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Moon S, Kang J, Kim Y, Jo E, Jeong P, Roh Y, Baek J. Carbon nanotube-based multiple source C-arm CT system: feasibility study with prototype system. OPTICS EXPRESS 2023; 31:44772-44797. [PMID: 38178538 DOI: 10.1364/oe.503421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 12/07/2023] [Indexed: 01/06/2024]
Abstract
To extend the field of view while reducing dimensions of the C-arm, we propose a carbon nanotube (CNT)-based C-arm computed tomography (CT) system with multiple X-ray sources. A prototype system was developed using three CNT X-ray sources, enabling a feasibility study. Geometry calibration and image reconstruction were performed to improve the quality of image acquisition. However, the geometry of the prototype system led to projection truncation for each source and an overlap region of object area covered by each source in the two-dimensional Radon space, necessitating specific corrective measures. We addressed these problems by implementing truncation correction and applying weighting techniques to the overlap region during the image reconstruction phase. Furthermore, to enable image reconstruction with a scan angle less than 360°, we designed a weighting function to solve data redundancy caused by the short scan angle. The accuracy of the geometry calibration method was evaluated via computer simulations. We also quantified the improvements in reconstructed image quality using mean-squared error and structural similarity. Moreover, detector lag correction was applied to address the afterglow observed in the experimental data obtained from the prototype system. Our evaluation of image quality involved comparing reconstructed images obtained with and without incorporating the geometry calibration results and images with and without lag correction. The outcomes of our simulation study and experimental investigation demonstrated the efficacy of our proposed geometry calibration, image reconstruction method, and lag correction in reducing image artifacts.
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Moon S, Choi S, Jang H, Shin M, Roh Y, Baek J. Geometry calibration and image reconstruction for carbon-nanotube-based multisource and multidetector CT. Phys Med Biol 2021; 66. [PMID: 34289459 DOI: 10.1088/1361-6560/ac16c1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 07/21/2021] [Indexed: 11/12/2022]
Abstract
Conventional intraoperative computed tomography (CT) has a long scan time, degrading the image quality. Its large size limits the position of a surgeon during surgery. Therefore, this study proposes a CT system comprising of eight carbon-nanotube (CNT)-based x-ray sources and 16 detector modules to solve these limitations. Gantry only requires 45° of rotation to acquire the whole projection, reducing the scan time to 1/8 compared to the full rotation. Moreover, the volume and scan time of the system can be significantly reduced using CNT sources with a small volume and short pulse width and placing a heavy and large high-voltage generator outside the gantry. We divided the proposed system into eight subsystems and sequentially devised a geometry calibration method for each subsystem. Accordingly, a calibration phantom consisting of four polytetrafluoroethylene beads, each with 15 mm diameter, was designed. The geometry calibration parameters were estimated by minimizing the difference between the measured bead projection and the forward projection of the formulated subsystem. By reflecting the estimated geometry calibration parameters, the projection data were obtained via rebinning to be used in the filtered-backprojection reconstruction. The proposed calibration and reconstruction methods were validated by computer simulations and real experiments. Additionally, the accuracy of the geometry calibration method was examined by computer simulation. Furthermore, we validated the improved quality of the reconstructed image through the mean-squared error (MSE), structure similarity (SSIM), and visual inspections for both the simulated and experimental data. The results show that the calibrated images, reconstructed by reflecting the calibration results, have smaller MSE and higher SSIM values than the uncalibrated images. The calibrated images were observed to have fewer artifacts than the uncalibrated images in visual inspection, demonstrating that the proposed calibration and reconstruction methods effectively reduce artifacts caused by geometry misalignments.
