Accepted: 12/21/2021] [Indexed: 11/13/2022] Open
Abstract
Purpose The technique of color-coding blood flow analysis was used to explore the correlation between the microcirculatory hemodynamic changes on digital subtraction angiography (DSA) images in patients with aneurysmal subarachnoid hemorrhage (SAH) at the early stage and functional outcomes at discharge. Methods Data of 119 patients who underwent DSA examination due to SAH were retrospectively analyzed. The following hemodynamic parameters of the four region of interests (ROIs) [an ophthalmic segment of the internal carotid artery (ICA), frontal and parietal lobe, and superior sagittal sinus] were analyzed: the time-to-peak (TTP), the area under the curve (AUC), the full width at half maximum (FWHM), mean transit time (MTT), and circulation time. Multifactor regression analysis was performed to explore the correlation between the hemodynamic parameters and functional outcomes in patients at discharge. Results Of 119 patients with SAH, good and poor outcomes were found in 83 (69.7%) and 36 (30.3%) patients, respectively. The hemodynamic parameters including the FWHM, relative TTP (rTTP), and circulation time were significantly correlated with the Hunt–Hess grade (p < 0.005, p = 0.03, and p < 0.005) and the World Federation of Neurological Societies Scale grade (p < 0.005, p = 0.02, and p = 0.01). The FWHM was significantly prolonged with the increase of modified Fisher grade (p = 0.02). The multifactor analysis showed that the FWHM [odds ratio (OR) 17.56, 95% CI: 1.13–272.03, p = 0.04] was an independent risk factor predicting the functional outcomes in patients at discharge. Conclusion The technique of color-coding blood flow analysis could be suitable for the qualified evaluation of disease conditions at an early stage of SAH as well as the prediction of outcomes.
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Affiliation(s)
- Lili Wen
- Department of Neurosurgery, Jinling Hospital, Jinling School of Clinical Medicine, Nanjing Medical University, Nanjing, China
| | - Longjiang Zhou
- Department of Neurosurgery, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
| | - Qi Wu
- Department of Neurosurgery, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
| | - Xiaoyu Tang
- Department of Neurosurgery, Jinling Hospital, Jinling School of Clinical Medicine, Nanjing Medical University, Nanjing, China
| | - Jiajia Ge
- Advanced Therapies, Siemens Healthineers Ltd., Shanghai, 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
- *Correspondence: Xin Zhang
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Quantitative Evaluation of Peripheral Arterial Blood Flow Using Peri-Interventional Fluoroscopic Parameters: An In Vivo Study Evaluating Feasibility and Clinical Utility. BIOMED RESEARCH INTERNATIONAL 2020; 2020:9526790. [PMID: 32190691 PMCID: PMC7071793 DOI: 10.1155/2020/9526790] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 12/16/2019] [Indexed: 11/17/2022]
Abstract
Purpose The purpose of this study was to evaluate various objective, quantitative, time-resolved fluoroscopic imaging parameters for use in the peri-interventional evaluation of stenotic peripheral arterial disease lesions. Material and Methods. Ten patients (median age, 64; age range, 52 to 79; 8 males, 2 females) with high-grade stenoses of either the superficial femoral or popliteal arteries who underwent endovascular treatment were included. During each intervention, two series of intraprocedural fluoroscopic images were collected, one preintervention and one postintervention. For each imaging series, four regions of interest (ROIs) were defined within the vessel lumen, with two ROIs being proximal (ROIs 1 and 2) and two being distal (ROIs 3 and 4) to the stenosis. The time-density curve (TDC) at each ROI was measured, and the resulting area under the curve (AUC), full width at half maximum (FWHM), and time-to-peak (TTP) were then calculated. Results The analysis of the TDC-derived parameters demonstrated significant differences between pre- and postinterventional flow rates in the ROI placed most distal to the stenosis, ROI 4. The AUC at ROI 4 (reported as a relative percentage of the AUC measured at ROI 1 proximal to the lesion) demonstrated a significant increase in the total flow (mean 67.84% vs. 128.68%, p=0.003). A significant reduction in FWHM at ROI 4 (mean 2.93 s vs. 1.87 s, p=0.003). A significant reduction in FWHM at ROI 4 (mean 2.93 s vs. 1.87 s, p=0.003). A significant reduction in FWHM at ROI 4 (mean 2.93 s vs. 1.87 s. Conclusion AUC, FWHM, and TTP are objective, reproducible, quantifiable tools for the peri-interventional fluoroscopic evaluation of vessel stenoses. When compared to the standard subjective interpretation of fluoroscopic imagery, AUC, FWHM, and TTP offer interventionalists the advantage of having an objective, complementary method of evaluating the success of a procedure, potentially allowing for more precisely targeted and quantitatively determined treatment goals and improved patient outcomes. This retrospective study was approved by the local ethics committee under the Number 372/2018BO2. The trial was registered at the German clinical trials register under the number DRKS00017813.
