Use of time attenuation curves to determine steady-state characteristics before C-arm CT measurement of cerebral blood volume
Cerebral blood volume (CBV) measurement by flat panel detector CT (FPCT) in the angiography suite seems to be a promising tool for patient management during endovascular therapies. A steady state of contrast agent distribution is mandatory during acquisition for accurate FPCT CBV assessment. To the best of our knowledge, this was the first time that steady-state parameters were studied in clinical practice.
Before the CBV study, test injections were performed and analyzed to determine a customized acquisition delay from injection for each patient. Injection protocol consisted in the administration of 72 mL of contrast agent material at the injection rate of 4.0 mL/s followed by a saline flush bolus at the same injection rate. Peripheral or central venous accesses were used depending on their availability. Twenty-four patients were treated for different types of neurovascular diseases. Maximal attenuation, steady-state length, and steady-state delay from injection were derived from the test injections’ time attenuation curves.
With a 15 % threshold from maximum attenuation values, average steady-state duration was less than 10 s. Maximum average steady-state duration with minimal delay variation was obtained with central injection protocols.
With clinically acceptable contrast agent volumes, steady state is a brief condition; thus, fast rotation speed acquisitions are needed. The use of central injections decreases the variability of steady-state’s delay from injection. Further studies are needed to optimize and standardize injection protocols to allow a larger diffusion of the FPCT CBV measurement during endovascular treatments.
KeywordsFlat detector computed tomography Perfusion imaging Cerebral blood flow Endovascular therapy Steady state
Conflict of interest
DR is employed by Philips Healthcare, Netherlands.
- 4.Chiu AHY, Wenderoth J (2012) Cerebral hyperperfusion after flow diversion of large intracranial aneurysms. Journal of neurointerventional surgeryGoogle Scholar
- 9.Schaefer PW, Mui K, Kamalian S, Nogueira RG, Gonzalez RG, Lev MH (2009) Avoiding “pseudo-reversibility” of CT-CBV infarct core lesions in acute stroke patients after thrombolytic therapy: the need for algorithmically “delay-corrected” CT perfusion map postprocessing software. Stroke 40:2875–2878PubMedCrossRefGoogle Scholar