Evaluation of time-resolved whole brain flat panel detector perfusion imaging using RAPID ANGIO in patients with acute stroke: comparison with CT perfusion imaging

Abstract

BackgroundIn contrast to conventional CT perfusion (CTP) imaging, flat panel detector CT perfusion (FD-CTP) imaging can be acquired directly in the angiosuite.ObjectiveTo evaluate time-resolved whole brain FD-CTP imaging and assess clinically important qualitative and quantitative perfusion parameters in correlation with previously acquired conventional CTP using the new RAPID for ANGIO software.MethodsWe included patients with internal carotid artery occlusions and M1 or M2 occlusions from six centers. All patients underwent mechanical thrombectomy (MT) with preinterventional conventional CTP and FD-CTP imaging. Quantitative performance was determined by comparing volumes of infarct core, penumbral tissue, and mismatch. Eligibility for MT according to the perfusion imaging criteria of DEFUSE 3 was determined for each case from both conventional CTP and FD-CTP imaging.ResultsA total of 20 patients were included in the final analysis. Conventional relative cerebral blood flow (rCBF) <30% and FD-CTP rCBF <45% showed good correlation (R2=0.84). Comparisons of conventional CTP Tmax >6 s versus FD-CTP Tmax >6 s and CTP mismatch versus FD-CTP mismatch showed more variability (R2=0.57, and R2=0.33, respectively). Based on FD-CTP, 16/20 (80%) patients met the inclusion criteria for MT according to the DEFUSE 3 perfusion criteria, in contrast to 18/20 (90%) patients based on conventional CTP. The vessel occlusion could be correctly extrapolated from the hypoperfusion in 18/20 cases (90%).ConclusionsIn our multicenter study, time-resolved whole brain FD-CTP was technically feasible, and qualitative and quantitative perfusion results correlated with those obtained with conventional CTP.

Advances in cerebral perfusion imaging techniques in acute ischemic stroke

“…However, CTP rCBF <30% and FD‐CTP rCBF <45% showed a good correlation ( R 2 = 0.84). Illustrative examples of patients who suffer from middle cerebral artery (MCA) occlusion are shown in Figure 2 77 . Itokawa et al 78 confirmed the efficacy of CBCT perfusion in patients with AIS using the Siemens Healthcare “Artis zee biplane” device by comparing image quality and decision‐making confidence with those of MRI.…”

“…Nicholson et al 76 believed that CBCT perfusion images (Philips X‐per CT) could provide an excellent addition to patients with AIS who intend to receive EVT therapy compared with MDCT perfusion. Kurmann et al 77 reported that the qualitative and overall quantitative perfusion results of time‐resolved whole‐brain FD‐CTP correlated well with conventional CTP, suggesting that establishing a direct‐to‐angio approach is feasible and increases the probability of a better clinical outcome. They acquired time‐resolved whole‐brain FD‐CTP datasets using a multiphase FD perfusion acquisition protocol (Syngo DynaCT Multiphase, Siemens Healthineers).…”

“…Nicholson et al 76 believed that CBCT perfusion images (Philips X-per CT) could provide an excellent addition to patients with AIS who intend to receive EVT therapy compared with MDCT perfusion. Kurmann et al 77 reported that the qualitative and overall quantitative perfusion results of time-resolved whole-brain FD-CTP correlated well with conventional CTP, suggesting that establishing a direct-to-angio approach is feasible and increases the Second, the data may be inaccurate due to the limited acquisition coverage of CBCT. At the same time, CBCT has lower density resolution and spatial resolution than multidetector CT. Third, while the radiation dose of CBCT perfusion is lower than that of CTP, it still generates a substantial amount of radiation.…”

“…(The term FD‐CT, as shown in the legend of Figure 2, is another name for CBCT. See reference 77 for an elaborate illustration)…”

Correlation of Collateral Scores Derived from Whole-Brain Time-Resolved Flat Panel Detector Imaging in Acute Ischemic Stroke

“…On the basis of flat panel detector CTP (FDCTP) source images, multiphase flat panel detector CTA (mFDCTA) and perfusion maps can be reconstructed. [8][9][10] This technology enables direct transport of patients to the angio suite ("direct-to-the angio" approach), which, in turn, can improve in-hospital workflows, reduce the time to treatment, and may ultimately increase the chances of good clinical outcome. [11][12][13][14][15][16] While collateral scores are well-validated in conventional multiphase CTA (mCTA)/CTP, data on the evaluation of the collateral status derived from FDCTP imaging is scarce.…”