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Affiliation(s)
- Seunghyuk Moon
- School of Integrated Technology, Yonsei University, Incheon, Republic Of Korea
| | - Seungwon Choi
- School of Integrated Technology, Yonsei University, Incheon, Republic Of Korea
| | - Hanjoo Jang
- School of Integrated Technology, Yonsei University, Incheon, Republic Of Korea
| | - Minsik Shin
- KohYoung Technology, Yongin, Republic Of Korea
| | | | - Jongduk Baek
- School of Integrated Technology, Yonsei University, Incheon, Republic Of Korea
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Melià-Sorolla M, Castaño C, DeGregorio-Rocasolano N, Rodríguez-Esparragoza L, Dávalos A, Martí-Sistac O, Gasull T. Relevance of Porcine Stroke Models to Bridge the Gap from Pre-Clinical Findings to Clinical Implementation. Int J Mol Sci 2020; 21:ijms21186568. [PMID: 32911769 PMCID: PMC7555414 DOI: 10.3390/ijms21186568] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 09/03/2020] [Accepted: 09/07/2020] [Indexed: 12/18/2022] Open
Abstract
In the search of animal stroke models providing translational advantages for biomedical research, pigs are large mammals with interesting brain characteristics and wide social acceptance. Compared to rodents, pigs have human-like highly gyrencephalic brains. In addition, increasingly through phylogeny, animals have more sophisticated white matter connectivity; thus, ratios of white-to-gray matter in humans and pigs are higher than in rodents. Swine models provide the opportunity to study the effect of stroke with emphasis on white matter damage and neuroanatomical changes in connectivity, and their pathophysiological correlate. In addition, the subarachnoid space surrounding the swine brain resembles that of humans. This allows the accumulation of blood and clots in subarachnoid hemorrhage models mimicking the clinical condition. The clot accumulation has been reported to mediate pathological mechanisms known to contribute to infarct progression and final damage in stroke patients. Importantly, swine allows trustworthy tracking of brain damage evolution using the same non-invasive multimodal imaging sequences used in the clinical practice. Moreover, several models of comorbidities and pathologies usually found in stroke patients have recently been established in swine. We review here ischemic and hemorrhagic stroke models reported so far in pigs. The advantages and limitations of each model are also discussed.
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Affiliation(s)
- Marc Melià-Sorolla
- Cellular and Molecular Neurobiology Research Group, Department of Neurosciences, Germans Trias i Pujol Research Institute, 08916 Badalona, Catalonia, Spain; (M.M.-S.); (N.D.-R.)
| | - Carlos Castaño
- Neurointerventional Radiology Unit, Department of Neurosciences, Hospital Germans Trias i Pujol, 08916 Badalona, Catalonia, Spain;
| | - Núria DeGregorio-Rocasolano
- Cellular and Molecular Neurobiology Research Group, Department of Neurosciences, Germans Trias i Pujol Research Institute, 08916 Badalona, Catalonia, Spain; (M.M.-S.); (N.D.-R.)
| | - Luis Rodríguez-Esparragoza
- Stroke Unit, Department of Neurology, Hospital Germans Trias i Pujol, 08916 Badalona, Catalonia, Spain; (L.R.-E.); (A.D.)
| | - Antoni Dávalos
- Stroke Unit, Department of Neurology, Hospital Germans Trias i Pujol, 08916 Badalona, Catalonia, Spain; (L.R.-E.); (A.D.)
| | - Octavi Martí-Sistac
- Cellular and Molecular Neurobiology Research Group, Department of Neurosciences, Germans Trias i Pujol Research Institute, 08916 Badalona, Catalonia, Spain; (M.M.-S.); (N.D.-R.)
- Department of Cellular Biology, Physiology and Immunology, Universitat Autònoma de Barcelona, 08916 Bellaterra, Catalonia, Spain
- Fundació Institut d’Investigació en Ciències de la Salut Germans Trias i Pujol (IGTP), Carretera del Canyet, Camí de les Escoles s/n, Edifici Mar, 08916 Badalona, Catalonia, Spain
- Correspondence: (O.M.-S.); (T.G.); Tel.: +34-930330531 (O.M.-S.)
| | - Teresa Gasull
- Cellular and Molecular Neurobiology Research Group, Department of Neurosciences, Germans Trias i Pujol Research Institute, 08916 Badalona, Catalonia, Spain; (M.M.-S.); (N.D.-R.)
