European Radiology

, Volume 23, Issue 5, pp 1242–1249 | Cite as

Optimisation of vascular input and output functions in CT-perfusion imaging using 256(or more)-slice multidetector CT

  • Joris M. NiestenEmail author
  • Irene C. van der Schaaf
  • Alan J. Riordan
  • Hugo W. A. M. de Jong
  • Willem P. T. M. Mali
  • Birgitta K. Velthuis
Computed Tomography



To evaluate the accuracy and reproducibility of CT-perfusion (CTP) by finding the optimal artery for the arterial input function (AIF) and re-evaluating the necessity of the venous output function (VOF).


Forty-four acute ischaemic stroke patients who underwent non-enhanced CT, CTP and CT-angiography using 256-slice multidetector computed tomography (MDCT) were evaluated. The anterior cerebral artery (ACA), middle cerebral artery (MCA), internal carotid artery (ICA) and basilar artery were selected as the AIF. Subsequently the resulting area under the time–enhancement curve of the AIF (AUCAIF) and quantitative perfusion measurements were analysed by repeated measures ANOVA and subsequently the paired t test. To evaluate reproducibility we examined if the VOF could be deleted by comparing the perfusion measurements using versus not using the VOF (paired t test).


The AUCAIF and perfusion measurements resulting from the different AIFs showed significant group differences (all P < 0.0001). The ICA had the largest AUCAIF and resulted in the highest mean transient time (MTT) and lowest cerebral blood flow (CBF), whereas the basilar artery showed the lowest cerebral blood volume (CBV). Not using the VOF showed significantly higher CBV and CBF in 66 % of patients on the ipsilateral (P < 0.0001 and P = 0.007, respectively) and contralateral hemisphere (P < 0.0001 and P = 0.019, respectively).


Selecting the ICA as the AIF and continuing the use of the VOF would improve the accuracy of CTP.

Key Points

Perfusion imaging is an increasingly important aspect of multidetector computed tomography (MDCT).

Vascular input functions were evaluated for CT-perfusion using 256-slice MDCT.

Selecting different arterial input functions (AIFs) leads to variation in quantitative values.

Using the internal carotid artery for AIF provides optimal perfusion values.

Deleting the venous output function would be detrimental for validity.


Stroke Infarction Computed tomography Neurological diagnostic techniques Cerebral perfusion 



arterial input function


anterior cerebral artery


area under the time–enhancement curve


area under the time–enhancement curve of the AIF


area under the time–enhancement curve of the VOF


Hounsfield units × seconds


venous output function



This study was supported by grants from the Dutch Heart Foundation (grant 2008T034) and NutsOhra Foundation (grant 0903-012).


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Copyright information

© European Society of Radiology 2012

Authors and Affiliations

  • Joris M. Niesten
    • 1
    Email author
  • Irene C. van der Schaaf
    • 1
  • Alan J. Riordan
    • 1
  • Hugo W. A. M. de Jong
    • 1
  • Willem P. T. M. Mali
    • 1
  • Birgitta K. Velthuis
    • 1
  1. 1.Department of RadiologyUniversity Medical Center UtrechtUtrechtNetherlands

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