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Reliability and Accuracy of Peri-Interventional Stenosis Grading in Peripheral Artery Disease Using Color-Coded Quantitative Fluoroscopy: A Phantom Study Comparing a Clinical and Scientific Postprocessing Software. BIOMED RESEARCH INTERNATIONAL 2018; 2018:6180138. [PMID: 30140698 PMCID: PMC6081527 DOI: 10.1155/2018/6180138] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Revised: 06/12/2018] [Accepted: 07/04/2018] [Indexed: 11/17/2022]
Abstract
Purpose To assess quantitative stenosis grading by color-coded fluoroscopy using an in vitro pulsatile flow phantom. Methods Three different stenotic tubes (80%, 60%, and 40% diameter restriction) and a nonstenotic reference tube were compared regarding their different flow behavior by using contrast-enhanced fluoroscopy with a flat-detector system for visualisation purposes. Time-density curves (TDC), area under the curve (AUC), time-to-peak (TTP), and different ROI sizes were analyzed in three independent measurements using two different postprocessing software solutions. In addition, exemplary TDCs of a patient with a high-grade stenosis before and after stent angioplasty were acquired. Results Color-coded fluoroscopy enabled depiction of differences in AUC and TDC between high-grade (80%), middle (60%), low-grade (40%), and nonstenotic tubes. The best correlation between high-, middle-, and low-grade stenosis was appreciated in ROIs behind the stenosis. This effect was enhanced by using longer integration times (5s, 7s) and a maximum frame rate of image acquisition for analysis (correlation coefficient rho=0.9284 at 5s). TTP showed no significant differences between high- and low-grade stenosis. Conclusions Various clinical studies in the literature already demonstrated reproducible and reliable stenosis grading by analyzing TDCs acquired with color-coded fluoroscopy. In contrast to TTP, AUC values derived in ROIs behind the stenosis proved to be reliable parameters for stenosis grading. However, our results also demonstrate that several factors are able to significantly impact the evaluation of AUC values. More precisely, accuracy of acquired AUC values can be improved by choosing longer integration times, a large ROI size adapted to the vessel diameter, and a higher frame rate of image acquisition.
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Maier IL, Leyhe JR, Tsogkas I, Behme D, Schregel K, Knauth M, Schnieder M, Liman J, Psychogios MN. Diagnosing Early Ischemic Changes with the Latest-Generation Flat Detector CT: A Comparative Study with Multidetector CT. AJNR Am J Neuroradiol 2018; 39:881-886. [PMID: 29567653 DOI: 10.3174/ajnr.a5595] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2017] [Accepted: 01/24/2018] [Indexed: 02/05/2023]
Abstract
BACKGROUND AND PURPOSE One-stop management of mechanical thrombectomy-eligible patients with large-vessel occlusion represents an innovative approach in acute stroke treatment. This approach reduces door-to-reperfusion times by omitting multidetector CT, using flat detector CT as pre-mechanical thrombectomy imaging. The purpose of this study was to compare the diagnostic performance of the latest-generation flat detector CT with multidetector CT. MATERIALS AND METHODS Prospectively derived data from patients with ischemic stroke with large-vessel occlusion and mechanical thrombectomy were analyzed in this monocentric study. All included patients underwent multidetector CT before referral to our comprehensive stroke center and flat detector CT in the angiography suite before mechanical thrombectomy. Diagnosis of early ischemic signs, quantified by the ASPECTS, was compared between modalities using cross tables, the Pearson correlation, and Bland-Altman plots. The predictive value of multidetector CT- and flat detector CT-derived ASPECTS for functional outcome was investigated using area under the receiver operating characteristic curve analysis. RESULTS Of 25 patients, 24 (96%) had flat detector CT with sufficient diagnostic quality. Median multidetector CT and flat detector CT ASPECTSs were 7 (interquartile range, 5.5-9 and 4.25-8, respectively) with a mean period of 143.6 ± 49.5 minutes between both modalities. The overall sensitivity was 85.1% and specificity was 83.1% for flat detector CT ASPECTS compared with multidetector CT ASPECTS as the reference technique. Multidetector CT and flat detector CT ASPECTS were strongly correlated (r = 0.849, P < .001) and moderately predicted functional outcome (area under the receiver operating characteristic curve, 0.738; P = .007 and .715; P = .069, respectively). CONCLUSIONS Determination of ASPECTS on flat detector CT is feasible, showing no significant difference compared with multidetector CT ASPECTS and a similar predictive value for functional outcome. Our findings support the use of flat detector CT for emergency stroke imaging before mechanical thrombectomy to reduce door-to-groin time.