- Fundació Institut d’Investigació en Ciències de la Salut Germans Trias i Pujol (IGTP), Carretera del Canyet, Camí de les Escoles s/n, Edifici Mar, 08916 Badalona, Catalonia, Spain
- Correspondence: (O.M.-S.); (T.G.); Tel.: +34-930330531 (O.M.-S.)
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Zwarzany Ł, Poncyljusz W, Burke TH. Flat detector CT and its applications in the endovascular treatment of wide-necked intracranial aneurysms-A literature review. Eur J Radiol 2017; 88:26-31. [PMID: 28189205 DOI: 10.1016/j.ejrad.2016.12.027] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2016] [Revised: 12/21/2016] [Accepted: 12/24/2016] [Indexed: 10/20/2022]
Abstract
Flat detector CT (FDCT) provides cross sectional imaging within an angiographic suite and is increasingly gaining popularity in various areas of interventional radiology, as an alternative imaging modality. Its relatively high spatial resolution improves visualization of intraluminal devices such as intracranial stents or flow-diverters. Device deployment and positioning, in relation to the parent vessel and surrounding structures, are easily assessible with FDCT. Furthermore, with contrast agent administration, it expands the diagnostic capabilities of this new imaging tool. However, beam-hardening artifacts is a major limitation in some cases. The examination can be performed both during the endovascular procedure and for pre- and post-treatment imaging. Intravenous contrast agent injection reduces the risk of complications, making it possible to perform this examination in the outpatient settings. The aim of this paper is to present an overview of published studies reporting experience with FDCT in the field of endovascular neurosurgery and in particular, FDCT's contribution in treatment of wide-necked intracranial aneurysms. The authors have focused specifically on stent-assisted coiling and flow-diverter implantation, since obtaining proper parent vessel wall apposition of these devices is essential for short- and long-term procedural outcomes.
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Affiliation(s)
- Łukasz Zwarzany
- Department of Radiology and Diagnostic Imaging, M. Curie Hospital, Arkońska 4, 71-455 Szczecin, Poland.
| | - Wojciech Poncyljusz
- Departament of Interventional Radiology, Pomeranian Medical University, Neurointerventional Cath Lab MSW Hospital, Al. Powst. Wielkopolskich 72, 70-111 Szczecin, Poland.
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Frölich AM, Buhk JH, Fiehler J, Kemmling A. Voxel-Based Sensitivity of Flat-Panel CT for the Detection of Intracranial Hemorrhage: Comparison to Multi-Detector CT. PLoS One 2016; 11:e0165794. [PMID: 27806106 PMCID: PMC5091958 DOI: 10.1371/journal.pone.0165794] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Accepted: 10/18/2016] [Indexed: 11/18/2022] Open
Abstract
Objectives Flat-panel CT (FPCT) allows cross-sectional parenchymal, vascular and perfusion imaging within the angiography suite, which could greatly facilitate acute stroke management. We hypothesized that FPCT offers equal diagnostic accuracy compared to multi-detector CT (MDCT) as a primary tool to exclude intracranial hemorrhage. Methods 22 patients with intracranial hematomas who had both MDCT and FPCT performed within 24 hours were retrospectively identified. Patients with visible change in hematoma size or configuration were excluded. Two raters independently segmented hemorrhagic lesions. Data sets and corresponding binary lesion maps were co-registered to compare hematoma volume. Diagnostic accuracy of FPCT to detect hemorrhage was calculated from voxel-wise analysis of lesion overlap compared to reference MDCT. Results Mean hematoma size was similar between MDCT (16.2±8.9 ml) and FPCT (16.1±8.6 ml), with near perfect correlation of hematoma sizes between modalities (ρ = 0.95, p<0.001). Sensitivity and specificity of FPCT to detect hemorrhagic voxels was 61.6% and 99.8% for intraventricular hematomas and 67.7% and 99.5% for all other intracranial hematomas. Conclusions In this small sample containing predominantly cases with subarachnoid hemorrhage, FPCT based assessment of hemorrhagic volume in brain yields acceptable accuracy compared to reference MDCT, albeit with a limited sensitivity on a voxel level. Further assessment and improvement of FPCT is necessary before it can be applied as a primary imaging modality to exclude intracranial hemorrhage in acute stroke patients.
