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Integrated Photoacoustic, Ultrasound, and Angiographic Tomography (PAUSAT) for NonInvasive Whole-Brain Imaging of Ischemic Stroke
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Arterial input function placement for accurate CT perfusion map construction in acute stroke.

Rafael M Ferreira1, Michael H Lev, Gregory V Goldmakher

  • 1Department of Radiology, Massachusetts General Hospital, Boston, MA, USA.

AJR. American Journal of Roentgenology
|April 23, 2010
PubMed
Summary

Arterial input function (AIF) placement distal to the clot in the ipsilateral hemisphere significantly alters CT perfusion parameters, impacting accuracy. Delay-insensitive software minimizes these effects for reliable stroke assessment.

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Area of Science:

  • Neuroradiology
  • Medical Imaging
  • Stroke Imaging

Background:

  • CT perfusion imaging is crucial for acute stroke assessment.
  • Accurate quantification of cerebral blood flow (CBF), cerebral blood volume (CBV), and mean transit time (MTT) depends on correct arterial input function (AIF) placement.
  • Variations in AIF placement can lead to inaccurate perfusion parameters.

Purpose of the Study:

  • To evaluate how different arterial input function (AIF) placements affect quantitative and qualitative CT perfusion parameters in acute stroke patients.
  • To compare the impact of AIF placement on perfusion maps generated by two different software programs.
  • To determine the optimal AIF placement strategy for accurate CT perfusion analysis.

Main Methods:

  • Retrospective analysis of CT perfusion data from 14 acute stroke patients with middle cerebral artery (MCA) clots.
  • Systematic variation of AIF placement in four positions relative to the MCA clot (ipsilateral/contralateral, proximal/distal).
  • Construction of CBF, CBV, and MTT maps using delay-insensitive and standard deconvolution methods.

Main Results:

  • AIF placement distal to the clot in the ipsilateral hemisphere significantly increased mean CBF and decreased mean MTT.
  • This specific AIF placement resulted in qualitatively different parametric maps, particularly for MTT and CBF.
  • Cerebral blood volume (CBV) was the least affected parameter by AIF location.

Conclusions:

  • Avoiding AIF placement distal to the clot in the ipsilateral hemisphere is critical for accurate quantitative CT perfusion maps.
  • Delay-insensitive deconvolution software mitigates the inaccuracies caused by suboptimal AIF placement compared to standard deconvolution methods.
  • Laterality of AIF is less critical than avoiding distal ipsilateral placement for reliable stroke assessment.