Clinical Applications of Quantitative Perfusion Imaging with a C-Arm Flat-Panel Detector—A Systematic Review

Abstract

C-arm systems with digital flat-panel detectors are used in interventional radiology and hybrid operating rooms for visualizing and performing interventions on three-dimensional structures. Advances in C-arm technology have enabled intraoperative quantitative perfusion imaging with these scanners. This systematic review provides an overview of flat-panel detector C-arm techniques for quantifying perfusion, their clinical applications, and their validation. A systematic search was performed for articles published between January 2000 and October 2022 in which a flat-panel detector C-arm technique for quantifying perfusion was compared with a reference technique. Nine articles were retrieved describing two techniques: two-dimensional perfusion angiography (n = 5) and dual-phase cone beam computed tomography perfusion (n = 4). A quality assessment revealed no concerns about the applicability of the studies. The risk of bias was relatively high for the index and reference tests. Both techniques demonstrated potential for clinical application; however, weak-to-moderate correlations were reported between them and the reference techniques. In conclusion, both techniques could add new possibilities to treatment planning and follow-up; however, the available literature is relatively scarce and heterogeneous. Larger-scale randomized prospective studies focusing on clinical outcomes and standardization are required for the full understanding and clinical implementation of these techniques.

Improved Precision and Safety of Supra-Tentorial Intracranial Hematoma Puncture Using C-Arm CT Four-Dimensional Navigation

“…With technological advances, minimally invasive surgery for intracerebral hemorrhage is known for speed, precision, reduced trauma, and faster recovery. Moreover, endoscopic procedures and minimally invasive puncture drainage are now widely used, especially for deep brain hematomas [8]. Minimally invasive drainage was previously considered inappropriate for patients with a significant volume of hemorrhage or signs of brain herniation [9].…”

“…C-arm computed tomography (CT), which is used in interventional procedures, uses digital flat-panel angiography systems and flat-panel C-arm rotational acquisition technology to simultaneously perform angiography and generate soft tissue images similar to that of CT [8]. This imaging modality allows clinicians to obtain high-resolution clinical examination results within 1 min [12].…”