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Affiliation(s)
- Andreas M Frölich
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Jan-Hendrik Buhk
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Jens Fiehler
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Andre Kemmling
- Department of Neuroradiology, Campus Lübeck, University Medical Center Schleswig-Holstein, Ratzeburger Allee 160, 23538, Lübeck, Germany
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Schneider T, Mahraun T, Schroeder J, Frölich A, Hoelter P, Wagner M, Darcourt J, Cognard C, Bonafé A, Fiehler J, Siemonsen S, Buhk JH. Intraparenchymal Hyperattenuations on Flat-Panel CT Directly After Mechanical Thrombectomy are Restricted to the Initial Infarct Core on Diffusion-Weighted Imaging. Clin Neuroradiol 2016; 28:91-97. [PMID: 27637922 DOI: 10.1007/s00062-016-0543-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Accepted: 08/23/2016] [Indexed: 11/26/2022]
Abstract
PURPOSE The presence of intraparenchymal hyperattenuations (IPH) on flat-panel computed tomography (FP-CT) after endovascular recanalization in stroke patients is a common phenomenon. They are thought to occur in ischemic areas with breakdown of the blood-brain barrier but previous studies that investigated a mutual interaction are scarce. We aimed to assess the relationship of IPH localization with prethrombectomy diffusion-weighted imaging (DWI) lesions. METHODS This retrospective multicenter study included 27 acute stroke patients who underwent DWI prior to FP-CT following mechanical thrombectomy. After software-based coregistration of DWI and FP-CT, lesion volumetry was conducted and overlapping was analyzed. RESULTS Two different patterns were observed: IPH corresponding to the DWI lesion and IPH exceeding the DWI lesion. The latter showed demarcated infarction of DWI exceeding IPH at 24 h. No major hemorrhage following IPH was observed. Most IPH were manifested within the basal ganglia and insular cortex. CONCLUSION The IPH primarily appeared within the initial ischemic core and secondarily within the penumbral tissue that progressed to infarction. The IPH represent the minimum final infarct volume, which may help in periinterventional decision making.
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Affiliation(s)
- Tanja Schneider
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, Haus O22, 20246, Hamburg, Germany.
| | - Tobias Mahraun
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, Haus O22, 20246, Hamburg, Germany
| | - Julian Schroeder
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Andreas Frölich
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, Haus O22, 20246, Hamburg, Germany
| | - Philip Hoelter
- Department of Neuroradiology, University Clinic Erlangen, Erlangen, Germany
| | - Marlies Wagner
- Institute of Neuroradiology, Goethe University Hospital, Frankfurt, Germany
| | - Jean Darcourt
- Départment de Neuroradiologie diagnostique et thérapeutique, University Hospital of Purpan, Toulouse, France
| | - Christophe Cognard
- Départment de Neuroradiologie diagnostique et thérapeutique, University Hospital of Purpan, Toulouse, France
| | - Alain Bonafé
- Départment de Neuroradiologie, Hospitalier Universitaire Gui de Chauliac, Montpellier, France
| | - Jens Fiehler
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, Haus O22, 20246, Hamburg, Germany
| | - Susanne Siemonsen
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, Haus O22, 20246, Hamburg, Germany
| | - Jan-Hendrik Buhk
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, Haus O22, 20246, Hamburg, Germany
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Pjontek R, Önenköprülü B, Scholz B, Kyriakou Y, Schubert GA, Nikoubashman O, Othman A, Wiesmann M, Brockmann MA. Metal artifact reduction for flat panel detector intravenous CT angiography in patients with intracranial metallic implants after endovascular and surgical treatment. J Neurointerv Surg 2015; 8:824-9. [PMID: 26346458 PMCID: PMC4975832 DOI: 10.1136/neurintsurg-2015-011787] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Accepted: 07/13/2015] [Indexed: 11/03/2022]
