CT Perfusion Cerebral Blood Flow Imaging in Neurological Critical Care

Harrigan, Mark R.; Leonardo, Jody; Gibbons, Kevin J.; Guterman, Lee R.; Hopkins, L. Nelson

doi:10.1385/ncc:2:3:352

Cited by 33 publications

(16 citation statements)

References 74 publications

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“…CT perfusion can be used to assess regional cerebral hypoperfusion due to vasospasm. But the posterior fossa is difficult to image due to bone artifacts and there are few data in the literature on CT perfusion of the brainstem [6]. The reason why BA vasospasm caused LIS and not coma in this observation is only speculative.…”

Section: Discussionmentioning

confidence: 78%

Transient Locked-in Syndrome and Basilar Artery Vasospasm

et al. 2011

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Section: Discussionmentioning

confidence: 78%

Transient Locked-in Syndrome and Basilar Artery Vasospasm

et al. 2011

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“…The goal of this work was to enhance parametric maps in low-dose CTP using a model with a “residue” function convolution kernel that relates the input (arterial enhancement) and response (tissue enhancement) (Miles and Griffiths, 2003; Hoeffner et al, 2004; Harrigan et al, 2005). We compared to several existing models including cTSVD and KSVD-SPD, which are based on similar underlying principles but using different approaches to solve the problem.…”

Section: Discussionmentioning

confidence: 99%

“…Cerebral perfusion imaging via computed tomography perfusion (CTP) has become more commonly used in clinical practice for the evaluation of patients with cerebrovascular disease such as acute stroke and vasospasm after subarachnoid hemorrhage (SAH) (Miles and Griffiths, 2003; König, 2003; Hoeffner et al, 2004). Various mathematical models have been used to process the acquired temporal data to ascertain quantitative information, such as cerebral blood flow (CBF), cerebral blood volume (CBV) and mean transit time (MTT), with higher radiation dosage compared to a standard CT of the head (Østergaard et al, 1996a; Hoeffner et al, 2004; Harrigan et al, 2005; Wittsack et al, 2008; He et al, 2010). However, recent reports on the overexposure of radiation in CTP imaging have brought the dosage problem to the limelight because many patients suffered biologic effects from radiation exposure, including hair loss, skin burns and even cancer risk (Wintermark and Lev, 2010).…”

Section: Introductionmentioning

confidence: 99%

Towards robust deconvolution of low-dose perfusion CT: Sparse perfusion deconvolution using online dictionary learning

Fang

Chen

Sanelli³

2013

Medical Image Analysis

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Computed tomography perfusion (CTP) is an important functional imaging modality in the evaluation of cerebrovascular diseases, particularly in acute stroke and vasospasm. However, the post-processed parametric maps of blood flow tend to be noisy, especially in low-dose CTP, due to the noisy contrast enhancement profile and the oscillatory nature of the results generated by the current computational methods. In this paper, we propose a robust sparse perfusion deconvolution method (SPD) to estimate cerebral blood flow in CTP performed at low radiation dose. We first build a dictionary from high-dose perfusion maps using online dictionary learning and then perform deconvolution-based hemodynamic parameters estimation on the low-dose CTP data. Our method is validated on clinical data of patients with normal and pathological CBF maps. The results show that we achieve superior performance than existing methods, and potentially improve the differentiation between normal and ischemic tissue in the brain.

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“…Absolute values for CBF, however, obtained by perfusion-CT, have limitations related to the deconvolution algorithms and are highly dependent on the arterial input function chosen for measurements [36]. Perfusion-CT results for given region of interests (ROI) are only reliable when interpreted in the context of data of other ROIs in the whole image [37]. The advantage of the technique is the short duration of the examination making perfusion-CT a technique, easy to be applied in stroke and head trauma patients.…”

Section: Imaging Methodsmentioning

confidence: 99%

Measurement of Cerebral Blood Flow with Near Infrared Spectroscopy and Indocyanine Green Dye Dilution

Keller¹,

Mudra

2007

CMIR

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Early detection and treatment of cerebral ischemia to prevent further neurological damage in patients with severe brain injuries, such as in trauma and stroke patients, is one of the most important issues in Neurocritical Care. Our own clinical experiences in treatment of patients with severe ischemic stroke and subarachnoid hemorrhage have shown that the available methods to monitor cerebral hemodynamics and oxygenation are insufficient with regard to detection of secondary ischemic events. The established methods for bedside monitoring of cerebral blood flow (CBF) and cerebral oxygenation are difficult to perform clinically, involve radioactive radiation, are invasive or require the patient to be transported, thus involving potentially high risks. Transcranial Doppler sonography produces indices that can be related to changes in CBF and cerebral oxygenation but does not measure actual flow rates.During recent years, near infrared spectroscopy (NIRS) was further developed and supplemented with the indocyanine green (ICG) dye dilution mode for bedside monitoring of CBF. The NIRS ICG dye dilution technique is a promising method for serial bedside CBF measurements in the environment of the intensive care unit. The NIRS method with optodes on the skin has the advantage of being non invasive, does not require the patient to be transported and provides data at the bedside within minutes.Preliminary data in a limited number of volunteers indicate that CBF measurements obtained by NIRS ICG dye dilution technique are in agreement with corresponding values obtained by perfusion-weighted MRI. More patient-validated data by correlating the measurement values with clinical events and comparing them with standard methods are needed. For the accuracy of absolute measurements and in order to quantify the individual extracerebral pathlengths as well as to allow appropriate correction to be made for extracerebral dead space tissue further modelling based on patients data is required.New-generation NIRS instrumentation, implementing spatially resolved spectroscopy (SRS), depth-resolved technologies and invasive NIRS probes will give the opportunity to reduce or eliminate extracerebral contamination and will provide some unique physiological information for NIRS technology. To calculate the influence of extracerebral contamination comparative measurements can be performed using noninvasive NIRS probes on the scalp and invasive probes for NIRS and intracranial pressure (ICP) monitoring. Combined monitoring of ICP and NIRS will be of special clinical value in patients with severe stroke, subarachnoid hemorrhage and head trauma, already provided with ICP probes for treatment of intracranial hypertension and being especially at risk for secondary ischemic brain damage.

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CT Perfusion Cerebral Blood Flow Imaging in Neurological Critical Care

Cited by 33 publications

References 74 publications

Transient Locked-in Syndrome and Basilar Artery Vasospasm

Transient Locked-in Syndrome and Basilar Artery Vasospasm

Towards robust deconvolution of low-dose perfusion CT: Sparse perfusion deconvolution using online dictionary learning

Measurement of Cerebral Blood Flow with Near Infrared Spectroscopy and Indocyanine Green Dye Dilution

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