Exploring the Value of Using Color-Coded Quantitative DSA Evaluation on Bilateral Common Carotid Arteries in...

Cerebral blood volume, acquired with flat panel detector CT by injecting contrast medium into the ascending aorta, enabled real-time acquisition of brain functional information with remarkable reduction of contrast medium usage comparing to an intravenous injection approach. However, individual vasculature and flow variations cause inhomogeneous contrast medium distribution and unexpected asymmetric perfusion for certain patients even without cerebral circulatory disorders. This work aimed at testing the feasibility of using color-coded quantitative DSA to predict the reliability of flat panel detector CT-based CBV maps by injecting contrast medium into the ascending aorta by exploring the correlation between measurements of color-coded quantitative DSA and the symmetry of CBV maps.

For 12 patients without perfusion-related cerebral abnormities, color-coded quantitative DSA at the aortic arch and flat panel detector CT-based CBV maps by injecting contrast medium into the ascending aorta were acquired. In color-coded quantitative DSA, ROIs were defined on the bilateral common carotid arteries. Time-density curves were extracted, and area under the curve values were calculated. To evaluate brain perfusion symmetry, we defined ROIs on the anterior and middle cerebral artery territories in CBV maps, and quantitative CBV values were extracted.

Eight patients demonstrated good perfusion symmetry with relative CBV of 0.96 ± 0.06, and their relative area under the curve was found to be 0.99 ± 0.02. For the other 4 patients, CBV from the left hemisphere was significantly lower than that from the right with relative CBV of 0.81 ± 0.09. This asymmetric perfusion was confirmed by the color-coded quantitative DSA with relative area under the curve values of 0.79 ± 0.03.

This preliminary study showed good correlation between relative area under the curve from color-coded quantitative DSA and relative CBV from CBV maps. Color-coded quantitative DSA potentially helped sort out patients whose vascular anatomy could support reliable CBV acquisitions of flat detector CT by injecting contrast medium into the ascending aorta.