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

• Published in: Neuroradiology Vol. 57; no. 9; pp. 937 - 949
• Main Authors: Kamran, Mudassar, Byrne, James V.
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.09.2015; Springer Nature B.V
• Subjects: Aneurysms; Blood Volume Determination; Brain; Cerebral Angiography - methods; Cerebrovascular Circulation; Circulatory system; Feasibility; Feasibility Studies; Female; Hemodynamics; Humans; Image Interpretation, Computer-Assisted; Imaging; Interventional Neuroradiology; Intracranial Aneurysm - diagnostic imaging; Magnetic Resonance Angiography; Male; Medicine; Medicine & Public Health; Middle Aged; Neurology; Neuroradiology; Neurosciences; Neurosurgery; Prospective Studies; Radiology; Sensitivity and Specificity; Subarachnoid Hemorrhage - diagnostic imaging; Tomography; Tomography, X-Ray Computed - methods; Parenchymal blood volume; C-arm flat detector computed tomography; Cerebral blood flow; Subarachnoid haemorrhage; MR perfusion-weighted imaging
• ISSN: 0028-3940; 1432-1920
• DOI: 10.1007/s00234-015-1545-1

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.