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1、3D Blood Volume Imaging Acute Ischemic StrokeKuncheng Li M.D.,Ph.D.Medical Imaging CenterMedical Imaging CenterDepartment of RadiologyDepartment of Radiology Xuanwu Hospital Xuanwu Hospital Capital Medical UniversityCapital Medical University 100053 China 100053 China Non-enhanced CT (NECT) : could
2、exclude Non-enhanced CT (NECT) : could exclude hemorrhage and indicate early signs of hemorrhage and indicate early signs of ischemic strokeischemic strokePerfusion CT (PCT) : shows hemodynamic Perfusion CT (PCT) : shows hemodynamic statusstatusCT angiography (CTA) : shows vascular CT angiography (C
3、TA) : shows vascular occlusion locationocclusion locationComprehensive Imaging in 15 MinutesPerfusion CT Images from PCT: Images from PCT: MIPMIPCBFCBFCBVCBVTTPTTP BUT: limited coverageWhole brain perfusionis ideal!Calculating 3D-PBV ImagesCTAlow pass filteringNECTRegistrationuses information3D PBVS
4、kullBonesCSFBonesVesselsPre-Studiesof 3D-PBVMaterials and Methods Twenty-five patients (7 women, 18 men; mean age 59 years; Twenty-five patients (7 women, 18 men; mean age 59 years; range 42-77 years) suffered from acute ischemic stroke of the range 42-77 years) suffered from acute ischemic stroke o
5、f the anterior circulation were studied within 6h after onset of anterior circulation were studied within 6h after onset of symptomssymptomsNECT, CTA and CTP were performed within an average time of NECT, CTA and CTP were performed within an average time of 2.8 hours (range 1-6 hours) after onset of
6、 symptoms2.8 hours (range 1-6 hours) after onset of symptomsIntravenous or intra-arterial thrombolytic therapy was Intravenous or intra-arterial thrombolytic therapy was performed in 11 of 25 patients performed in 11 of 25 patients Follow-up CT and MRI examinations were done at 2 to 7 days Follow-up
7、 CT and MRI examinations were done at 2 to 7 days for the depiction of definite infarctionfor the depiction of definite infarction NECT: spiral mode covering the base to vertex NECT: spiral mode covering the base to vertex reconstruct with 5/1mm slice thickness reconstruct with 5/1mm slice thickness
8、 CTP: dynamic scan 3 adjacent slices (28.8 mm CTP: dynamic scan 3 adjacent slices (28.8 mm thickness) 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: spiral mode covering C5 to vertex CTA: spiral mode coverin
9、g C5 to vertex 60 ml non-ionic contrast, 4 ml/sec 60 ml non-ionic contrast, 4 ml/secCT Scan ProtocolResultsNECT: signs of ischemia were demonstrated in 13 NECT: signs of ischemia were demonstrated in 13 of 25 acute stroke patients of 25 acute stroke patientsCTP: CBF, CBV, and TTP demonstrated perfus
10、ion CTP: CBF, CBV, and TTP demonstrated perfusion deficits in 21 patients deficits in 21 patients CBF, CBV, and TTP demonstrated suspected CBF, CBV, and TTP demonstrated suspected perfusion deficits in 2 patients perfusion deficits in 2 patients Only TTP demonstrated perfusion deficits in Only TTP d
11、emonstrated perfusion deficits in 2 of 25 patients 2 of 25 patients3D-PBV: demonstrated perfusion deficits in all of 3D-PBV: demonstrated perfusion deficits in all of the 25 acute stroke patients the 25 acute stroke patients 3D-PBV has a higher detection rate for infarct lesion than NECT and CTP, an
12、d can depict the whole infarction lesionResultsCTP: lesion volume significantly correlated with the follow-up CT CTP: lesion volume significantly correlated with the follow-up CT (R=0.776/P0.001 for CBF; R=0.723/ P0.001 for CBV; (R=0.776/P0.001 for CBF; R=0.723/ P0.001 for CBV; R=0.629/P=0.001 for T
13、TP)R=0.629/P=0.001 for TTP)PBV: lesion volume significantly correlated with the follow-up CT PBV: lesion volume significantly correlated with the follow-up CT (R=0.837, P0.001)(R=0.837, P0.001)Volume cm3R=0.776P0.001R=0.723P0.001R=0.629P=0.001R=0.837P0.001CBF-follow-up CTCBV-follow-up CTTTP-follow-u
14、p CTPBV-follow-up CTResultsThrombolysis GroupCTP: the lesion volume significantly correlated with the CTP: the lesion volume significantly correlated with the follow-up plain CT follow-up plain CT CBF R=0.811,P0.001 CBF R=0.811,P0.001 CBV R=0.829,P0.001 CBV R=0.829,P0.001 TTP R=0.807,P0.001 TTP R=0.
15、807,P0.001PBV: the lesion volume significantly correlated with the PBV: the lesion volume significantly correlated with the follow-up plain CT follow-up plain CT R=0.851,P0.001 R=0.851,P0.001Thrombolysis GroupR=0.755P=0.007PBV-follow-up CTCBF-follow-up CTCBV-follow-up CTTTP-follow-up CTR=0.851P0.001
16、R=0.811P0.001R=0.829P0.001R=0.807P0.001Conclusions3D PBV can improve detection rate of ischemia 3D PBV can improve detection rate of ischemia by avoiding lesion omitting and assess the full by avoiding lesion omitting and assess the full extent of ischemia which correlates well with extent of ischem
17、ia which correlates well with follow-up plain CTfollow-up plain CT3D PBV requires no additional scan or contrast 3D PBV requires no additional scan or contrast injection and can be performed in a short period injection and can be performed in a short period of time. The integration of 3D-PBV with of
18、 time. The integration of 3D-PBV with multimodal CT (NECT, CTP and CTA) can add the multimodal CT (NECT, CTP and CTA) can add the diagnostic value in acute ischemic strokediagnostic value in acute ischemic strokeTEXTNECTCTA CTP 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
