Quantitative Dose Dependency Analysis of Whole-Brain CT Perfusion Imaging

Manniesing, Rashindra; Oei, Marcel T. H.; Ginneken, Bram van; Prokop, Mathias

doi:10.1148/radiol.2015142230

Cited by 22 publications

(18 citation statements)

References 30 publications

(22 reference statements)

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“…An overview of the configurations used in this work is given in Table 2. Five studies are presented of which two have been published separately (Van den Boom et al, 2014; Manniesing et al, 2016). …”

Section: Experiments and Resultsmentioning

confidence: 99%

“…There are no definite answers which method should be used, but the digital phantom provides a direct mean to investigate these properties. For example, by duplicating the dose dependency study (Manniesing et al, 2016) for different perfusion analysis methods, the difference of their responses can be quantified and their robustness to noise can be assessed.…”

Section: Discussionmentioning

confidence: 99%

“…These factors include the temporal sampling rate of the acquisition protocols (Wintermark et al, 2004), the selection of the arterial input and venous output functions (Sanelli et al, 2004; Soares et al, 2009), the type and implementation of the software that is used for perfusion calculations (Sanelli et al, 2007; Kudo et al, 2010; Fahmi et al, 2012), and the total radiation dose utilized in the CT acquisition protocols (Manniesing et al, 2016). Not all factors have been identified nor have their influences on perfusion values and clinical interpretation been rigorously assessed.…”

Section: Introductionmentioning

confidence: 99%

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A 4D CT digital phantom of an individual human brain for perfusion analysis

Manniesing

Brüne

Ginneken

et al. 2016

PeerJ

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Brain perfusion is of key importance to assess brain function. Modern CT scanners can acquire perfusion maps of the cerebral parenchyma in vivo at submillimeter resolution. These perfusion maps give insights into the hemodynamics of the cerebral parenchyma and are critical for example for treatment decisions in acute stroke. However, the relations between acquisition parameters, tissue attenuation curves, and perfusion values are still poorly understood and cannot be unraveled by studies involving humans because of ethical concerns. We present a 4D CT digital phantom specific for an individual human brain to analyze these relations in a bottom-up fashion. Validation of the signal and noise components was based on 1,000 phantom simulations of 20 patient imaging data. This framework was applied to quantitatively assess the relation between radiation dose and perfusion values, and to quantify the signal-to-noise ratios of penumbra regions with decreasing sizes in white and gray matter. This is the first 4D CT digital phantom that enables to address clinical questions without having to expose the patient to additional radiation dose.

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Section: Experiments and Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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A 4D CT digital phantom of an individual human brain for perfusion analysis

Manniesing

Brüne

Ginneken

et al. 2016

PeerJ

Self Cite

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“…In the nine-sweep CBCTP acquisition protocol used in this study, a total radiation dose of 4.6 mSv 9 were delivered to the patient. The dose from a state-of-the-art diagnostic CTP exam is 5.0 mSv 16 .…”

Section: Methodsmentioning

confidence: 99%

C-Arm Conebeam CT Perfusion Imaging in the Angiographic Suite: A Comparison with Multidetector CT Perfusion Imaging

Niu¹,

Yang

Wu³

et al. 2016

American Journal of Neuroradiology

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Purpose and background Perfusion imaging in the angiography suite may provide a way to reduce time from stroke onset to endovascular revascularization of patients with a large vessel occlusion. Our purpose was to compare CBCTP with MDCTP. Materials and Methods Data from seven subjects with both MDCTP and CBCTP were retrospectively processed and analyzed. Two algorithms were used to enhance temporal resolution, temporal sampling density and reduce noise of CBCT data before generating perfusion maps. Two readers performed qualitative image quality evaluation on maps using a 5-point scale. ROIs indicating CBF/CBV abnormalities were drawn. Quantitative analyses were performed using the Sørensen–Dice coefficients to quantify the similarity of abnormalities. A non-inferiority hypothesis was tested to compare CBCTP against CBCTP. Results Averaged image quality score for MDCTP and CBCTP images was 2.4 and 2.3 respectively. Averaged confidence scores in diagnosis were both 1.4 for MDCT and CBCT; averaged confidence scores on presence of a CBV/CBF mismatch was 1.7 (κ = 0.50) and 1.5 (κ = 0.64). For MDCTP and CBCTP maps the average score of confidence in making treatment decision was 1.4 (κ = 0.79) and 1.3 (κ = 0.90). Area under visual grading characteristic (AVGC) for the above four qualitative quality score showed an average AVGC of 0.50 with 95% confidence level cover centered at the mean for both readers. Sørensen–Dice coefficient for CBF maps is 0.81 and for CBV maps is 0.55. Conclusions After post-processing methods were applied to enhance image quality for CBCTP maps, the CBCTP maps were not inferior to those generated from MDCTP.

