scholarly journals Feasibility of Cerebral Blood Volume Mapping by Flat Panel Detector CT in the Angiography Suite: First Experience in Patients with Acute Middle Cerebral Artery Occlusions

2011 ◽  
Vol 33 (4) ◽  
pp. 618-625 ◽  
Author(s):  
T. Struffert ◽  
Y. Deuerling-Zheng ◽  
T. Engelhorn ◽  
S. Kloska ◽  
P. Gölitz ◽  
...  
Keyword(s):  
Middle Cerebral Artery ◽  
Blood Volume ◽  
Cerebral Artery ◽  
Cerebral Blood Volume ◽  
Flat Panel ◽  
Flat Panel Detector ◽  
Angiography Suite

scholarly journals Flat Panel Computed Tomography Pooled Blood Volume and Infarct Prediction in Endovascular Stroke Treatment

Stroke ◽  
2019 ◽  
Vol 50 (11) ◽  
pp. 3274-3276 ◽  
Author(s):  
Aneka Mueller ◽  
Marlies Wagner ◽  
Elke Hattingen ◽  
Alexander Seiler ◽  
Se-Jong You ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Endovascular Treatment ◽  
Blood Volume ◽  
Cerebral Artery ◽  
Clinical Decision Making ◽  
Infarct Volume ◽  
Multislice Ct ◽  
Flat Panel ◽  
Flat Panel Detector ◽  
Angiography Suite

Background and Purpose— Patients with large-vessel stroke frequently need to be transferred to comprehensive stroke centers for endovascular treatment. An update of physiological perfusion parameters and stroke progression on arrival is desirable. We examined the reliability of preinterventional pooled blood volume (PBV)-maps acquired by flat-panel detector computed tomography (CT) in the interventional angiography suite. Methods— The volumes of preinterventional perfusion deficit in flat-panel detector CT-PBV source images were compared with final infarct volume on follow-up multislice-CT after endovascular treatment of 29 consecutive patients with occlusion of the middle cerebral artery (MCA) or the distal internal carotid artery (ICA). Results— Endovascular treatment was successful in 26 patients (Thrombolysis in Cerebral Infarction, 2b-3). Overall, the median preinterventional PBV-deficit was 9×larger than median final infarct volume on multislice-CT (86.4 mL [10.3; 111.6] versus 9.6 mL [3.6; 36.8]). This was especially evident in the subgroup of successful recanalization (PBV-deficit: 87.5 mL [10.6; 115.1], final infarct: 8.7 mL [3.6; 29]). In futile recanalization, the final infarct tended to be underestimated (PBV-deficit: 86.4 mL [5.9; –] and final infarct: 116.4 mL [3.5; –]). Conclusions— Flat panel detector CT-PBV is not reliable in predicting the final infarct volume and should not be used in clinical decision making for endovascular treatment of acute cerebral artery occlusions.

Abstract P557: Hypoperfusion Intensity Ratio and Cerebral Blood Volume Index as Predictors of Outcome for Recanalized Middle Cerebral Artery Occlusions

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Jonathan M Parish ◽  
Dale Strong ◽  
Tanushree Prasad ◽  
Jeremy B Rhoten ◽  
Jonathan D Clemente ◽  
...  
Keyword(s):  
Middle Cerebral Artery ◽  
Computerized Tomography ◽  
Blood Volume ◽  
Cerebral Artery ◽  
Intensity Ratio ◽  
Cerebral Blood Volume ◽  
Favorable Outcome ◽  
Volume Index ◽  
Collateral Flow ◽  
Mca Occlusion