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Affiliation(s)
- I L Maier
- From the Departments of Neurology (I.L.M., M.S., J.L.)
| | - J R Leyhe
- Neuroradiology (J.R.L., I.T., D.B., K.S., M.K., M.-N.P.), University Medical Center Goettingen, Goettingen, Germany
| | - I Tsogkas
- Neuroradiology (J.R.L., I.T., D.B., K.S., M.K., M.-N.P.), University Medical Center Goettingen, Goettingen, Germany
| | - D Behme
- Neuroradiology (J.R.L., I.T., D.B., K.S., M.K., M.-N.P.), University Medical Center Goettingen, Goettingen, Germany
| | - K Schregel
- Neuroradiology (J.R.L., I.T., D.B., K.S., M.K., M.-N.P.), University Medical Center Goettingen, Goettingen, Germany
| | - M Knauth
- Neuroradiology (J.R.L., I.T., D.B., K.S., M.K., M.-N.P.), University Medical Center Goettingen, Goettingen, Germany
| | - M Schnieder
- From the Departments of Neurology (I.L.M., M.S., J.L.)
| | - J Liman
- From the Departments of Neurology (I.L.M., M.S., J.L.)
| | - M-N Psychogios
- Neuroradiology (J.R.L., I.T., D.B., K.S., M.K., M.-N.P.), University Medical Center Goettingen, Goettingen, Germany.
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Chen KK, Guo WY, Yang HC, Lin CJ, Wu CHF, Gehrisch S, Kowarschik M, Wu YT, Chung WY. Application of Time-Resolved 3D Digital Subtraction Angiography to Plan Cerebral Arteriovenous Malformation Radiosurgery. AJNR Am J Neuroradiol 2017; 38:740-746. [PMID: 28126751 DOI: 10.3174/ajnr.a5074] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Accepted: 11/18/2016] [Indexed: 01/14/2023]
Abstract
BACKGROUND AND PURPOSE Time-resolved 3D-DSA (4D-DSA) enables viewing vasculature from any desired angle and time frame. We investigated whether these advantages may facilitate treatment planning and the feasibility of using 4D-DSA as a single imaging technique in AVM/dural arteriovenous fistula radiosurgery. MATERIALS AND METHODS Twenty consecutive patients (8 dural arteriovenous fistulas and 12 AVMs; 13 men and 7 women; mean age, 45 years; range, 18-64 years) who were scheduled for gamma knife radiosurgery were recruited (November 2014 to October 2015). An optimal volume of reconstructed time-resolved 3D volumes that defines the AVM nidus/dural arteriovenous fistula was sliced into 2D-CT-like images. The original radiosurgery treatment plan was overlaid retrospectively. The registration errors of stereotactic 4D-DSA were compared with those of integrated stereotactic imaging. AVM/dural arteriovenous fistula volumes were contoured, and disjoint and conjoint components were identified. The Wilcoxon signed rank test and the Wilcoxon rank sum test were adopted to evaluate registration errors and contoured volumes of stereotactic 4D-DSA and integration of stereotactic MR imaging and stereotactic 2D-DSA. RESULTS Sixteen of 20 patients were successfully registered in Advanced Leksell GammaPlan Program. The registration error of stereotactic 4D-DSA was smaller than that of integrated stereotactic imaging (P = .0009). The contoured AVM volume of 4D-DSA was smaller than that contoured on the integration of MR imaging and 2D-DSA, while major inconsistencies existed in cases of dural arteriovenous fistula (P = .042 and 0.039, respectively, for measurements conducted by 2 authors). CONCLUSIONS Implementation of stereotactic 4D-DSA data for gamma knife radiosurgery for brain AVM/dural arteriovenous fistula is feasible. The ability of 4D-DSA to demonstrate vascular morphology and hemodynamics in 4 dimensions potentially reduces the target volumes of irradiation in vascular radiosurgery.