Abstract
BACKGROUND Flat panel detector CT angiography with intravenous contrast agent injection (IV CTA) allows high-resolution imaging of cerebrovascular structures. Artifacts caused by metallic implants like platinum coils or clips lead to degradation of image quality and are a significant problem. OBJECTIVE To evaluate the influence of a prototype metal artifact reduction (MAR) algorithm on image quality in patients with intracranial metallic implants. METHODS Flat panel detector CT after intravenous application of 80 mL contrast agent was performed with an angiography system (Artis zee; Siemens, Forchheim, Germany) using a 20 s rotation protocol (200° rotation angle, 20 s acquisition time, 496 projections). The data before and after MAR of 26 patients with a total of 34 implants (coils, clips, stents) were independently evaluated by two blinded neuroradiologists. RESULTS MAR improved the assessability of the brain parenchyma and small vessels (diameter <1 mm) in the neighborhood of metallic implants and at a distance of 6 cm (p<0.001 each, Wilcoxon test). Furthermore, MAR significantly improved the assessability of parent vessel patency and potential aneurysm remnants (p<0.005 each, McNemar test). MAR, however, did not improve assessability of stented vessels. CONCLUSIONS When an intravenous contrast protocol is used, MAR significantly ameliorates the assessability of brain parenchyma, vessels, and treated aneurysms in patients with intracranial coils or clips.
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Affiliation(s)
- Rastislav Pjontek
- Department of Diagnostic and Interventional Neuroradiology, University Hospital RWTH Aachen, Aachen, Germany
| | - Belgin Önenköprülü
- Department of Diagnostic and Interventional Neuroradiology, University Hospital RWTH Aachen, Aachen, Germany
| | - Bernhard Scholz
- Healthcare, Imaging & Therapy Division, Siemens AG, Forchheim, Germany
| | - Yiannis Kyriakou
- Healthcare, Imaging & Therapy Division, Siemens AG, Forchheim, Germany
| | - Gerrit A Schubert
- Department of Neurosurgery, University Hospital RWTH Aachen, Aachen, Germany
| | - Omid Nikoubashman
- Department of Diagnostic and Interventional Neuroradiology, University Hospital RWTH Aachen, Aachen, Germany Institute of Neuroscience and Medicine 4, Medical Imaging Physics, Forschungszentrum Jülich, Jülich, Germany
| | - Ahmed Othman
- Department of Diagnostic and Interventional Neuroradiology, University Hospital RWTH Aachen, Aachen, Germany
| | - Martin Wiesmann
- Department of Diagnostic and Interventional Neuroradiology, University Hospital RWTH Aachen, Aachen, Germany
| | - Marc A Brockmann
- Department of Diagnostic and Interventional Neuroradiology, University Hospital RWTH Aachen, Aachen, Germany
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Delgado AP, Deutschmann H, Schwarz G. [Transcranial cerebral oxymetry in interventional neuroradiology. Sources of error in interpretation of measurement data]. Anaesthesist 2014; 62:919-23. [PMID: 24114381 DOI: 10.1007/s00101-013-2245-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Transcranial cerebral oximetry is a non-invasive method to support the estimation of the balance in cerebral oxygen metabolism status during interventional neuroradiological procedures. The simple data acquisition can lead to errors by oversimplification in interpretation of the displayed data. To avoid fatal mistakes of the acquired data the complex interactions of the examined substrate with physiological and pathophysiological interactions have to be critically judged as well as the procedural approach and methodological limitations.
