Computed tomography perfusion evaluation after extracranial–intracranial bypass surgery

Highlights • We compared different perfusion algorithms in EC–IC bypass surgery patients. • Significant differences were found in perfusion asymmetry per algorithm. • Delayinsensitive algorithms seem to detect EC–IC patients with infarct on follow-up.

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Published inClinical neurology and neurosurgery Vol. 136; pp. 139 - 146
Main Authors Vos, Pieter C, Riordan, Alan J, Smit, Ewoud J, de Jong, Hugo W.A.M, van der Zwan, Albert, Velthuis, Birgitta K, Viergever, Max A, Dankbaar, Jan Willem
Format Journal Article
LanguageEnglish
Published Netherlands Elsevier B.V 01.09.2015
Elsevier Limited
Subjects
Adolescent
Adult
Aged
Aged, 80 and over
Algorithms
Blood Flow Velocity
Brain - blood supply
Brain - surgery
Carotid arteries
Cerebral blood flow
Cerebral blood volume
Cerebrovascular Circulation
Computed tomography perfusion
Contrast Media
Extracranial–intracranial bypass surgery
Female
Heart surgery
Humans
Male
Mean transit time
Middle Aged
Neurology
Neurosurgery
Patients
Perfusion - methods
Retrospective Studies
Software packages
Tomography, X-Ray Computed - methods
Young Adult
Cerebral blood volume
Extracranial–intracranial bypass surgery
Mean transit time
Computed tomography perfusion
Cerebral blood flow
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Abstract Highlights • We compared different perfusion algorithms in EC–IC bypass surgery patients. • Significant differences were found in perfusion asymmetry per algorithm. • Delayinsensitive algorithms seem to detect EC–IC patients with infarct on follow-up.
AbstractList OBJECTIVEPerfusion imaging is increasingly used for postoperative evaluation of extracranial to intracranial (EC-IC) bypass surgery. Altered hemodynamics and delayed arrival of the contrast agent in the area fed by the bypass can influence perfusion measurement. We compared perfusion asymmetry obtained with different algorithms in EC-IC bypass surgery patients.METHODSWe retrospectively identified all patients evaluated with computed tomography perfusion (CTP) between May 2007 and May 2011 after EC-IC bypass surgery at our institution. CTP images were analyzed with three perfusion algorithms that differ among their ability to anticipate for delayed arrival time of contrast material: the delay-sensitive first-moment mean transit time (fMTT), the semi-delay-sensitive standard singular value decomposition (sSVD) and the delay-insensitive block-circulant SVD (bSVD). The interhemispheric difference in bolus arrival time (ΔBAT) was determined to confirm altered hemodynamics. Interhemispheric asymmetry in perfusion values (mean transit time (MTT) difference, cerebral blood flow (CBF) ratio and cerebral blood volume (CBV) ratio) was compared between the three algorithms. Presence of a new infarct in the treated hemisphere was evaluated on follow-up imaging and perfusion asymmetry was compared between patients with and without infarction.RESULTSTwenty-two patients were included. The median interhemispheric difference in ΔBAT was 0.98 s. The median MTT difference was significantly smaller when calculated with the delay-insensitive algorithm than with the other algorithms (0.44 s versus 0.90 s and 0.93 s, p<0.01). The CBF ratio was similar for all algorithms (111.98 versus 112.59 and 112.60). The CBV ratio was similar for all algorithms (113.20 versus 111.95 and 113.97). There was a significant difference in MTT asymmetry between patients with and without infarction with the delay-insensitive algorithm only (1.57 s versus 0.38 s, p=0.04).CONCLUSIONIn patients with EC-IC bypass surgery, delay-sensitive algorithms showed larger MTT asymmetry than delay-insensitive algorithms. Furthermore, only the delay-insensitive method seems to differentiate between patients with and without infarction on follow-up.
Highlights • We compared different perfusion algorithms in EC–IC bypass surgery patients. • Significant differences were found in perfusion asymmetry per algorithm. • Delayinsensitive algorithms seem to detect EC–IC patients with infarct on follow-up.
