Interventional 4-D C-arm CT perfusion imaging using interleaved scanning and partial reconstruction interpolation

Model-based perfusion reconstruction with time separation technique in cone-beam CT dynamic liver perfusion imaging

BACKGROUND

The success of embolization, a minimally invasive treatment of liver cancer, could be evaluated in the operational room with cone-beam CT by acquiring a dynamic perfusion scan to inspect the contrast agent flow.

PURPOSE

The reconstruction algorithm must address the issues of low temporal sampling and higher noise levels inherent in cone-beam CT systems, compared to conventional CT.

METHODS

Therefore, a model-based perfusion reconstruction based on the time separation technique (TST) was applied. TST uses basis functions to model time attenuation curves. These functions are either analytical or based on prior knowledge (PK), extracted using singular value decomposition of the classical CT perfusion data of animal subjects. To explore how well the PK can model perfusion dynamics and what the potential limitations are, the dynamic cone-beam CT (CBCT) perfusion scan was simulated from a dynamic CT perfusion scan under different noise levels. The TST method was compared to static reconstruction.

RESULTS

It was demonstrated on this simulated dynamic CBCT perfusion scan that a set consisting of only four basis functions results in perfusion maps that preserve relevant information, denoise the data, and outperform static reconstruction under higher noise levels. TST with PK would not only outperform static reconstruction but also the TST with analytical basis functions. Furthermore, it has been shown that only eight CBCT rotations, unlike previously assumed ten, are sufficient to obtain the perfusion maps comparable to the reference CT perfusion maps. This contributes to saving dose and reconstruction time. The real dynamic CBCT perfusion scan, reconstructed under the same conditions as the simulated scan, shows potential for maintaining the accuracy of the perfusion maps. By visual inspection, the embolized region was matching to that in corresponding CT perfusion maps.

CONCLUSIONS

CBCT reconstruction of perfusion scan data using the TST method has shown promising potential, outperforming static reconstructions and potentially saving dose by reducing the necessary number of acquisition sweeps. Further analysis of a larger cohort of patient data is needed to draw final conclusions regarding the expected advantages of the TST.

Clinical Applications of Conebeam CTP Imaging in Cerebral Disease: A Systematic Review

BACKGROUND

Perfusion imaging with multidetector CT is integral to the evaluation of patients presenting with ischemic stroke due to large-vessel occlusion. Using conebeam CT perfusion in a direct-to-angio approach could reduce workflow times and improve functional outcome.

PURPOSE

Our aim was to provide an overview of conebeam CT techniques for quantifying cerebral perfusion, their clinical applications, and validation.

DATA SOURCES

A systematic search was performed for articles published between January 2000 and October 2022 in which a conebeam CT imaging technique for quantifying cerebral perfusion in human subjects was compared against a reference technique.

STUDY SELECTION

Eleven articles were retrieved describing 2 techniques: dual-phase (n = 6) and multiphase (n = 5) conebeam CTP.

DATA ANALYSIS

Descriptions of the conebeam CT techniques and the correlations between them and the reference techniques were retrieved.

DATA SYNTHESIS

Appraisal of the quality and risk of bias of the included studies revealed little concern about bias and applicability. Good correlations were reported for dual-phase conebeam CTP; however, the comprehensiveness of its parameter is unclear. Multiphase conebeam CTP demonstrated the potential for clinical implementation due to its ability to produce conventional stroke protocols. However, it did not consistently correlate with the reference techniques.

LIMITATIONS

The heterogeneity within the available literature made it impossible to apply meta-analysis to the data.

CONCLUSIONS

The reviewed techniques show promise for clinical use. Beyond evaluating their diagnostic accuracy, future studies should address the practical challenges associated with implementing these techniques and the potential benefits for different ischemic diseases.

Inferring CT perfusion parameters and uncertainties using a Bayesian approach

BACKGROUND

Computed tomography perfusion imaging is commonly used for the rapid assessment of patients presenting with symptoms of acute stroke. Maps of perfusion parameters, such as cerebral blood volume (CBV), cerebral blood flow (CBF), and mean transit time (MTT) derived from the perfusion scan data, provide crucial information for stroke diagnosis and treatment decisions. Most CT scanners use singular value decomposition (SVD)-based methods to calculate these parameters. However, some known problems are associated with conventional methods.

METHODS

In this work, we propose a Bayesian inference algorithm, which can derive both the perfusion parameters and their uncertainties. We apply the variational technique to the inference, which then becomes an expectation-maximization problem. The probability distribution (with Gaussian mean and variance) of each estimated parameter can be obtained, and the coefficient of variation is used to indicate the uncertainty. We perform evaluations using both simulations and patient studies.