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Affiliation(s)
- A P Delgado
- Klinische Abteilung für Neuro-und Gesichtschirurgische, Anästhesiologie und Intensivmedizin, Universitätsklinik für Anästhesiologie und Intensivmedizin, Medizinischen Universität Graz, Auenbruggerplatz 29/I, 8036, Graz, Österreich,
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Kau T, Hauser M, Obmann SM, Niedermayer M, Weber JR, Hausegger KA. Flat detector angio-CT following intra-arterial therapy of acute ischemic stroke: identification of hemorrhage and distinction from contrast accumulation due to blood-brain barrier disruption. AJNR Am J Neuroradiol 2014; 35:1759-64. [PMID: 24948498 DOI: 10.3174/ajnr.a4021] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Flat panel detector CT in the angiography suite may be valuable for the detection of intracranial hematomas; however, abnormal contrast enhancement frequently mimics hemorrhage. We aimed to assess the accuracy of flat panel detector CT in detecting/excluding intracranial bleeding after endovascular stroke therapy and whether it was able to reliably differentiate hemorrhage from early blood-brain barrier disruption. MATERIALS AND METHODS Seventy-three patients were included for retrospective evaluation following endovascular stroke therapy: 32 after stent-assisted thrombectomy, 14 after intra-arterial thrombolysis, and 27 after a combination of both. Flat panel CT images were assessed for image quality and the presence and type of intracranial hemorrhage and BBB disruption by 2 readers separately and in consensus. Follow-up by multisection head CT, serving as the reference standard, was evaluated by a single reader. RESULTS Conventional head CT revealed intracranial hematomas in 12 patients (8 subarachnoid hemorrhages, 7 cases of intracerebral bleeding, 3 SAHs plus intracerebral bleeding). Image quality of flat panel detector CT was considered sufficient in all cases supratentorially and in 92% in the posterior fossa. Regarding detection or exclusion of intracranial hemorrhage, flat panel detector CT reached a sensitivity, specificity, positive and negative predictive values, and accuracy of 58%, 85%, 44%, 91%, and 81%, respectively. Maximum attenuation measurements were not valuable for the differentiation of hemorrhage and BBB disruption. CONCLUSIONS Flat panel CT after endovascular stroke treatment was able to exclude the rare event of an intracranial hemorrhage with a high negative predictive value. Future studies should evaluate the predictive value of BBB disruptions in flat panel detector CT for the development of relevant hematomas.
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Affiliation(s)
- T Kau
- From the Institute of Diagnostic and Interventional Radiology (T.K., M.H., M.N., K.A.H.)
| | - M Hauser
- From the Institute of Diagnostic and Interventional Radiology (T.K., M.H., M.N., K.A.H.)
| | - S M Obmann
- Department of Neurology (S.M.O., J.R.W.), Klinikum Klagenfurt, Klagenfurt, Austria
| | - M Niedermayer
- From the Institute of Diagnostic and Interventional Radiology (T.K., M.H., M.N., K.A.H.)
| | - J R Weber
- Department of Neurology (S.M.O., J.R.W.), Klinikum Klagenfurt, Klagenfurt, Austria
| | - K A Hausegger
- From the Institute of Diagnostic and Interventional Radiology (T.K., M.H., M.N., K.A.H.)
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Rouchaud A, Pistocchi S, Blanc R, Engrand N, Bartolini B, Piotin M. Predictive value of flat-panel CT for haemorrhagic transformations in patients with acute stroke treated with thrombectomy. J Neurointerv Surg 2013; 6:139-43. [PMID: 23468539 DOI: 10.1136/neurintsurg-2012-010644] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Haemorrhagic transformations are pejorative for patients with acute ischaemic stroke (AIS). We estimated flat-panel CT performances to detect brain parenchymal hyperdense lesions immediately after mechanical thrombectomy directly on the angiography table in patients with AIS, and its ability to predict haemorrhagic transformation. We also evaluated an easy-reading protocol for post-procedure flat-panel CT evaluation by clinicians to enable them to determine the potential risk of haemorrhage. METHODS Two neuroradiologists retrospectively reviewed post-procedural flat-panel CT and 24 h follow-up imaging. We evaluated hyperdense lesions on flat-panel CT to predict the occurrence of haemorrhagic transformation within 24 h detected with conventional imaging. RESULTS Of 63 patients, 60.3% presented post-procedural parenchymal hyperdensity and 54.0% had haemorrhagic transformation. Significantly more patients with hyperdense lesions on post-thrombectomy flat-panel CT presented haemorrhagic transformation (84.2% vs 8.0%; p<0.0001). No significant haemorrhagic transformations were detected for patients without parenchymal hyperdensity. Sensitivity and specificity of hyperdense lesions on flat-panel CT for the prediction of haemorrhagic transformation were 94.1% (80.3-99.3%) and 79.3% (60.3-92.0%), respectively. The positive and negative predictive values for the occurrence of haemorrhage were 84.2% (68.8-94.0%) and 92.0% (74.0-99.0%), respectively. For significant parenchymal haemorrhage type 2, sensitivity and negative predictive values were 100%. We observed good homogeneity between the different readers. Hyperdensity on post-procedural flat-panel CT was associated with a tendency for higher risk of death and lower risk of good clinical outcome. CONCLUSIONS Flat-panel CT appears to be a good tool to detect brain parenchymal hyperdensities after mechanical thrombectomy in patients with AIS and to predict haemorrhagic transformation.