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Affiliation(s)
- K-K Chen
- From the Department of Biomedical Imaging and Radiological Sciences (K.-K.C., Y.-T.W.), National Yang-Ming University, Taipei, Taiwan
| | - W-Y Guo
- Departments of Radiology (W.-Y.G., C.-J.L.)
- School of Medicine (W.-Y.G., C.-J.L.), National Yang-Ming University, Taipei, Taiwan
| | - H-C Yang
- Neurosurgery (H.-C.Y., W.-Y.C.), Taipei Veterans General Hospital, Taipei, Taiwan
| | - C-J Lin
- Departments of Radiology (W.-Y.G., C.-J.L.)
- School of Medicine (W.-Y.G., C.-J.L.), National Yang-Ming University, Taipei, Taiwan
| | - C-H F Wu
- Siemens Healthcare Ltd, Advanced Therapies (C.-H.F.W.), Taipei, Taiwan
| | - S Gehrisch
- Siemens, Advanced Therapies (S.G., M.K.), Forchheim, Germany
| | - M Kowarschik
- Siemens, Advanced Therapies (S.G., M.K.), Forchheim, Germany
| | - Y-T Wu
- From the Department of Biomedical Imaging and Radiological Sciences (K.-K.C., Y.-T.W.), National Yang-Ming University, Taipei, Taiwan
| | - W-Y Chung
- Neurosurgery (H.-C.Y., W.-Y.C.), Taipei Veterans General Hospital, Taipei, Taiwan
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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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Niu K, Yang P, Wu Y, Struffert T, Doerfler A, Schafer S, Royalty K, Strother C, Chen GH. C-Arm Conebeam CT Perfusion Imaging in the Angiographic Suite: A Comparison with Multidetector CT Perfusion Imaging. AJNR Am J Neuroradiol 2016; 37:1303-9. [PMID: 26892987 DOI: 10.3174/ajnr.a4691] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Accepted: 12/09/2015] [Indexed: 01/12/2023]
Abstract
BACKGROUND AND PURPOSE Perfusion imaging in the angiography suite may provide a way to reduce time from stroke onset to endovascular revascularization of patients with large-vessel occlusion. Our purpose was to compare conebeam CT perfusion with multidetector CT perfusion. MATERIALS AND METHODS Data from 7 subjects with both multidetector CT perfusion and conebeam CT perfusion were retrospectively processed and analyzed. Two algorithms were used to enhance temporal resolution and temporal sampling density and reduce the noise of conebeam CT data before generating perfusion maps. Two readers performed qualitative image-quality evaluation on maps by using a 5-point scale. ROIs indicating CBF/CBV abnormalities were drawn. Quantitative analyses were performed by using the Sørensen-Dice coefficients to quantify the similarity of abnormalities. A noninferiority hypothesis was tested to compare conebeam CT perfusion against multidetector CT perfusion. RESULTS Average image-quality scores for multidetector CT perfusion and conebeam CT perfusion images were 2.4 and 2.3, respectively. The average confidence score in diagnosis was 1.4 for both multidetector CT and conebeam CT; the average confidence scores for the presence of a CBV/CBF mismatch were 1.7 (κ = 0.50) and 1.5 (κ = 0.64). For multidetector CT perfusion and conebeam CT perfusion maps, the average scores of confidence in making treatment decisions were 1.4 (κ = 0.79) and 1.3 (κ = 0.90). The area under the visual grading characteristic for the above 4 qualitative quality scores showed an average area under visual grading characteristic of 0.50, with 95% confidence level cover centered at the mean for both readers. The Sørensen-Dice coefficient for CBF maps was 0.81, and for CBV maps, 0.55. CONCLUSIONS After postprocessing methods were applied to enhance image quality for conebeam CT perfusion maps, the conebeam CT perfusion maps were not inferior to those generated from multidetector CT perfusion.