RESULTS

In a simulation, we show that the proposed method has much less bias than conventional methods. Then, in separate simulations, we apply the proposed method to evaluate the impacts of various scan conditions, i.e., with different frame intervals, truncated measurement, or motion, on the parameter estimate. In one patient study, the method produced CBF and MTT maps indicating an ischemic lesion consistent with the radiologist's report. In a second patient study affected by patient movement, we showed the feasibility of applying the proposed method to motion corrected data.

CONCLUSIONS

The proposed method can be used to evaluate confidence in parameter estimation and the scan protocol design. More clinical evaluation is required to fully test the proposed method.

Three-dimensional regions-of-interest-based intra-operative four-dimensional soft tissue perfusion imaging using a standard x-ray system with no gantry rotation: A simulation study for a proof of concept

PURPOSE

Many interventional procedures aim at changing soft tissue perfusion or blood flow. One problem at present is that soft tissue perfusion and its changes cannot be assessed in an interventional suite because cone-beam computed tomography is too slow (it takes 4-10 s per volume scan). In order to address the problem, we propose a novel method called IPEN for Intra-operative four-dimensional soft tissue PErfusion using a standard x-ray system with No gantry rotation.

METHODS

IPEN uses two input datasets: (a) the contours and locations of three-dimensional regions-of-interest (ROIs) such as arteries and sub-sections of cancerous lesions, and (b) a series of x-ray projection data obtained from an intra-arterial contrast injection to contrast enhancement to wash-out. IPEN then estimates a time-enhancement curve (TEC) for each ROI directly from projections without reconstructing cross-sectional images by maximizing the agreement between synthesized and measured projections with a temporal roughness penalty. When path lengths through ROIs are known for each x-ray beam, the ROI-specific enhancement can be accurately estimated from projections. Computer simulations are performed to assess the performance of the IPEN algorithm. Intra-arterial contrast-enhanced liver scans over 25 s were simulated using XCAT phantom version 2.0 with heterogeneous tissue textures and cancerous lesions. The following four sub-studies were performed: (a) The accuracy of the estimated TECs with overlapped lesions was evaluated at various noise (dose) levels with either homogeneous or heterogeneous lesion enhancement patterns; (b) the accuracy of IPEN with inaccurate ROI contours was assessed; (c) we investigated how overlapping ROIs and noise in projections affected the accuracy of the IPEN algorithm; and (d) the accuracy of the perfusion indices was assessed.

RESULTS

The TECs estimated by IPEN were sufficiently accurate at a reference dose level with the root-mean-square deviation (RMSD) of 0.0027 ± 0.0001 cm^-1 or 13 ± 1 Hounsfield unit (mean ± standard deviation) for the homogeneous lesion enhancement and 0.0032 ± 0.0005 cm^-1 for the heterogeneous enhancement (N = 20 each). The accuracy was degraded with decreasing doses: The RMSD with homogeneous enhancement was 0.0220 ± 0.0003 cm^-1 for 20% of the reference dose level. Performing 3 × 3 pixel averaging on projection data improved the RMSDs to 0.0051 ± 0.0002 cm^-1 for 20% dose. When the ROI contours were inaccurate, smaller ROI contours resulted in positive biases in TECs, whereas larger ROI contours produced negative biases. The bias remained small, within ± 0.0070 cm^-1 , when the Sorenson-Dice coefficients (SDCs) were larger than 0.81. The RMSD of the TEC estimation was strongly associated with the condition of the problem, which can be empirically quantified using the condition number of a matrix A z that maps a vector of ROI enhancement values z to projection data and a weighted variance of projection data: a linear correlation coefficient (R) was 0.794 (P < 0.001). The perfusion index values computed from the estimated TECs agreed well with the true values (R ≥ 0.985, P < 0.0001).

CONCLUSION

The IPEN algorithm can estimate ROI-specific TECs with high accuracy especially when 3 × 3 pixel averaging is applied, even when lesion enhancement is heterogeneous, or ROI contours are inaccurate but the SDC is at least 0.81.

