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C-arm flat detector computed tomography parenchymal blood volume imaging: the nature of parenchymal blood volume parameter and the feasibility of parenchymal blood volume imaging in aneurysmal subarachnoid haemorrhage patients

  • Interventional Neuroradiology
  • Published:
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Abstract

Introduction

C-arm flat detector computed tomography (FDCT) parenchymal blood volume (PBV) measurements allow assessment of cerebral haemodynamics in the neurointerventional suite. This paper explores the feasibility of C-arm computed tomography (CT) PBV imaging and the relationship between the C-arm CT PBV and the MR-PWI-derived cerebral blood volume (CBV) and cerebral blood flow (CBF) parameters in aneurysmal subarachnoid haemorrhage (SAH) patients developing delayed cerebral ischemia (DCI).

Methods

Twenty-six patients with DCI following aneurysmal SAH underwent a research C-arm CT PBV scan using a biplane angiography system and contemporaneous MR-PWI scan as part of a prospective study. Quantitative whole-brain atlas-based volume-of-interest analysis in conjunction with Pearson correlation and Bland-Altman tests was performed to explore the agreement between C-arm CT PBV and MR-derived CBV and CBF measurements.

Results

All patients received medical management, while eight patients (31 %) underwent selective intra-arterial chemical angioplasty. Colour-coded C-arm CT PBV maps were 91 % sensitive and 100 % specific in detecting the perfusion abnormalities. C-arm CT rPBV demonstrated good agreement and strong correlation with both MR-rCBV and MR-rCBF measurements; the agreement and correlation were stronger for MR-rCBF relative to MR-rCBV and improved for C-arm CT PBV versus the geometric mean of MR-rCBV and MR-rCBF. Analysis of weighted means showed that the C-arm CT PBV has a preferential blood flow weighting (≈60 % blood flow and ≈40 % blood volume weighting).

Conclusions

C-arm CT PBV imaging is feasible in DCI following aneurysmal SAH. PBV is a composite perfusion parameter incorporating both blood flow and blood volume weightings. That PBV has preferential (≈60 %) blood flow weighting is an important finding, which is of clinical significance when interpreting the C-arm CT PBV maps, particularly in the setting of acute brain ischemia.

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Acknowledgments

The authors would like to thank the staff and Department of Neuroradiology, John Radcliffe Hospital, Oxford, UK, for their support in patient recruitment and scanning. We also thank Siemens for the hardware and software support. MK would like to thank The Rhodes Trust, Oxford, for funding his doctoral studies at the University of Oxford.

Ethical Standards and Patient Consent

We declare that all human and animal studies have been approved by the Coventry Research Ethics Committee and have therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. We declare that all patients gave informed consent prior to inclusion in this study.

Conflict of Interest

We declare that we have no conflict of interest.

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Authors and Affiliations

  1. Nuffield Department of Surgical Sciences, University of Oxford, Room 6607, Level 6, John Radcliffe Hospital, Headington, Oxford, OX3 9DU, UK

    Mudassar Kamran & James V. Byrne

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  1. Mudassar Kamran
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  2. James V. Byrne
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Correspondence to Mudassar Kamran.

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Kamran, M., Byrne, J.V. C-arm flat detector computed tomography parenchymal blood volume imaging: the nature of parenchymal blood volume parameter and the feasibility of parenchymal blood volume imaging in aneurysmal subarachnoid haemorrhage patients. Neuroradiology 57, 937–949 (2015). https://doi.org/10.1007/s00234-015-1545-1

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  • DOI: https://doi.org/10.1007/s00234-015-1545-1

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