Introduction: Preliminary data suggest the Hypoperfusion Intensity Ratio (HIR) and the Cerebral Blood Volume Index (CBVI) derived from Computerized Tomography Perfusion (CTP) imaging predict the rate of collateral flow, speed of infarct growth, and clinical outcome. We hypothesized that functional outcomes at hospital discharge would be significantly better for middle cerebral artery (MCA) occlusion patients achieving Thrombolysis in Cerebral Infarction (TICI) 2b or greater recanalization with presenting hospital CTPs consistent with “good” (HIR <0.5 and CBVI >0.7) versus “poor” (HIR ≥0.5 and CBVI ≤0.7) indices. Methods: We conducted a retrospective cohort study. A neuroradiologist confirmed the MCA occlusion based on the initial Computerized Tomography Angiogram (CTA). All TICI scores were confirmed by neurointerventionalists blinded to patient outcomes. We defined independent outcome as mRS ≤2, and favorable outcome as an mRS ≤3. We additionally stratified patients as initially presenting to thrombectomy versus non-thrombectomy centers. Results: We identified a total of 162 patients over a 3 ½ year period with an MCA occlusion achieving TICI 2b recanalization or greater, of whom 67 had good indices and 48 had poor indices. For patients with good compared to poor indices, there was a trend for achieving independent outcome (55% vs 37%, p=0.061) that reached significance for favorable outcome (69% vs 50%, p=0.043). Limiting the analysis to only patients presenting to non-thrombectomy centers (n=67), these findings were consistent, with a trend for achieving independent outcome for good versus poor collaterals (48% vs 30% p=0.173), which was again significant for a favorable outcome (66% vs 39%, p=0.036). Across all patients, HIR <0.5 (n=86) or CBVI >0.7 (n=95) were not independently associated with independent outcomes, but for patients presenting to non-thrombectomy centers, an HIR <0.5 alone (n=51) was significantly associated with favorable outcome. Conclusion: For MCA occlusion patients achieving TICI 2b recanalization, the combination of good HIR and CBVI is significantly associated with a favorable functional outcome. For patients presenting to non-thrombectomy centers, HIR alone may be sufficient to predict favorable outcome.

scholarly journals Optimal dilution of contrast medium for quantitating parenchymal blood volume using a flat-panel detector

2017 ◽  
Vol 46 (1) ◽  
pp. 464-474 ◽  
Author(s):  
Takumi Kuriyama ◽  
Nobuyuki Sakai ◽  
Mikiya Beppu ◽  
Chiaki Sakai ◽  
Hirotoshi Imamura ◽  
...  
Keyword(s):  
Contrast Medium ◽  
Blood Volume ◽  
Cerebral Blood Volume ◽  
Therapeutic Interventions ◽  
Flat Panel ◽  
Flat Panel Detector ◽  
Perfusion Studies ◽  
Power Injector ◽  
Before And After ◽  
Parenchymal Blood Volume

Objective Similar to perfusion studies after acute ischemic stroke, measuring cerebral blood volume (CBV) via C-arm computed tomography before and after therapeutic interventions may help gauge subsequent revascularization. We tested serial dilutions of intra-arterial injectable contrast medium (CM) to determine the optimal CM concentration for quantifying parenchymal blood volume by flat-panel detector imaging (FD-PBV). Methods CM was diluted via saline power injector, instituting time delays for FD-PBV studies. A red/green/blue (RGB) color scale was employed to quantify/compare FD-PBV and magnetic resonance-derived CBV (MRCBV). Results Contrast values of right and left common carotid arteries did not differ significantly at CM dilutions of ≥20%. RGB analysis of FD-PBV imaging (relative to MR-CVB), showed CM dilution altered the colors (by 16%), increasing red and decreasing blue ratios. Conclusion Diluting CM to 20% resulted in no laterality differential of FD-PBV imaging, with left/right quantitative ratios approaching 1.1 (optimal for clinical use).

Abstract 3842: Angiographic Assessment Of Leptomeningeal Collateral Perfusion Parameters Following Experimental Transient Middle Cerebral Artery Occlusion

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Brian Theyel ◽  
Marc Benayoun ◽  
Cameron Rink ◽  
Chandan Sen ◽  
Gregory Christoforidis
Keyword(s):  
Middle Cerebral Artery ◽  
Middle Cerebral Artery Occlusion ◽  
Blood Volume ◽  
Cerebral Artery ◽  
Cerebral Blood Volume ◽  
Infarct Volume ◽  
Artery Occlusion ◽  
Regions Of Interest ◽  
Custom Made ◽  
Cerebral Artery Occlusion

