C-Arm CT Measurement of Cerebral Blood Volume and Cerebral Blood Flow Using a Novel High-Speed Acquisition and a Single Intravenous Contrast Injection

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Abstract

Assessment of perfusion parameters is important in the selection of patients who are most likely to benefit from revascularization after an acute ischemic stroke. The aim of this study was to evaluate the feasibility of measuring cerebral perfusion parameters with the use of a novel high-speed C-arm CT acquisition in conjunction with a single intravenous injection of contrast.

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Differences in CT perfusion maps generated by different commercial software: quantitative analysis by using identical source data of acute stroke patients.

Kohsuke Kudo, Makoto Sasaki, Kei Yamada … (2010)

To examine the variability in the qualitative and quantitative results of computed tomographic (CT) perfusion imaging generated from identical source data of stroke patients by using commercially available software programs provided by various CT manufacturers. Institutional review board approval and informed consent were obtained. CT perfusion imaging data of 10 stroke patients were postprocessed by using five commercial software packages, each of which had a different algorithm: singular-value decomposition (SVD), maximum slope (MS), inverse filter (IF), box modulation transfer function (bMTF), and by using custom-made original software with standard (sSVD) and block-circulant (bSVD) SVD methods. Areas showing abnormalities in cerebral blood flow (CBF), mean transit time (MTT), and cerebral blood volume (CBV) were compared with each other and with the final infarct areas. Differences among the ratios of quantitative values in the final infarct areas and those in the unaffected side were also examined. The areas with CBF or MTT abnormalities and the ratios of these values significantly varied among software, while those of CBV were stable. The areas with CBF or MTT abnormalities analyzed by using SVD or bMTF corresponded to those obtained with delay-sensitive sSVD, but overestimated the final infarct area. The values obtained from software by using MS or IF corresponded well with those obtained from the delay-insensitive bSVD and the final infarct area. Given the similarities between CBF and MTT, all software were separated in two groups (ie, sSVD and bSVD). The ratios of CBF or MTTs correlated well within both groups, but not across them. CT perfusion imaging maps were significantly different among commercial software even when using identical source data, presumably because of differences in tracer-delay sensitivity.

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Projection space denoising with bilateral filtering and CT noise modeling for dose reduction in CT.

Armando Manduca, G. Fletcher, Natalia Khaylova … (2009)

To investigate a novel locally adaptive projection space denoising algorithm for low-dose CT data. The denoising algorithm is based on bilateral filtering, which smooths values using a weighted average in a local neighborhood, with weights determined according to both spatial proximity and intensity similarity between the center pixel and the neighboring pixels. This filtering is locally adaptive and can preserve important edge information in the sinogram, thus maintaining high spatial resolution. A CT noise model that takes into account the bowtie filter and patient-specific automatic exposure control effects is also incorporated into the denoising process. The authors evaluated the noise-resolution properties of bilateral filtering incorporating such a CT noise model in phantom studies and preliminary patient studies with contrast-enhanced abdominal CT exams. On a thin wire phantom, the noise-resolution properties were significantly improved with the denoising algorithm compared to commercial reconstruction kernels. The noise-resolution properties on low-dose (40 mA s) data after denoising approximated those of conventional reconstructions at twice the dose level. A separate contrast plate phantom showed improved depiction of low-contrast plates with the denoising algorithm over conventional reconstructions when noise levels were matched. Similar improvement in noise-resolution properties was found on CT colonography data and on five abdominal low-energy (80 kV) CT exams. In each abdominal case, a board-certified subspecialized radiologist rated the denoised 80 kV images markedly superior in image quality compared to the commercially available reconstructions, and denoising improved the image quality to the point where the 80 kV images alone were considered to be of diagnostic quality. The results demonstrate that bilateral filtering incorporating a CT noise model can achieve a significantly better noise-resolution trade-off than a series of commercial reconstruction kernels. This improvement in noise-resolution properties can be used for improving image quality in CT and can be translated into substantial dose reduction.

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Theoretic basis and technical implementations of CT perfusion in acute ischemic stroke, part 2: technical implementations.

A.A. Konstas, G.V Goldmakher, T-Y Lee … (2009)

CT perfusion (CTP) is a functional imaging technique that provides important information about capillary-level hemodynamics of the brain parenchyma and is a natural complement to the strengths of unenhanced CT and CT angiography in the evaluation of acute stroke, vasospasm, and other neurovascular disorders. CTP is critical in determining the extent of irreversibly infarcted brain tissue (infarct "core") and the severely ischemic but potentially salvageable tissue ("penumbra"). This is achieved by generating parametric maps of cerebral blood flow, cerebral blood volume, and mean transit time.