低剂量全脑灌注动脉峰值前后期数据移除对脑灌注参数影响的初步研究
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摘要
目的评估去除动脉峰值邻近前、后两期数据对Revolution CT低剂量正常脑灌注参数值的影响,初步探讨低剂量全脑灌注和大范围头颈CTA"一站式"成像中脑灌注参数值的准确性。方法回顾性分析39例全脑灌注无异常发现患者数据,所有患者均采用Revolution CT低剂量轴扫模式(70 kV,100 mAs,采集19期,扫描总时间41 s),将每一患者图像分别进行两次处理分为A、B两组,A组保留所有灌注数据,B组去除峰值前期、峰值后期两期数据,保留峰值期及其他数据。采用AW volumeshare 5工作站测量双侧额颞顶叶、小脑半球相应灰白质及尾状核、豆状核、丘脑、半卵圆中心脑血流量(CBF)、脑血容量(CBV)、平均通过时间(MTT)等灌注值,按灰、白质计算平均灌注值,计算两组灰、白质CBF、CBV、MTT平均值差值及其平均绝对百分误,统计学评估两组间灌注参数值的差异性及一致性。计算A组动、静脉峰值期灌注原始图像及灌注参数图像信噪比(SNR),记录剂量长度乘积(DLP)及有效辐射剂量(ED)。结果两组间灰、白质CBF(P_(灰质)=0.96;P_(白质)=0.63)、CBV(P_(灰质)=0.22;P_(白质)=0.46)、MTT(P_(灰质)=0.48;P_(白质)=0.24)值差异性均无统计学意义(P>0.05);两组间灌注值一致性较好;两组间灰、白质CBF、CBV、MTT平均绝对百分误差分别为2.2%、4.6%、5.3%;3.7%、0.3%、9.1%;CTP动、静脉峰值原始图像及灰、白质CBF、CBV、MTT灌注伪彩图SNR分别为4.7,4.1;3.7,3;6.3,4.3;3,5。平均辐射剂量约为2.4 mSv。结论去除峰值期前、后两期数据对Revolution CT低剂量全脑灌注正常参数值无显著影响,低剂量全脑灌注和大范围头颈CTA"一站式"扫描中脑灌注参数值具有一定的价值。
Objective To verify the accuracy of computed tomography perfusion measurements of "one-stop" protocol which interleaves whole brain CTP with head and neck CTA scanning on Revolution CT by secondary peak arterial phase extracted from conventional low-dose CTP source images. Methods 39 healthy patients underwent whole brain perfusion imaging using Revolution CT 16 cm volume axial scan mode with low-dose protocol(70 kv,100 mAs,19 pass with 41 second duration time).The interval time between pass was set as 2 seconds.Regions of interests(ROI) were put into the locations of frontal,temporal,parietal lobe,caudate lobe, lenticular,thalamus and centrum semiovale.Perfusion maps and measurements of CBF,CBV and MTT were calculated using brain perfusion software on AW VolumeShare 5.Evaluation was performed for different intervals between rush in and rush out series by using all phases data(Group A) and removing secondary peak time of 2 pass(Group B). This method can simulate the time expended by head and neck CTA spiral scanning during Variable volume scan of brain CT perfusion combined with head and neck CT angiography on Revolution CT. Paired t test and Bland-Altman analysis were applied for evaluating the differences and consisitency between the two groups,respectively.The mean absolute percentage error of perfusion parameters between the conventional CTP and the secondary peak arterial phase extracted CTP was calculated.SNR of source images at peak arterial,venous max and parametric maps were caculated.The radiation dose was recorded. Results There was no statistical significance on perfusion parameters between the two groups(P>0.05).There was good data consistency between the two groups.The mean absolute percentage errors were 2.2%,3.7 % for CBF,4.6%,0.3 % for CBV,5.3%,9.1 % for MTT in gray matter and white matter,respectively.The SNR was 4.7 for arterial max,4.1 for venous max,3.7,3 for CBF,6.3,4.3 for CBV,3,5 for MTT in gray matter and white matter,respectively.The mean radiation dose was 2.4 msv. Conclusion Low-dose whole brain CT perfusion result parameters were not affected significantly by secondary peak arterial phase extraction,computed tomography perfusion parameters of "one-stop"scanning have the same value.
Objective To verify the accuracy of computed tomography perfusion measurements of "one-stop" protocol which interleaves whole brain CTP with head and neck CTA scanning on Revolution CT by secondary peak arterial phase extracted from conventional low-dose CTP source images. Methods 39 healthy patients underwent whole brain perfusion imaging using Revolution CT 16 cm volume axial scan mode with low-dose protocol(70 kv,100 mAs,19 pass with 41 second duration time).The interval time between pass was set as 2 seconds.Regions of interests(ROI) were put into the locations of frontal,temporal,parietal lobe,caudate lobe, lenticular,thalamus and centrum semiovale.Perfusion maps and measurements of CBF,CBV and MTT were calculated using brain perfusion software on AW VolumeShare 5.Evaluation was performed for different intervals between rush in and rush out series by using all phases data(Group A) and removing secondary peak time of 2 pass(Group B). This method can simulate the time expended by head and neck CTA spiral scanning during Variable volume scan of brain CT perfusion combined with head and neck CT angiography on Revolution CT. Paired t test and Bland-Altman analysis were applied for evaluating the differences and consisitency between the two groups,respectively.The mean absolute percentage error of perfusion parameters between the conventional CTP and the secondary peak arterial phase extracted CTP was calculated.SNR of source images at peak arterial,venous max and parametric maps were caculated.The radiation dose was recorded. Results There was no statistical significance on perfusion parameters between the two groups(P>0.05).There was good data consistency between the two groups.The mean absolute percentage errors were 2.2%,3.7 % for CBF,4.6%,0.3 % for CBV,5.3%,9.1 % for MTT in gray matter and white matter,respectively.The SNR was 4.7 for arterial max,4.1 for venous max,3.7,3 for CBF,6.3,4.3 for CBV,3,5 for MTT in gray matter and white matter,respectively.The mean radiation dose was 2.4 msv. Conclusion Low-dose whole brain CT perfusion result parameters were not affected significantly by secondary peak arterial phase extraction,computed tomography perfusion parameters of "one-stop"scanning have the same value.
