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1、3D Blood Volume Imaging Acute Ischemic StrokeKuncheng Li M.D.,Ph.D.Medical Imaging Center Department of RadiologyXuanwu Hospital Capital Medical University Beijing 100053 China Non-enhanced CT (NECT) : could exclude Non-enhanced CT (NECT) : could exclude hemorrhage and indicate early signs of hemorr
2、hage and indicate early signs of ischemic strokeischemic stroke Perfusion CT (PCT) : shows hemodynamic Perfusion CT (PCT) : shows hemodynamic statusstatus CT angiography (CTA) : shows vascular CT angiography (CTA) : shows vascular occlusion locationocclusion locationComprehensive Imaging in 15 Minut
3、esPerfusion CT Images from PCT: MIPCBFCBVTTPBUT: limited coverageWhole brain perfusion is ideal!Calculating 3D-PBV ImagesCTAlow pass filteringNECTRegistrationuses information3D PBVSkullBonesCSFBonesVesselsPre-Studies of 3D-PBVMaterials and Methods Twenty-five patients (7 women, 18 men; mean age 59 y
4、ears; range 42-77 years) suffered from acute ischemic stroke of the anterior circulation were studied within 6h after onset of symptomsNECT, CTA and CTP were performed within an average time of 2.8 hours (range 1-6 hours) after onset of symptomsIntravenous or intra-arterial thrombolytic therapy was
5、performed in 11 of 25 patients Follow-up CT and MRI examinations were done at 2 to 7 days for the depiction of definite infarction NECT: NECT: spiral mode covering the base to vertexspiral mode covering the base to vertexreconstruct with 5/1mm slice thicknessreconstruct with 5/1mm slice thickness CT
6、P: dynamic scan CTP: dynamic scan 3 adjacent slices3 adjacent slices ( (28.8 mm28.8 mmthickness) covering the basal ganglia thickness) covering the basal ganglia 40 ml non-ionic contrast, 8 ml/sec 40 ml non-ionic contrast, 8 ml/sec CTA: CTA: spiral mode covering C5 to vertexspiral mode covering C5 t
7、o vertex 60 ml non-ionic contrast, 4 ml/sec 60 ml non-ionic contrast, 4 ml/secCT Scan ProtocolResults NECT: signs of ischemia were demonstrated in 13 of 25 acute stroke patientsCTP: CBF, CBV, and TTP demonstrated perfusion deficits in 21 patients CBF, CBV, and TTP demonstrated suspectedperfusion def
8、icits in 2 patients Only TTP demonstrated perfusion deficits in 2 of 25 patients3D-PBV: demonstrated perfusion deficits in all of the 25 acute stroke patients 3D-PBV has a higher detection rate for infarct lesion than NECT and CTP, and can depict the whole infarction lesionResults CTP: lesion volume
9、 significantly correlated with the follow-up CT (R=0.776/P0.001 for CBF; R=0.723/ P0.001 for CBV; R=0.629/P=0.001 for TTP) PBV: lesion volume significantly correlated with the follow-up CT (R=0.837, P0.001)Volume cm3R=0.776 P0.001R=0.723 P0.001R=0.629 P=0.001R=0.837 P0.001CBF-follow-up CTCBV-follow-
10、up CTTTP-follow-up CTPBV-follow-up CTResultsThrombolysis Group CTP: the lesion volume significantly correlated with the follow-up plain CT CBF R=0.811,P0.001 CBV R=0.829,P0.001TTP R=0.807,P0.001PBV: the lesion volume significantly correlated with the follow-up plain CT R=0.851,P0.001Thrombolysis Gro
11、upR=0.755 P=0.007PBV-follow-up CTCBF-follow-up CTCBV-follow-up CTTTP-follow-up CTR=0.851 P0.001R=0.811 P0.001R=0.829 P0.001R=0.807 P0.001Conclusions3D PBV can improve detection rate of ischemia by avoiding lesion omitting and assess the full extent of ischemia which correlates well with follow-up pl
12、ain CT 3D PBV requires no additional scan or contrast injection and can be performed in a short period of time. The integration of 3D-PBV with multimodal CT (NECT, CTP and CTA) can add the diagnostic value in acute ischemic strokeTEXTNECTCTACTP 3D-PBVAcute Ischemic Stroke New Multimodal CT Protocol Jie Lu M.D.,Ph.D.Miao Zhang M.D.Xiangying Du M.D.,Ph.D.Yan Gao M.D.Yunyun Duan M.D.Yanxiang Cao M.D.Xin Sui M.D.AcknowledgmentsSiemens Ltd., ChinaJiu-hong Chen Ph,D.Reto D. Merges