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Affiliation(s)
- Aymeric Rouchaud
- Department of Interventional Neuroradiology, Fondation Adolphe de Rothschild Hospital, Paris, France
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C-arm flat detector computed tomography: the technique and its applications in interventional neuro-radiology. Neuroradiology 2009; 52:319-27. [PMID: 19859702 DOI: 10.1007/s00234-009-0609-5] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2009] [Accepted: 10/05/2009] [Indexed: 10/20/2022]
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Transarterielle Chemoperfusion und -embolisation thorakaler Neoplasmen mittels C-Arm CT. Radiologe 2009; 49:837-41. [DOI: 10.1007/s00117-009-1863-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Abstract
In 2008 we witnessed a rapid advancement in stent technology, which is reflected in the high number of case reports, publications of case series, and randomized trials. Stents not only served for a combined intrasaccular and extrasaccular treatment of challenging aneurysms but also assisted the revascularization in acute and chronic ischemic conditions of the neurovascular system. Although a self-expanding nitinol semiopen cell stent is currently used for intracranial occlusive disease, a new retrievable closed-cell designed stent is widely used for aneurysms because of its easy delivery through a microcatheter in frequently tortuous head and neck as well as cerebrovascular circulation (
Figure 1
). However, despite numerous publications in the field, the widespread acceptance of the use of stents to routinely treat carotid stenosis awaits the results of the multicenter randomized clinical trials that should be available in 2009. The role of interventional neuroradiology in the treatment of acute ischemic stroke continues to expand and excite interest.
Figure 1.
Intracranial nitinol self-expanding stents used for endovascular treatment of aneurysm in conjunction with coil embolization. A, Closed cell design with flaring ends (Enterprise VRD; Codman Neurovascular, Raynham, MA). B, Semiopen cell design (Neuroform; Boston Scientific, Natick, MA).
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Affiliation(s)
- Ajay K. Wakhloo
- From Department of Radiology (A.K.W., M.J.D.), University of Massachusetts, Worcester, Mass; Institute of Neurology (M.M.B.), National Hospital, London, UK
| | - Michael J. Deleo
- From Department of Radiology (A.K.W., M.J.D.), University of Massachusetts, Worcester, Mass; Institute of Neurology (M.M.B.), National Hospital, London, UK
| | - Martin M. Brown
- From Department of Radiology (A.K.W., M.J.D.), University of Massachusetts, Worcester, Mass; Institute of Neurology (M.M.B.), National Hospital, London, UK
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Struffert T, Richter G, Engelhorn T, Doelken M, Goelitz P, Kalender WA, Ganslandt O, Doerfler A. Visualisation of intracerebral haemorrhage with flat-detector CT compared to multislice CT: results in 44 cases. Eur Radiol 2008; 19:619-25. [DOI: 10.1007/s00330-008-1183-7] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2008] [Revised: 07/17/2008] [Accepted: 07/24/2008] [Indexed: 10/21/2022]
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