Objective Perfusion imaging is increasingly used for postoperative evaluation of extracranial to intracranial (EC-IC) bypass surgery. Altered hemodynamics and delayed arrival of the contrast agent in the area fed by the bypass can influence perfusion measurement. We compared perfusion asymmetry obtained with different algorithms in EC-IC bypass surgery patients. Methods We retrospectively identified all patients evaluated with computed tomography perfusion (CTP) between May 2007 and May 2011 after EC-IC bypass surgery at our institution. CTP images were analyzed with three perfusion algorithms that differ among their ability to anticipate for delayed arrival time of contrast material: the delay-sensitive first-moment mean transit time (fMTT), the semi-delay-sensitive standard singular value decomposition (sSVD) and the delay-insensitive block-circulant SVD (bSVD). The interhemispheric difference in bolus arrival time ( Delta BAT) was determined to confirm altered hemodynamics. Interhemispheric asymmetry in perfusion values (mean transit time (MTT) difference, cerebral blood flow (CBF) ratio and cerebral blood volume (CBV) ratio) was compared between the three algorithms. Presence of a new infarct in the treated hemisphere was evaluated on follow-up imaging and perfusion asymmetry was compared between patients with and without infarction. Results Twenty-two patients were included. The median interhemispheric difference in Delta BAT was 0.98s. The median MTT difference was significantly smaller when calculated with the delay-insensitive algorithm than with the other algorithms (0.44s versus 0.90s and 0.93s, p<0.01). The CBF ratio was similar for all algorithms (111.98 versus 112.59 and 112.60). The CBV ratio was similar for all algorithms (113.20 versus 111.95 and 113.97). There was a significant difference in MTT asymmetry between patients with and without infarction with the delay-insensitive algorithm only (1.57s versus 0.38s, p=0.04). Conclusion In patients with EC-IC bypass surgery, delay-sensitive algorithms showed larger MTT asymmetry than delay-insensitive algorithms. Furthermore, only the delay-insensitive method seems to differentiate between patients with and without infarction on follow-up.
Objective Perfusion imaging is increasingly used for postoperative evaluation of extracranial to intracranial (EC-IC) bypass surgery. Altered hemodynamics and delayed arrival of the contrast agent in the area fed by the bypass can influence perfusion measurement. We compared perfusion asymmetry obtained with different algorithms in EC-IC bypass surgery patients. Methods We retrospectively identified all patients evaluated with computed tomography perfusion (CTP) between May 2007 and May 2011 after EC-IC bypass surgery at our institution. CTP images were analyzed with three perfusion algorithms that differ among their ability to anticipate for delayed arrival time of contrast material: the delay-sensitive first-moment mean transit time (fMTT), the semi-delay-sensitive standard singular value decomposition (sSVD) and the delay-insensitive block-circulant SVD (bSVD). The interhemispheric difference in bolus arrival time (δBAT) was determined to confirm altered hemodynamics. Interhemispheric asymmetry in perfusion values (mean transit time (MTT) difference, cerebral blood flow (CBF) ratio and cerebral blood volume (CBV) ratio) was compared between the three algorithms. Presence of a new infarct in the treated hemisphere was evaluated on follow-up imaging and perfusion asymmetry was compared between patients with and without infarction. Results Twenty-two patients were included. The median interhemispheric difference in δBAT was 0.98s. The median MTT difference was significantly smaller when calculated with the delay-insensitive algorithm than with the other algorithms (0.44s versus 0.90s and 0.93s,p<0.01). The CBF ratio was similar for all algorithms (111.98 versus 112.59 and 112.60). The CBV ratio was similar for all algorithms (113.20 versus 111.95 and 113.97). There was a significant difference in MTT asymmetry between patients with and without infarction with the delay-insensitive algorithm only (1.57s versus 0.38s,p=0.04). Conclusion In patients with EC-IC bypass surgery, delay-sensitive algorithms showed larger MTT asymmetry than delay-insensitive algorithms. Furthermore, only the delay-insensitive method seems to differentiate between patients with and without infarction on follow-up.
•We compared different perfusion algorithms in EC–IC bypass surgery patients.•Significant differences were found in perfusion asymmetry per algorithm.•Delayinsensitive algorithms seem to detect EC–IC patients with infarct on follow-up. Perfusion imaging is increasingly used for postoperative evaluation of extracranial to intracranial (EC–IC) bypass surgery. Altered hemodynamics and delayed arrival of the contrast agent in the area fed by the bypass can influence perfusion measurement. We compared perfusion asymmetry obtained with different algorithms in EC–IC bypass surgery patients. We retrospectively identified all patients evaluated with computed tomography perfusion (CTP) between May 2007 and May 2011 after EC–IC bypass surgery at our institution. CTP images were analyzed with three perfusion algorithms that differ among their ability to anticipate for delayed arrival time of contrast material: the delay-sensitive first-moment mean transit time (fMTT), the semi-delay-sensitive standard singular value decomposition (sSVD) and the delay-insensitive block-circulant SVD (bSVD). The interhemispheric difference in bolus arrival time (ΔBAT) was determined to confirm altered hemodynamics. Interhemispheric asymmetry in perfusion values (mean transit time (MTT) difference, cerebral blood flow (CBF) ratio and cerebral blood volume (CBV) ratio) was compared between the three algorithms. Presence of a new infarct in the treated hemisphere was evaluated on follow-up imaging and perfusion asymmetry was compared between patients with and without infarction. Twenty-two patients were included. The median interhemispheric difference in ΔBAT was 0.98s. The median MTT difference was significantly smaller when calculated with the delay-insensitive algorithm than with the other algorithms (0.44s versus 0.90s and 0.93s, p<0.01). The CBF ratio was similar for all algorithms (111.98 versus 112.59 and 112.60). The CBV ratio was similar for all algorithms (113.20 versus 111.95 and 113.97). There was a significant difference in MTT asymmetry between patients with and without infarction with the delay-insensitive algorithm only (1.57s versus 0.38s, p=0.04). In patients with EC–IC bypass surgery, delay-sensitive algorithms showed larger MTT asymmetry than delay-insensitive algorithms. Furthermore, only the delay-insensitive method seems to differentiate between patients with and without infarction on follow-up.