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Affiliation(s)
- K Niu
- From the Departments of Medical Physics (K.N., Y.W., G.-H.C.)
| | - P Yang
- Radiology (P.Y., C.S., G.-H.C.), University of Wisconsin-Madison, Madison, Wisconsin Department of Neurosurgery (P.Y.), Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Y Wu
- From the Departments of Medical Physics (K.N., Y.W., G.-H.C.)
| | - T Struffert
- University of Erlangen-Nuremberg (T.S., A.D.), Erlangen, Germany
| | - A Doerfler
- University of Erlangen-Nuremberg (T.S., A.D.), Erlangen, Germany
| | - S Schafer
- Siemens Medical Solutions USA (S.S., K.R.), Hoffman Estates, Illinois
| | - K Royalty
- Siemens Medical Solutions USA (S.S., K.R.), Hoffman Estates, Illinois
| | - C Strother
- Radiology (P.Y., C.S., G.-H.C.), University of Wisconsin-Madison, Madison, Wisconsin
| | - G-H Chen
- From the Departments of Medical Physics (K.N., Y.W., G.-H.C.) Radiology (P.Y., C.S., G.-H.C.), University of Wisconsin-Madison, Madison, Wisconsin
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Doerfler A, Gölitz P, Engelhorn T, Kloska S, Struffert T. Flat-Panel Computed Tomography (DYNA-CT) in Neuroradiology. From High-Resolution Imaging of Implants to One-Stop-Shopping for Acute Stroke. Clin Neuroradiol 2015; 25 Suppl 2:291-7. [PMID: 26091842 DOI: 10.1007/s00062-015-0423-x] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Accepted: 06/09/2015] [Indexed: 10/23/2022]
Abstract
Originally aimed at improving standard radiography by providing higher absorption efficiency and a wider dynamic range, flat-panel detector technology has meanwhile got widely accepted in the neuroradiological community. Especially flat-panel detector computed tomography (FD-CT) using rotational C-arm mounted flat-panel detector technology is capable of volumetric imaging with a high spatial resolution. By providing CT-like images of the brain within the angio suite, FD-CT is able to rapidly visualize hemorrhage and may thus improve complication management without the need of patient transfer. As "Angiographic CT" FD-CT may be helpful during many diagnostic and neurointerventional procedures and for noninvasive monitoring and follow-up. In addition, spinal interventions and high-resolution imaging of the temporal bone might also benefit from FD-CT. Finally, using novel dynamic perfusion and angiographic protocols, FD-CT may provide functional information on brain perfusion and vasculature with the potential to replace standard imaging in selected acute stroke patients.
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Affiliation(s)
- A Doerfler
- Department of Neuroradiology, University Erlangen-Nuremberg, Schwabachanlage 6 (Kopfklinikum), 91052, Erlangen, Germany.
| | - P Gölitz
- Department of Neuroradiology, University Erlangen-Nuremberg, Schwabachanlage 6 (Kopfklinikum), 91052, Erlangen, Germany
| | - T Engelhorn
- Department of Neuroradiology, University Erlangen-Nuremberg, Schwabachanlage 6 (Kopfklinikum), 91052, Erlangen, Germany
| | - S Kloska
- Department of Neuroradiology, University Erlangen-Nuremberg, Schwabachanlage 6 (Kopfklinikum), 91052, Erlangen, Germany
| | - T Struffert
- Department of Neuroradiology, University Erlangen-Nuremberg, Schwabachanlage 6 (Kopfklinikum), 91052, Erlangen, Germany
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11
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Lin CJ, Chang FC, Guo WY, Hung SC, Luo CB, Beilner J, Kowarschik M, Chu WF. Changes of time-attenuation curve blood flow parameters in patients with and without carotid stenosis. AJNR Am J Neuroradiol 2015; 36:1176-81. [PMID: 25721077 DOI: 10.3174/ajnr.a4239] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2014] [Accepted: 12/01/2014] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE From the time-attenuation curves of DSA flow parameters, maximal intensity, maximal slope, and full width at half maximum of selected vascular points are defined. The study explores the reliability of defining the flow parameters by the time-attenuation curves of DSA. MATERIALS AND METHODS Seventy patients with unilateral carotid artery stenosis (group A) and 56 healthy controls (group B) were retrospectively enrolled. Fixed contrast injection protocols and DSA acquisition parameters were used with all patients. The M1, sigmoid sinus, and internal jugular vein on anteroposterior view DSA and the M2, parietal vein, and superior sagittal sinus on lateral view DSA were chosen as ROI targets for measuring flow parameters. The difference of time of maximal intensity between 2 target points was defined as the circulation time between the target points. RESULTS The maximal intensity difference of 2 selected points from the ICA to the M1, sigmoid sinus, internal jugular vein, M2, parietal vein, and superior sagittal sinus was significantly longer in group A than in group B. The maximum slope of M1, M2, and the superior sagittal sinus was significantly lower in group A than in group B. The full width at half maximum of M1 and M2 was significantly larger in group A than in group B. The maximal slope of M1 demonstrated the best diagnostic performance. CONCLUSIONS The maximal intensity difference of 2 selected points derived from DSA can be used as a definitive alternative flow parameter for intracranial circulation time measurement. Maximal slope and full width at half maximum complement the maximal intensity difference of 2 selected points in defining flow characteristics of healthy subjects and patients with carotid stenosis.