引文
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15 Corcuera-Solano I,Mclellan AM,Doshi AH,et al.Whole-Brain Adaptive 70-kVp Perfusion Imaging with Variable and Extended Sampling Improves Quality and Consistency While Reducing Dose[J].American Journal of Neuroradiology,2014,35:2045-2051.
16 Warach SJ,Luby M,Albers GW,et al.Acute Stroke Imaging Research Roadmap III Imaging Selection and Outcomes in Acute Stroke Reperfusion Clinical Trials[J].Stroke,2016,47:1389-1398.
17 Niu S,Zhang S,Huang J,et al.Low-dose cerebral perfusion computed tomography image restoration via low-rank and total variation regularizations[J].Neurocomputing,2016,197:143-160.
18 Othman AE,Brockmann C,Yang Z,et al.Effects of radiation dose reduction in Volume Perfusion CT imaging of acute ischemic stroke[J].European Radiology,2015,25:3415-3422.
19 Murphy A,So A,Lee T,et al.Low dose CT perfusion in acute ischemic stroke[J].Neuroradiology,2014,56:1055-1062.
20 Wintermark M,Albers GW,Alexandrov AV,et al.Acute stroke imaging research roadmap[J].AJNR,2008,29:e23-e30.
2 Bracard S,Ducrocq X,Mas JL,et al.Mechanical thrombectomy after intravenous alteplase versus alteplase alone after stroke (THRACE):a randomised controlled trial[J].Lancet Neurol,2016,15:1138-1147.
3 Goyal M,Demchuk AM,Menon BK,et al.Randomized assessment of rapid endovascular treatment of ischemic stroke[J].N Engl J Med,2015,372:1019-1030.
4 Saver JL,Goyal M,Bonafe A,et al.Stent-retriever thrombectomy after intravenous t-PA vs.t-PA alone in stroke[J].N Engl J Med,2015,372:2285-2295.
5 Jovin TG,Chamorro A,Cobo E,et al.Thrombectomy within 8 hours after symptom onset in ischemic stroke[J].N Engl J Med,2015,372:2296-2306.
6 Campbell BC,Mitchell PJ,Kleinig TJ,et al.Endovascular therapy for ischemic stroke with perfusion-imaging selection[J].N Engl J Med,2015,372:1009-1018.
7 Mulder MJ,van Oostenbrugge RJ,Dippel DW.Letter by Mulder et al Regarding Article,"2015 AHA/ASA Focused Update of the 2013 Guidelines for the Early Management of Patients With Acute Ischemic Stroke Regarding Endovascular Treatment:A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association"[J].Stroke,2015,46:e235.
8 Valentin J.Managing patient dose in multi-detector computed tomography(MDCT).ICRP Publication 102[J].Ann ICRP,2007,37:1-79.
9 高艳,李坤成,杜祥颖,等.64排螺旋CT脑灌注和CT血管成像在大脑中动脉狭窄或闭塞的应用[J].中国医学影像技术,2006,22:1155-1158.
10 隋昕,卢洁,李坤成,等.容积穿梭80 mm CT脑灌注成像及动态四维CT血管成像诊断颈内动脉系统血管狭窄和闭塞[J].中华放射学杂志,2010,44:249-254.
11 Soares BP,Dankbaar JW,Bredno J,et al.Automated versus manual post-processing of perfusion-CT data in patients with acute cerebral ischemia:influence on interobserver variability[J].Neuroradiology,2009,51:445-451.
12 Fiorella D,Heiserman J,Prenger E,et al.Assessment of the reproducibility of postprocessing dynamic CT perfusion data[J].AJNR,2004,25:97-107.
13 Sanelli PC,Nicola G,Tsiouris AJ,et al.Reproducibility of postprocessing of quantitative CT perfusion maps[J].AJR,2007,188:213-218.
14 Li Z,Li H,Zhang K,et al.Improvement of image quality and radiation dose of CT perfusion of the brain by means of low-tube voltage (70 KV)[J].European Radiology,2014,24:1906-1913.
15 Corcuera-Solano I,Mclellan AM,Doshi AH,et al.Whole-Brain Adaptive 70-kVp Perfusion Imaging with Variable and Extended Sampling Improves Quality and Consistency While Reducing Dose[J].American Journal of Neuroradiology,2014,35:2045-2051.
16 Warach SJ,Luby M,Albers GW,et al.Acute Stroke Imaging Research Roadmap III Imaging Selection and Outcomes in Acute Stroke Reperfusion Clinical Trials[J].Stroke,2016,47:1389-1398.
17 Niu S,Zhang S,Huang J,et al.Low-dose cerebral perfusion computed tomography image restoration via low-rank and total variation regularizations[J].Neurocomputing,2016,197:143-160.
18 Othman AE,Brockmann C,Yang Z,et al.Effects of radiation dose reduction in Volume Perfusion CT imaging of acute ischemic stroke[J].European Radiology,2015,25:3415-3422.
19 Murphy A,So A,Lee T,et al.Low dose CT perfusion in acute ischemic stroke[J].Neuroradiology,2014,56:1055-1062.
20 Wintermark M,Albers GW,Alexandrov AV,et al.Acute stroke imaging research roadmap[J].AJNR,2008,29:e23-e30.