Perfusion imaging is increasingly used for postoperative evaluation of extracranial to intracranial (EC-IC) bypass surgery. Altered hemodynamics and delayed arrival of the contrast agent in the area fed by the bypass can influence perfusion measurement. We compared perfusion asymmetry obtained with different algorithms in EC-IC bypass surgery patients. We retrospectively identified all patients evaluated with computed tomography perfusion (CTP) between May 2007 and May 2011 after EC-IC bypass surgery at our institution. CTP images were analyzed with three perfusion algorithms that differ among their ability to anticipate for delayed arrival time of contrast material: the delay-sensitive first-moment mean transit time (fMTT), the semi-delay-sensitive standard singular value decomposition (sSVD) and the delay-insensitive block-circulant SVD (bSVD). The interhemispheric difference in bolus arrival time (ΔBAT) was determined to confirm altered hemodynamics. Interhemispheric asymmetry in perfusion values (mean transit time (MTT) difference, cerebral blood flow (CBF) ratio and cerebral blood volume (CBV) ratio) was compared between the three algorithms. Presence of a new infarct in the treated hemisphere was evaluated on follow-up imaging and perfusion asymmetry was compared between patients with and without infarction. Twenty-two patients were included. The median interhemispheric difference in ΔBAT was 0.98 s. The median MTT difference was significantly smaller when calculated with the delay-insensitive algorithm than with the other algorithms (0.44 s versus 0.90 s and 0.93 s, p<0.01). The CBF ratio was similar for all algorithms (111.98 versus 112.59 and 112.60). The CBV ratio was similar for all algorithms (113.20 versus 111.95 and 113.97). There was a significant difference in MTT asymmetry between patients with and without infarction with the delay-insensitive algorithm only (1.57 s versus 0.38 s, p=0.04). In patients with EC-IC bypass surgery, delay-sensitive algorithms showed larger MTT asymmetry than delay-insensitive algorithms. Furthermore, only the delay-insensitive method seems to differentiate between patients with and without infarction on follow-up.
Author Smit, Ewoud J
de Jong, Hugo W.A.M
Velthuis, Birgitta K
Dankbaar, Jan Willem
Viergever, Max A
Vos, Pieter C
van der Zwan, Albert
Riordan, Alan J
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BackLink https://www.ncbi.nlm.nih.gov/pubmed/26196329$$D View this record in MEDLINE/PubMed
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CitedBy_id crossref_primary_10_1016_j_wneu_2019_08_174
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Keywords Cerebral blood volume
Extracranial–intracranial bypass surgery
Mean transit time
Computed tomography perfusion
Cerebral blood flow
Language English
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Snippet Highlights • We compared different perfusion algorithms in EC–IC bypass surgery patients. • Significant differences were found in perfusion asymmetry per...
•We compared different perfusion algorithms in EC–IC bypass surgery patients.•Significant differences were found in perfusion asymmetry per...
Perfusion imaging is increasingly used for postoperative evaluation of extracranial to intracranial (EC-IC) bypass surgery. Altered hemodynamics and delayed...
Objective Perfusion imaging is increasingly used for postoperative evaluation of extracranial to intracranial (EC-IC) bypass surgery. Altered hemodynamics and...
OBJECTIVEPerfusion imaging is increasingly used for postoperative evaluation of extracranial to intracranial (EC-IC) bypass surgery. Altered hemodynamics and...
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StartPage 139
SubjectTerms Adolescent
Adult
Aged
Aged, 80 and over
Algorithms
Blood Flow Velocity
Brain - blood supply
Brain - surgery
Carotid arteries
Cerebral blood flow
Cerebral blood volume
Cerebrovascular Circulation
Computed tomography perfusion
Contrast Media
Extracranial–intracranial bypass surgery
Female
Heart surgery
Humans
Male
Mean transit time
Middle Aged
Neurology
Neurosurgery
Patients
Perfusion - methods
Retrospective Studies
Software packages
Tomography, X-Ray Computed - methods
Young Adult
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Title Computed tomography perfusion evaluation after extracranial–intracranial bypass surgery
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