Objectives: This work aims to develop and validate an angiographically based quantitative assessment of leptomeningeal collateral perfusion (QLCP) in experimental reversible middle cerebral artery occlusion (MCAO). Methods: Pial collaterals were assessed during MCAO using an angiographically based transient MCAO model in eight mongrel dogs (20-30 kg). Angiographic images were analyzed using a custom-made MATLAB program which measured contrast density over time. Using bivariate linear fit analysis relative cerebral blood volume (rCBV), relative transit time (rTT) and relative cerebral blood flow (rCBF) derived from regions of interest (ROI) from the normal and abnormal hemispheres were extracted and compared to one hour post reperfusion MRI based infarct volume calculations and leptomeningeal collateral scoring using previously published methods. Results: QLCP was reproducibly assessed but variably predictive of infarct volume on one hour post reperfusion mean diffusivity maps using rCBV (p<0.0001; r2=0.937), rTT (p = 0.05, r2 = 0.494), and rCBF (p=0.0024, r2=0.807). Leptomeningeal collateral scoring variably correlated with rCBV (p<0.0001, r2 = 0.948), rTT (p=0.0285, r2= 0.578) and rCBF (p0.0021, r2= 0.817). Conclusion: QLCP was validated in an experimental MCAO model based on correlation with a leptomeningeal collateral scoring system. QLCP assessment of rCBV is a better predictor for infarct volume than rTT or rCBF in a transient MCAO model. It is noteworthy that an angiographically based assessment of rCBV, rTT and rCBF differs from CT and MRI based assessments. In particular , the time frame used and the relative density of the vasculature on the derived color maps differ ( figure 1). figure 1: QLCP derived cerebral blood volume map. The boxes indicate regions of interest for analysis.

scholarly journals Mapping the dynamics of brain perfusion using functional ultrasound in a rat model of transient middle cerebral artery occlusion

2016 ◽  
Vol 37 (1) ◽  
pp. 263-276 ◽  
Author(s):  
Clément Brunner ◽  
Clothilde Isabel ◽  
Abraham Martin ◽  
Clara Dussaux ◽  
Anne Savoye ◽  
...  
Keyword(s):  
Middle Cerebral Artery ◽  
Middle Cerebral Artery Occlusion ◽  
Blood Volume ◽  
Ultrasound Imaging ◽  
Cerebral Artery ◽  
Rat Model ◽  
Cerebral Blood Volume ◽  
Imaging Technique ◽  
Artery Occlusion ◽  
Cerebral Artery Occlusion

Following middle cerebral artery occlusion, tissue outcome ranges from normal to infarcted depending on depth and duration of hypoperfusion as well as occurrence and efficiency of reperfusion. However, the precise time course of these changes in relation to tissue and behavioral outcome remains unsettled. To address these issues, a three-dimensional wide field-of-view and real-time quantitative functional imaging technique able to map perfusion in the rodent brain would be desirable. Here, we applied functional ultrasound imaging, a novel approach to map relative cerebral blood volume without contrast agent, in a rat model of brief proximal transient middle cerebral artery occlusion to assess perfusion in penetrating arterioles and venules acutely and over six days thanks to a thinned-skull preparation. Functional ultrasound imaging efficiently mapped the acute changes in relative cerebral blood volume during occlusion and following reperfusion with high spatial resolution (100 µm), notably documenting marked focal decreases during occlusion, and was able to chart the fine dynamics of tissue reperfusion (rate: one frame/5 s) in the individual rat. No behavioral and only mild post-mortem immunofluorescence changes were observed. Our study suggests functional ultrasound is a particularly well-adapted imaging technique to study cerebral perfusion in acute experimental stroke longitudinally from the hyper-acute up to the chronic stage in the same subject.

scholarly journals Intraprocedural Detection of Cerebral Hyperperfusion by Flat Detector Computed Tomography in the Evaluation of Cerebral Blood Volume during Carotid Artery Stenting

2014 ◽  
Vol 20 (4) ◽  
pp. 502-509 ◽  
Author(s):  
Yukinori Terada ◽  
Taketo Hatano ◽  
Yasunori Nagai ◽  
Makoto Hayase ◽  
Masashi Oda ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Carotid Artery ◽  
Blood Volume ◽  
Carotid Artery Stenting ◽  
Cerebral Blood Volume ◽  
Present Report ◽  
Neurological Deficits ◽  
Flat Detector ◽  
Cerebral Hyperperfusion ◽  
Angiography Suite