An Enhanced SMART-RECON Algorithm for Time-Resolved C-Arm Cone-Beam CT Imaging

Temporal resolution in time-resolved cone-beam CT (TR-CBCT) imaging is often limited by the time needed to acquire a complete data set for image reconstruction. With the recent developments of performing nearly limited-view artifact-free reconstruction from data in a limited-view angle range and a prior image, temporal resolution of TR-CBCT imaging can be improved. One such an example is the use of Simultaneous Multiple Artifacts Reduction in Tomographic RECONstruction (SMART-RECON) [1] technique. However, with SMART-RECON, one can only improve temporal resolution up to 1 frame per second (fps) which is an improvement of 4.5 times over that of the conventional FBP reconstruction. In this paper, a new technique referred to as enhanced SMART-RECON (eSMART-RECON) was introduced to enhance the temporal performance of SMART-RECON in a multi-sweep CBCT data acquisition protocol. Both numerical simulation studies with ground truth and in vivo human subject studies using C-arm CBCT acquisition systems were conducted to demonstrate the following key results: for a multi-sweep CBCT acquisition protocol, eSMART-RECON enables 4-7.5 fps temporal resolution for TR-CBCT which is 4-7.5 times better than that offered by the original SMART-RECON, and 18-34 times better than that offered by the conventional FBP reconstruction.

Diagnostic accuracy of flat-panel computed tomography in assessing cerebral perfusion in comparison with perfusion computed tomography and perfusion magnetic resonance: a systematic review

Purpose

Flat-panel computed tomography (FP-CT) is increasingly available in angiographic rooms and hybrid OR’s. Considering its easy access, cerebral imaging using FP-CT is an appealing modality for intra-procedural applications. The purpose of this systematic review is to assess the diagnostic accuracy of FP-CT compared with perfusion computed tomography (CTP) and perfusion magnetic resonance (MRP) in cerebral perfusion imaging.

Methods

We performed a systematic literature search in the Cochrane Library, MEDLINE, Embase, and Web of Science up to June 2019 for studies directly comparing FP-CT with either CTP or MRP in vivo. Methodological quality was assessed using the QUADAS-2 tool. Data on diagnostic accuracy was extracted and pooled if possible.

Results

We found 11 studies comparing FP-CT with CTP and 5 studies comparing FP-CT with MRP. Most articles were pilot or feasibility studies, focusing on scanning and contrast protocols. All patients studied showed signs of cerebrovascular disease. Half of the studies were animal trials. Quality assessment showed unclear to high risks of bias and low concerns regarding applicability. Five studies reported on diagnostic accuracy; FP-CT shows good sensitivity (range 0.84–1.00) and moderate specificity (range 0.63–0.88) in detecting cerebral blood volume (CBV) lesions.

Conclusions

Even though FP-CT provides similar CBV values and reconstructed blood volume maps as CTP in cerebrovascular disease, additional studies are required in order to reliably compare its diagnostic accuracy with cerebral perfusion imaging.

Electronic supplementary material

The online version of this article (10.1007/s00234-019-02285-y) contains supplementary material, which is available to authorized users.

Reconstruction-of-difference (RoD) imaging for cone-beam CT neuro-angiography

Timely evaluation of neurovasculature via CT angiography (CTA) is critical to the detection of pathology such as ischemic stroke. Cone-beam CTA (CBCT-A) systems provide potential advantages in the timely use at the point-of-care, although challenges of a relatively slow gantry rotation speed introduce tradeoffs among image quality, data consistency and data sparsity. This work describes and evaluates a new reconstruction-of-difference (RoD) approach that is robust to such challenges. A fast digital simulation framework was developed to test the performance of the RoD over standard reference reconstruction methods such as filtered back-projection (FBP) and penalized likelihood (PL) over a broad range of imaging conditions, grouped into three scenarios to test the trade-off between data consistency, data sparsity and peak contrast. Two experiments were also conducted using a CBCT prototype and an anthropomorphic neurovascular phantom to test the simulation findings in real data. Performance was evaluated primarily in terms of normalized root mean square error (NRMSE) in comparison to truth, with reconstruction parameters chosen to optimize performance in each case to ensure fair comparison. The RoD approach reduced NRMSE in reconstructed images by up to 50%-53% compared to FBP and up to 29%-31% compared to PL for each scenario. Scan protocols well suited to the RoD approach were identified that balance tradeoffs among data consistency, sparsity and peak contrast-for example, a CBCT-A scan with 128 projections acquired in 8.5 s over a 180°  +  fan angle half-scan for a time attenuation curve with ~8.5 s time-to-peak and 600 HU peak contrast. With imaging conditions such as the simulation scenarios of fixed data sparsity (i.e. varying levels of data consistency and peak contrast), the experiments confirmed the reduction of NRMSE by 34% and 17% compared to FBP and PL, respectively. The RoD approach demonstrated superior performance in 3D angiography compared to FBP and PL in all simulation and physical experiments, suggesting the possibility of CBCT-A on low-cost, mobile imaging platforms suitable to the point-of-care. The algorithm demonstrated accurate reconstruction with a high degree of robustness against data sparsity and inconsistency.

