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Comparative Study
. 2012 Dec;33(11):2171-7.
doi: 10.3174/ajnr.A3118. Epub 2012 May 24.

Improved arterial visualization in cerebral CT perfusion-derived arteriograms compared with standard CT angiography: a visual assessment study

A M Mendrik  1 , E P A Vonken, G A P de Kort, B van Ginneken, E J Smit, M A Viergever, M Prokop
Affiliations
Comparative Study

Improved arterial visualization in cerebral CT perfusion-derived arteriograms compared with standard CT angiography: a visual assessment study

A M Mendrik et al. AJNR Am J Neuroradiol. 2012 Dec.

Abstract

Background and purpose: Invasive cerebral DSA has largely been replaced by CTA, which is noninvasive but has a compromised arterial view due to superimposed bone and veins. The purpose of this study was to evaluate whether arterial visualization in CTPa is superior to standard CTA, which would eliminate the need for an additional CTA scan to assess arterial diseases and therefore reduce radiation dose.

Materials and methods: In this study, we included 24 patients with subarachnoid hemorrhage for whom CTA and CTP were available. Arterial quality and presence of superimposed veins and bone in CTPa were compared with CTA and scored by 2 radiologists by using a VAS (0%-100%). Average VAS scores were determined and VAS scores per patient were converted to a 10-point NRS. Arterial visualization was considered to be improved when the highest rate (NRS 10, VAS > 90%) was scored for arterial quality, and the lowest rate (NRS 1, VAS < 10%), for the presence of superimposed veins and bone. A sign test with continuity correction was used to test whether the number of cases with these rates was significant.

Results: Average VAS scores in the proximal area were 94% (arterial quality), 4% (presence of bone), and 7% (presence of veins). In this area, the sign test showed that a significant number of cases scored NRS 10 for arterial quality (P < .02) and NRS 1 for the presence of superimposed veins and bone (P < .01).

Conclusions: Cerebral CTPa shows improved arterial visualization in the proximal area compared with CTA, with similar arterial quality but no superimposed bone and veins.

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Figures

Fig 1.
Fig 1.
Schematic representation of the automatic algorithm to derive arteriograms (CTPa) from CT perfusion data described in Mendrik et al.
Fig 2.
Fig 2.
Maximum intensity projections (20 mm) of 2 cases from the evaluation dataset in which the proximal arterial quality in the CTPa was considered equivalent to standard CTA by both observers. Left: Standard CT angiogram. Middle: CTP-derived angiogram showing both arteries and veins. Right: CTPa showing the arteries. Case 7: window = 870 HU, level = 340 HU. Case 21: window = 540 HU, level = 270 HU. Arrows indicate superimposed veins in CTA that are absent in CTPa.
Fig 3.
Fig 3.
Maximum intensity projections (30 mm; window, 780 HU; level, 400 HU) of case 2, which received low VAS scores for arterial quality in CTPa from both observers. The right medial cerebral artery is occluded; the small collateral arteries have a time-to-peak of the contrast enhancement curve similar to that of the veins and thus are not present in the CTP-derived arteriogram (arrow). On the CTP-derived angiogram, however, the collateral arteries are visible (arrow). The source of subarachnoid hemorrhage in this patient is thought to have been the earlier infarction that was caused by the right media occlusion.
Fig 4.
Fig 4.
Maximum intensity projection (20 mm) subimages of 4 different patients from the evaluation dataset with a window of 800 HU and a level of 350 HU. Two patients with subarachnoid blood (cases 11 and 20) and 2 with large aneurysms (cases 3 and 14) near the skull base, illustrating a clear arterial view due to the absence of bone, veins, and subarachnoid hemorrhage in CTPa. Top row: Standard CTA scans. Middle row: CTPa. Bottom row: Angiograms (showing both arteries and veins) derived from the CTP scans.
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References

    1. Fifi JT, Meyers PM, Lavine SD, et al. . Complications of modern diagnostic cerebral angiography in an academic medical center. J Vasc Interv Radiol 2009;20:442–47 - PubMed
    1. Ringer AJ, Rodriguez-Mercado R, Veznedaroglu E, et al. . Defining the risk of retreatment for aneurysm recurrence or residual after initial treatment by endovascular coiling: a multicenter study. Neurosurgery 2009;65:311–15 - PubMed
    1. Preda L, Gaetani P, Rodriguez y Baena R, et al. . Spiral CT angiography and surgical correlations in the evaluation of intracranial aneurysms. Eur Radiol 1998;8:739–45 - PubMed
    1. Li Q, Lv F, Li Y, et al. . Evaluation of 64-section CT angiography for detection and treatment planning of intracranial aneurysms by using DSA and surgical findings. Radiology 2009;252:808–15 - PubMed
    1. Prestigiacomo CJ, Sabit A, He W, et al. . Three-dimensional CT angiography versus digital subtraction angiography in the detection of intracranial aneurysms in subarachnoid hemorrhage. J Neurointerv Surg 2010;2:385–89 - PubMed

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