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Affiliation(s)
- C-J Lin
- From the Department of Radiology (C.-J.L., F.-C.C., W.-Y.G., S.-C.H., C.-B.L., W.-F.C.), Taipei Veterans General Hospital, Taipei, Taiwan School of Medicine (C.-J.L., F.-C.C., W.-Y.G., S.-C.H., C.-B.L.), National Yang-Ming University, Taipei, Taiwan
| | - F-C Chang
- From the Department of Radiology (C.-J.L., F.-C.C., W.-Y.G., S.-C.H., C.-B.L., W.-F.C.), Taipei Veterans General Hospital, Taipei, Taiwan School of Medicine (C.-J.L., F.-C.C., W.-Y.G., S.-C.H., C.-B.L.), National Yang-Ming University, Taipei, Taiwan
| | - W-Y Guo
- From the Department of Radiology (C.-J.L., F.-C.C., W.-Y.G., S.-C.H., C.-B.L., W.-F.C.), Taipei Veterans General Hospital, Taipei, Taiwan School of Medicine (C.-J.L., F.-C.C., W.-Y.G., S.-C.H., C.-B.L.), National Yang-Ming University, Taipei, Taiwan
| | - S-C Hung
- From the Department of Radiology (C.-J.L., F.-C.C., W.-Y.G., S.-C.H., C.-B.L., W.-F.C.), Taipei Veterans General Hospital, Taipei, Taiwan School of Medicine (C.-J.L., F.-C.C., W.-Y.G., S.-C.H., C.-B.L.), National Yang-Ming University, Taipei, Taiwan
| | - C-B Luo
- From the Department of Radiology (C.-J.L., F.-C.C., W.-Y.G., S.-C.H., C.-B.L., W.-F.C.), Taipei Veterans General Hospital, Taipei, Taiwan School of Medicine (C.-J.L., F.-C.C., W.-Y.G., S.-C.H., C.-B.L.), National Yang-Ming University, Taipei, Taiwan
| | - J Beilner
- Angiography and Interventional X-Ray Systems (J.B.), Siemens Ltd China, Healthcare Sector, Shanghai, P.R. China
| | - M Kowarschik
- Angiography and Interventional X-Ray Systems (M.K.), Siemens AG, Healthcare Sector, Erlangen, Germany
| | - W-F Chu
- From the Department of Radiology (C.-J.L., F.-C.C., W.-Y.G., S.-C.H., C.-B.L., W.-F.C.), Taipei Veterans General Hospital, Taipei, Taiwan
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12
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Chu WF, Lin CJ, Chen WS, Hung SC, Chiu CF, Wu TH, Guo WY. Radiation doses of cerebral blood volume measurements using C-arm CT: A phantom study. AJNR Am J Neuroradiol 2014; 35:1073-7. [PMID: 24371024 PMCID: PMC7965136 DOI: 10.3174/ajnr.a3822] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2013] [Accepted: 10/12/2013] [Indexed: 12/22/2022]
Abstract
BACKGROUND AND PURPOSE Parenchymal blood volume measurement by C-arm CT facilitates in-room peritherapeutic perfusion evaluation. However, the radiation dose remains a major concern. This study aimed to compare the radiation dose of parenchymal blood volume measurement using C-arm CT with that of conventional CTP using multidetector CT. MATERIALS AND METHODS A biplane DSA equipped with C-arm CT and a Rando-Alderson phantom were used. Slab parenchymal blood volume (8-cm scanning range in a craniocaudal direction) and whole-brain parenchymal blood volume with identical