Time-resolved C-arm cone beam CT angiography (TR-CBCTA) imaging from a single short-scan C-arm cone beam CT acquisition with intra-arterial contrast injection

Time-resolved C-arm cone-beam CT (CBCT) angiography (TR-CBCTA) images can be generated from a series of CBCT acquisitions that satisfy data sufficiency condition in analytical image reconstruction theory. In this work, a new technique was developed to generate TR-CBCTA images from a single short-scan CBCT data acquisition with contrast media injection. The reconstruction technique enabling this application is a previously developed image reconstruction technique, synchronized multi-artifact reduction with tomographic reconstruction (SMART-RECON). In this new application, the acquired short-scan CBCT projection data were sorted into a union of several sub-sectors of view angles and each sub-sector of view angles corresponds to an individual image volume to be reconstructed. The SMART-RECON method was then used to jointly reconstruct all of these individual image volumes under two constraints: (1) each individual image volume is maximally consistent with the measured cone-beam projection data within the corresponding view angle sector and (2) the nuclear norm of the image matrix is minimized. The difference between these reconstructed individual image volumes is used to generated the desired subtracted angiograms. To validate the technique, numerical simulation data generated from a fractal tree angiogram phantom were used to quantitatively study the accuracy of the proposed method and retrospective in vivo human subject studies were used to demonstrate the feasibility of generating TR-CBCTA in clinical practice.

Using Flat-Panel Perfusion Imaging to Measure Cerebral Hemodynamics: A Pilot Feasibility Study in Patients With Carotid Stenosis

Flat-detector CT perfusion (FD-CTP) imaging has demonstrated efficacy in qualitatively accessing the penumbra in acute stroke equivalent to that of magnetic resonance perfusion (MRP). The aim of our study was to evaluate the feasibility of quantifying oligemia in the brain in patients with carotid stenosis.Ten patients with unilateral carotid stenosis of >70% were included. All MRPs and FD-CTPs were performed before stenting. Region-of-interests (ROIs) including middle cerebral artery territory at basal ganglia level on both stenotic and contralateral sides were used for quantitative analysis. Relative time to peak (rTTP) was defined as TTP of the stenotic side divided by TTP of the contralateral side, and so as relative cerebral blood volume (rCBV), relative mean transit time (rMTT), and relative cerebral blood flow (rCBF). Absolute and relative TTP, CBV, MTT, CBF between two modalities were compared.For absolute quantitative analysis, the correlation of TTP was highest (r = 0.56), followed by CBV (r = 0.47), MTT (r = 0.47), and CBF (r = 0.43); for relative quantitative analysis, rCBF was the highest (r = 0.79), followed by rTTP (r = 0.75) and rCBV (r = 0.50).We confirmed that relative quantitative assessment of FD-CTP is feasible in chronic ischemic disease. Absolute quantitative measurements between MRP and FD-CTP only expressed moderate correlations. Optimization of acquisitions and algorithms is warranted to achieve better quantification.

Time density curve analysis for C-arm FDCT PBV imaging

INTRODUCTION

Parenchymal blood volume (PBV) estimation using C-arm flat detector computed tomography (FDCT) assumes a steady-state contrast concentration in cerebral vasculature for the scan duration. Using time density curve (TDC) analysis, we explored if the steady-state assumption is met for C-arm CT PBV scans, and how consistent the contrast-material dynamics in cerebral vasculature are across patients.

METHODS

Thirty C-arm FDCT datasets of 26 patients with aneurysmal-SAH, acquired as part of a prospective study comparing C-arm CT PBV with MR-PWI, were analysed. TDCs were extracted from the 2D rotational projections. Goodness-of-fit of TDCs to a steady-state horizontal-line-model and the statistical similarity among the individual TDCs were tested. Influence of the differences in TDC characteristics on the agreement of resulting PBV measurements with MR-CBV was calculated.