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“…Despite the high radiation dose, cerebral VP CT received little attention. Few technical studies showed that reduced dose VP CT with low tube-current time product might yield sufficient image quality for the diagnosis of acute stroke (13)(14)(15)(16). However, perfusion impairment in patients with cerebral vasospasm is often more subtle, detectability might be compromised at lower dose levels (17).…”

Section: Data Acquisitionmentioning

confidence: 99%

Diagnostic Accuracy of Simulated Low-Dose Perfusion CT to Detect Cerebral Perfusion Impairment after Aneurysmal Subarachnoid Hemorrhage: A Retrospective Analysis

Afat¹,

Brockmann²,

Nikoubashman³

et al. 2018

Radiology

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Purpose To evaluate diagnostic accuracy of low-dose volume perfusion (VP) computed tomography (CT) compared with original VP CT regarding the detection of cerebral perfusion impairment after aneurysmal subarachnoid hemorrhage. Materials and Methods In this retrospective study, 85 patients (mean age, 59.6 years; 62 women) with aneurysmal subarachnoid hemorrhage and who were suspected of having cerebral vasospasm at unenhanced CT and VP CT (tube voltage, 80 kVp; tube current-time product, 180 mAs) were included, 37 of whom underwent digital subtraction angiography (DSA) within 6 hours. Low-dose VP CT data sets at tube current-time product of 72 mAs were retrospectively generated by validated realistic simulation. Perfusion maps were generated from both data sets and reviewed by two neuroradiologists for overall image quality, diagnostic confidence and presence and/or severity of perfusion impairment indicating vasospasm. An interventional neuroradiologist evaluated 16 vascular segments at DSA. Diagnostic accuracy of low-dose VP CT was calculated with original VP CT as reference standard. Agreement between findings of both data sets was assessed by using weighted Cohen κ and findings were correlated with DSA by using Spearman correlation. After quantitative volumetric analysis, lesion volumes were compared on both VP CT data sets. Results Low-dose VP CT yielded good ratings of image quality and diagnostic confidence and classified all patients correctly with high diagnostic accuracy (sensitivity, 99.0%; specificity, 99.5%) without significant differences regarding presence and/or severity of perfusion impairment between original and low-dose data sets (Z = -0.447; P = .655). Findings of both data sets correlated significantly with DSA (original, r = 0.671; low dose, r = 0.667). Lesion volume was comparable for both data sets (relative difference, 5.9% ± 5.1 [range, 0.2%-25.0%; median, 4.0%]) with strong correlation (r = 0.955). Conclusion The results suggest that radiation dose reduction to 40% of original dose levels (tube current-time product, 72 mAs) may be performed in VP CT imaging of patients with aneurysmal subarachnoid hemorrhage without compromising the diagnostic accuracy regarding detection of cerebral perfusion impairment indicating vasospasm. RSNA, 2018 Online supplemental material is available for this article.

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Quantitative Dose Dependency Analysis of Whole-Brain CT Perfusion Imaging

Abstract: The total dose of a clinical cerebral CT perfusion protocol can be lowered to 2.5 mSv, with only minor quantitative effects on perfusion values. Dose reduction beyond this point resulted in overestimation of perfusion values.

Cited by 22 publications

References 30 publications

A 4D CT digital phantom of an individual human brain for perfusion analysis

A 4D CT digital phantom of an individual human brain for perfusion analysis

C-Arm Conebeam CT Perfusion Imaging in the Angiographic Suite: A Comparison with Multidetector CT Perfusion Imaging

Diagnostic Accuracy of Simulated Low-Dose Perfusion CT to Detect Cerebral Perfusion Impairment after Aneurysmal Subarachnoid Hemorrhage: A Retrospective Analysis

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