scanning parameters, except for scanning ranges, were undertaken on DSA. Eighty thermoluminescent dosimeters were embedded into 22 organ sites of the phantom. We followed the guidelines of the International Commission on Radiation Protection number 103 to calculate the effective doses. For comparison, 8-cm CTP with the same phantom and thermoluminescent dosimeter distribution was performed on a multidetector CT. Two repeat dose experiments with the same scanning parameters and phantom and thermoluminescent dosimeter settings were conducted. RESULTS Brain-equivalent dose in slab parenchymal blood volume, whole-brain parenchymal blood volume, and CTP were 52.29 ± 35.31, 107.51 ± 31.20, and 163.55 ± 89.45 mSv, respectively. Variations in the measurement of an equivalent dose for the lens were highest in slab parenchymal blood volume (64.5%), followed by CTP (54.6%) and whole-brain parenchymal blood volume (29.0%). The effective doses of slab parenchymal blood volume, whole-brain parenchymal blood volume, and CTP were 0.87 ± 0.55, 3.91 ± 0.78, and 2.77 ± 1.59 mSv, respectively. CONCLUSIONS The dose measurement conducted in the current study was reliable and reproducible. The effective dose of slab parenchymal blood volume is about one-third that of CTP. With the advantages of on-site and immediate imaging availability and saving procedural time and patient transportation, slab parenchymal blood volume measurement using C-arm CT can be recommended for clinical application.
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Affiliation(s)
- W F Chu
- From the Department of Radiology (W.F.C., C.J.L., S.C.H., C.F.C., W.Y.G.), Taipei Veterans General Hospital, Taipei, TaiwanSchool of Medicine (W.F.C., C.J.L., S.C.H., C.F.C., W.Y.G.)
| | - C J Lin
- From the Department of Radiology (W.F.C., C.J.L., S.C.H., C.F.C., W.Y.G.), Taipei Veterans General Hospital, Taipei, TaiwanSchool of Medicine (W.F.C., C.J.L., S.C.H., C.F.C., W.Y.G.)
| | - W S Chen
- Department of Biomedical Imaging and Radiological Sciences (W.S.C., T.H.W.), National Yang-Ming University, Taipei, Taiwan
| | - S C Hung
- From the Department of Radiology (W.F.C., C.J.L., S.C.H., C.F.C., W.Y.G.), Taipei Veterans General Hospital, Taipei, TaiwanSchool of Medicine (W.F.C., C.J.L., S.C.H., C.F.C., W.Y.G.)
| | - C F Chiu
- From the Department of Radiology (W.F.C., C.J.L., S.C.H., C.F.C., W.Y.G.), Taipei Veterans General Hospital, Taipei, TaiwanSchool of Medicine (W.F.C., C.J.L., S.C.H., C.F.C., W.Y.G.)
| | - T H Wu
- Department of Biomedical Imaging and Radiological Sciences (W.S.C., T.H.W.), National Yang-Ming University, Taipei, Taiwan.
| | - W Y Guo
- From the Department of Radiology (W.F.C., C.J.L., S.C.H., C.F.C., W.Y.G.), Taipei Veterans General Hospital, Taipei, TaiwanSchool of Medicine (W.F.C., C.J.L., S.C.H., C.F.C., W.Y.G.)