RESULTS

Despite identical scan parameters and contrast-injection-protocol, the individual TDCs were statistically non-identical (p < 0.01). Using Dunn's multiple comparisons test, of the total 435 individual comparisons among the 30 TDCs, 330 comparisons (62%) reached statistical significance for difference. All TDCs deviated significantly (p < 0.01) from the steady-state horizontal-line-model. PBV values of those datasets for which the TDCs showed largest deviations from the steady-state model demonstrated poor agreement and correlation with MR-CBV, compared with the PBV values of those datasets for which the TDCs were closer to steady-state.

CONCLUSION

For clinical C-arm CT PBV examinations, the administered contrast material does not reach the assumed 'ideal steady-state' for the duration of scan. Using a prolonged injection protocol, the degree to which the TDCs approximate the ideal steady-state influences the agreement of resulting PBV measurements with MR-CBV.

Dynamic Angiography and Perfusion Imaging Using Flat Detector CT in the Angiography Suite: A Pilot Study in Patients with Acute Middle Cerebral Artery Occlusions

BACKGROUND AND PURPOSE

Perfusion and angiographic imaging using intravenous contrast application to evaluate stroke patients is now technically feasible by flat detector CT performed by the angiographic system. The aim of this pilot study was to show the feasibility and qualitative comparability of a novel flat detector CT dynamic perfusion and angiographic imaging protocol in comparison with a multimodal stroke MR imaging protocol.

MATERIALS AND METHODS

In 12 patients with acute stroke, MR imaging and the novel flat detector CT protocol were performed before endovascular treatment. Perfusion parameter maps (MTT, TTP, CBV, CBF) and MIP/volume-rendering technique images obtained by using both modalities (MR imaging and flat detector CT) were compared.

RESULTS

Comparison of MIP/volume-rendering technique images demonstrated equivalent visibility of the occlusion site. Qualitative comparison of perfusion parameter maps by using ASPECTS revealed high Pearson correlation coefficients for parameters CBF, MTT, and TTP (0.95-0.98), while for CBV, the coefficient was lower (0.49).

CONCLUSIONS

We have shown the feasibility of a novel dynamic flat detector CT perfusion and angiographic protocol for the diagnosis and triage of patients with acute ischemic stroke. In a qualitative comparison, the parameter maps and MIP/volume-rendering technique images compared well with MR imaging. In our opinion, this flat detector CT application may substitute for multisection CT imaging in selected patients with acute stroke so that in the future, patients with acute stroke may be directly referred to the angiography suite, thereby avoiding transportation and saving time.

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

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.

Dynamic iterative reconstruction for interventional 4-D C-arm CT perfusion imaging

Tissue perfusion measurement using C-arm angiography systems capable of CT-like imaging (C-arm CT) is a novel technique with potentially high benefit for catheter guided treatment of stroke in the interventional suite. However, perfusion C-arm CT (PCCT) is challenging: the slow C-arm rotation speed only allows measuring samples of contrast time attenuation curves (TACs) every 5-6 s if reconstruction algorithms for static data are used. Furthermore, the peak values of the TACs in brain tissue typically lie in a range of 5-30 HU, thus perfusion imaging is very sensitive to noise. We present a dynamic, iterative reconstruction (DIR) approach to reconstruct TACs described by a weighted sum of basis functions. To reduce noise, a regularization technique based on joint bilateral filtering (JBF) is introduced. We evaluated the algorithm with a digital dynamic brain phantom and with data from six canine stroke models. With our dynamic approach, we achieve an average Pearson correlation (PC) of the PCCT canine blood flow maps to co-registered perfusion CT maps of 0.73. This PC is just as high as the PC achieved in a recent PCCT study, which required repeated injections and acquisitions.

C-arm CT measurement of cerebral blood volume and cerebral blood flow using a novel high-speed acquisition and a single intravenous contrast injection

BACKGROUND AND PURPOSE

Assessment of perfusion parameters is important in the selection of patients who are most likely to benefit from revascularization after an acute ischemic stroke. The aim of this study was to evaluate the feasibility of measuring cerebral perfusion parameters with the use of a novel high-speed C-arm CT acquisition in conjunction with a single intravenous injection of contrast.

MATERIALS AND METHODS

Seven canines had experimentally induced focal ischemic regions confirmed by CT perfusion imaging. Four hours after ischemic injury creation, each subject underwent cerebral perfusion measurements with the use of standard perfusion CT, immediately followed by the use of C-arm CT. Cerebral blood flow and cerebral blood volume maps measured by C-arm CT were quantitatively and qualitatively compared with those measured by perfusion CT for 6 of the 7 canine subjects.