Cerebral blood volume (CBV) can be measured using a C-arm flat detector angiographic system. The present report describes a case in which cerebral hyperperfusion was detected with the Neuro parenchymal blood volume (PBV) system (syngo Neuro PBV IR, Siemens Medical Solutions, Erlangen, Germany) during carotid artery stenting (CAS). An 89-year-old man was referred to our hospital for cerebral brain infarction and severe stenosis of the left carotid artery. CAS was performed, and Neuro PBV was used to measure CBV both during and after the procedure. Postoperative Neuro PBV revealed dramatically increased CBV, and a hyperperfusion state was suspected. The next day, subarachnoid hemorrhage along the sulcus of the left hemisphere was revealed on computed tomography. Strict management of blood pressure was instituted just after the detection of hyperperfusion, and the patient was ultimately discharged from the hospital without any new neurological deficits. Neuro PBV has the advantage that it can be performed in the angiography suite and does not require patient transfer to an alternate setting. Therefore, intracranial hemodynamic changes can be detected during the procedure. We conclude that the Neuro PBV system is useful for monitoring intracranial hemodynamics during endovascular procedures.

LOWER PRETREATMENT CEREBRAL BLOOD VOLUME AFFECTS HEMORRHAGIC RISKS AFTER INTRA-ARTERIAL REVASCULARIZATION IN ACUTE STROKE

Neurosurgery ◽  
2008 ◽  
Vol 63 (5) ◽  
pp. 874-879 ◽  
Author(s):  
Archit Bhatt ◽  
Nirav A. Vora ◽  
Ajith J. Thomas ◽  
Arshad Majid ◽  
Mounzer Kassab ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Middle Cerebral Artery ◽  
Blood Volume ◽  
Intracranial Hemorrhage ◽  
Cerebral Blood Volume ◽  
Michigan State University ◽  
State University ◽  
University Of Pittsburgh ◽  
Computed Tomography Perfusion ◽  
The University

Abstract OBJECTIVE Intra-arterial therapies are being used more frequently in patients presenting with acute cerebral occlusions, but they have been limited by the potential for hemorrhage. We sought to determine whether pretreatment computed tomography perfusion parameters might help to identify patients at a higher risk of developing intracranial hemorrhage after intra-arterial stroke revascularization treatment. METHODS We retrospectively reviewed all patients at the University of Pittsburgh Medical Center and Michigan State University who underwent computed tomography perfusion imaging of the brain before intra-arterial thrombolysis between January 2006 and June 2007. Demographic information, angiographic variables, and types of endovascular interventions were recorded. The mean transit time and cerebral blood volumes were recorded for the ipsilateral and contralateral middle cerebral artery territories. A binary logistic regression model was constructed to determine the independent predictors of developing intracranial hemorrhage. RESULTS A total of 57 patients (33 from the University of Pittsburgh and 24 from Michigan State University) with a mean age of 66 ± 13 years and mean National Institutes of Health Stroke Scale scores of 16 ± 5 were studied. The overall recanalization (Thrombolysis in Myocardial Infarction Trial scale 2 or 3 flow) was 72% for the cohort, and the overall rate of parenchymal hemorrhage was 5 of 57 (9%) patients. The overall hemorrhage rate was 19 of 57 (33%) patients. The only variable found to be predictive of the development of hemorrhage after intervention was reduced pretreatment cerebral blood volume (odds ratio, 0.49; 95% confidence interval, 0.35–0.91; P &lt; 0.022). CONCLUSION A reduced pretreatment ipsilateral cerebral blood volume value before endovascular revascularization of an acute middle cerebral artery or internal carotid artery occlusion significantly increases the risk of an intracranial hemorrhage.

Abstract WMP15: Flat Panel Detector CT Assessment in Stroke to Reduce Times to Intra-Arterial Treatment (FAST-IA): A Study of Multi-Phase CTA in the Angiography Suite to Bypass Conventional Imaging

Stroke ◽  
2019 ◽  
Vol 50 (Suppl_1) ◽  
Author(s):  
Mehdi Bouslama ◽  
Diogo Haussen ◽  
Jonathan Grossberg ◽  
Clara Barreira ◽  
Imramsjah Martijn J. van der Bom ◽  
...  
Keyword(s):  
Conventional Imaging ◽  
Flat Panel ◽  
Flat Panel Detector ◽  
Angiography Suite ◽  
Multi Phase
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