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13
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Hung SC, Wu CC, Lin CJ, Guo WY, Luo CB, Chang FC, Chang CY. Artifact reduction of different metallic implants in flat detector C-arm CT. AJNR Am J Neuroradiol 2014; 35:1288-92. [PMID: 24457821 DOI: 10.3174/ajnr.a3851] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Flat detector CT has been increasingly used as a follow-up examination after endovascular intervention. Metal artifact reduction has been successfully demonstrated in coil mass cases, but only in a small series. We attempted to objectively and subjectively evaluate the feasibility of metal artifact reduction with various metallic objects and coil lengths. MATERIALS AND METHODS We retrospectively reprocessed the flat detector CT data of 28 patients (15 men, 13 women; mean age, 55.6 years) after they underwent endovascular treatment (20 coiling ± stent placement, 6 liquid embolizers) or shunt drainage (n = 2) between January 2009 and November 2011 by using a metal artifact reduction correction algorithm. We measured CT value ranges and noise by using region-of-interest methods, and 2 experienced neuroradiologists rated the degrees of improved imaging quality and artifact reduction by comparing uncorrected and corrected images. RESULTS After we applied the metal artifact reduction algorithm, the CT value ranges and the noise were substantially reduced (1815.3 ± 793.7 versus 231.7 ± 95.9 and 319.9 ± 136.6 versus 45.9 ± 14.0; both P < .001) regardless of the types of metallic objects and various sizes of coil masses. The rater study achieved an overall improvement of imaging quality and artifact reduction (85.7% and 78.6% of cases by 2 raters, respectively), with the greatest improvement in the coiling group, moderate improvement in the liquid embolizers, and the smallest improvement in ventricular shunting (overall agreement, 0.857). CONCLUSIONS The metal artifact reduction algorithm substantially reduced artifacts and improved the objective image quality in every studied case. It also allowed improved diagnostic confidence in most cases.
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Affiliation(s)
- S-C Hung
- From the Department of Radiology (S.-C.H., C.-C.W., C.-J.L., W.-Y.G., C.-B.L., F.-C.C., C.-Y.C.), Taipei Veterans General Hospital, Taipei, TaiwanDepartment of Biomedical Imaging and Radiological Sciences (S.-C.H.)School of Medicine (S.-C.H., C.-C.W., C.-J.L., W.-Y.G., C.-B.L., F.-C.C., C.-Y.C.), National Yang-Ming University, Taipei, Taiwan
| | - C-C Wu
- From the Department of Radiology (S.-C.H., C.-C.W., C.-J.L., W.-Y.G., C.-B.L., F.-C.C., C.-Y.C.), Taipei Veterans General Hospital, Taipei, TaiwanSchool of Medicine (S.-C.H., C.-C.W., C.-J.L., W.-Y.G., C.-B.L., F.-C.C., C.-Y.C.), National Yang-Ming University, Taipei, Taiwan
| | - C-J Lin
- From the Department of Radiology (S.-C.H., C.-C.W., C.-J.L., W.-Y.G., C.-B.L., F.-C.C., C.-Y.C.), Taipei Veterans General Hospital, Taipei, TaiwanSchool of Medicine (S.-C.H., C.-C.W., C.-J.L., W.-Y.G., C.-B.L., F.-C.C., C.-Y.C.), National Yang-Ming University, Taipei, Taiwan
| | - W-Y Guo
- From the Department of Radiology (S.-C.H., C.-C.W., C.-J.L., W.-Y.G., C.-B.L., F.-C.C., C.-Y.C.), Taipei Veterans General Hospital, Taipei, TaiwanSchool of Medicine (S.-C.H., C.-C.W., C.-J.L., W.-Y.G., C.-B.L., F.-C.C., C.-Y.C.), National Yang-Ming University, Taipei, Taiwan.
| | - C-B Luo
- From the Department of Radiology (S.-C.H., C.-C.W., C.-J.L., W.-Y.G., C.-B.L., F.-C.C., C.-Y.C.), Taipei Veterans General Hospital, Taipei, TaiwanSchool of Medicine (S.-C.H., C.-C.W., C.-J.L., W.-Y.G., C.-B.L., F.-C.C., C.-Y.C.), National Yang-Ming University, Taipei, Taiwan
| | - F-C Chang
- From the Department of Radiology (S.-C.H., C.-C.W., C.-J.L., W.-Y.G., C.-B.L., F.-C.C., C.-Y.C.), Taipei Veterans General Hospital, Taipei, TaiwanSchool of Medicine (S.-C.H., C.-C.W., C.-J.L., W.-Y.G., C.-B.L., F.-C.C., C.-Y.C.), National Yang-Ming University, Taipei, Taiwan
| | - C-Y Chang
- From the Department of Radiology (S.-C.H., C.-C.W., C.-J.L., W.-Y.G., C.-B.L., F.-C.C., C.-Y.C.), Taipei Veterans General Hospital, Taipei, TaiwanSchool of Medicine (S.-C.H., C.-C.W., C.-J.L., W.-Y.G., C.-B.L., F.-C.C., C.-Y.C.), National Yang-Ming University, Taipei, Taiwan
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