RESULTS

Results from independent observer evaluations of perfusion CT and C-arm perfusion maps show strong agreement between observers for identification of ischemic lesion location. Significant percentage agreement between observers for lesion detection and identification of perfusion mismatch between CBV and CBF maps indicate that the maps for both perfusion CT and C-arm are easy to interpret. Quantitative region of interest-based evaluation showed a strong correlation between the perfusion CT and C-arm CBV and CBF maps (R(2) = 0.68 and 0.85). C-arm measurements for both CBV and CBF were consistently overestimated when compared with perfusion CT.

CONCLUSIONS

Qualitative and quantitative measurements of CBF and CBV with the use of a C-arm CT acquisition and a single intravenous injection of contrast agent are feasible. Future improvements in flat detector technology and software algorithms probably will enable more accurate quantitative perfusion measurements with the use of C-arm CT.

In vitro evaluation of the imaging accuracy of C-arm conebeam CT in cerebral perfusion imaging

PURPOSE

The authors have developed a method to enable cerebral perfusion CT imaging using C-arm based conebeam CT (CBCT). This allows intraprocedural monitoring of brain perfusion during treatment of stroke. Briefly, the technique consists of acquiring multiple scans (each scan comprised of six sweeps) acquired at different time delays with respect to the start of the x-ray contrast agent injection. The projections are then reconstructed into angular blocks and interpolated at desired time points. The authors have previously demonstrated its feasibility in vivo using an animal model. In this paper, the authors describe an in vitro technique to evaluate the accuracy of their method for measuring the relevant temporal signals.

METHODS

The authors' evaluation method is based on the concept that any temporal signal can be represented by a Fourier series of weighted sinusoids. A sinusoidal phantom was developed by varying the concentration of iodine as successive steps of a sine wave. Each step corresponding to a different dilution of iodine contrast solution contained in partitions along a cylinder. By translating the phantom along the axis at different velocities, sinusoidal signals at different frequencies were generated. Using their image acquisition and reconstruction algorithm, these sinusoidal signals were imaged with a C-arm system and the 3D volumes were reconstructed. The average value in a slice was plotted as a function of time. The phantom was also imaged using a clinical CT system with 0.5 s rotation. C-arm CBCT results using 6, 3, 2, and 1 scan sequences were compared to those obtained using CT. Data were compared for linear velocities of the phantom ranging from 0.6 to 1 cm∕s. This covers the temporal frequencies up to 0.16 Hz corresponding to a frequency range within which 99% of the spectral energy for all temporal signals in cerebral perfusion imaging is contained.

RESULTS

The errors in measurement of temporal frequencies are mostly below 2% for all multiscan sequences. For single scan sequences, the errors increase sharply beyond 0.10 Hz. The amplitude errors increase with frequency and with decrease in the number of scans used.

CONCLUSIONS

Our multiscan perfusion CT approach allows low errors in signal frequency measurement. Increasing the number of scans reduces the amplitude errors. A two-scan sequence appears to offer the best compromise between accuracy and the associated total x-ray and iodine dose.

Spatially regularized region-based perfusion estimation in peripherals using angiographic C-arm systems

The outcome assessment of endovascular revascularization procedures in the lower limbs is currently carried out by x-ray digital subtraction angiography (DSA). Due to the two-dimensional nature of this technique, only visual assessment of arterial blood flow is possible and no tissue blood flow information (i.e. perfusion) is available to assess the effective restoration of blood supply to the tissue. In this work, we propose a method for interventional perfusion estimation in peripherals using C-arms which is based on DSA and two additional 3D images reconstructed from rotational scans. The method assumes spatial homogeneity of contrast within multiple regions identified by segmentation of the reconstructed 3D images. A dedicated segmentation method which relies on local contrast homogeneity and connectivity of anatomical structures is introduced. Region-based perfusion is obtained by mapping the 2D blood flow information from DSA to the 3D segments by solving an inverse problem. Instability of the solution due to the spatial overlap of the regions is addressed by applying spatial and temporal regularizations. The method was evaluated on data simulated from CT perfusion scans of the lower limb. Blood flow values estimated with the optimal number of segmented regions exhibited errors of 1 ± 4  and 2 ± 11 ml/100 ml min(-1) for the two analyzed cases, respectively, which showed to be sufficient to differentiate hypoperfused and normally perfused areas. The use of spatial and temporal regularization proved to be an effective way to limit inaccuracies due to instability in the solution of the inverse problem. Results in general proved the feasibility of C-arm interventional perfusion imaging by a combination of temporal information derived from DSA and spatial information derived from 3D reconstructions.