Influence of Thin Slice Reconstruction on CT Brain Perfusion Analysis
Edwin Bennink, Jaap Oosterbroek, Alexander D Horsch, Jan Willem Dankbaar, Birgitta K Velthuis, Max A Viergever, Hugo W A M de Jong, Edwin Bennink, Jaap Oosterbroek, Alexander D Horsch, Jan Willem Dankbaar, Birgitta K Velthuis, Max A Viergever, Hugo W A M de Jong
Abstract
Objectives: Although CT scanners generally allow dynamic acquisition of thin slices (1 mm), thick slice (≥5 mm) reconstruction is commonly used for stroke imaging to reduce data, processing time, and noise level. Thin slice CT perfusion (CTP) reconstruction may suffer less from partial volume effects, and thus yield more accurate quantitative results with increased resolution. Before thin slice protocols are to be introduced clinically, it needs to be ensured that this does not affect overall CTP constancy. We studied the influence of thin slice reconstruction on average perfusion values by comparing it with standard thick slice reconstruction.
Materials and methods: From 50 patient studies, absolute and relative hemisphere averaged estimates of cerebral blood volume (CBV), cerebral blood flow (CBF), mean transit time (MTT), and permeability-surface area product (PS) were analyzed using 0.8, 2.4, 4.8, and 9.6 mm slice reconstructions. Specifically, the influence of Gaussian and bilateral filtering, the arterial input function (AIF), and motion correction on the perfusion values was investigated.
Results: Bilateral filtering gave noise levels comparable to isotropic Gaussian filtering, with less partial volume effects. Absolute CBF, CBV and PS were 22%, 14% and 46% lower with 0.8 mm than with 4.8 mm slices. If the AIF and motion correction were based on thin slices prior to reconstruction of thicker slices, these differences reduced to 3%, 4% and 3%. The effect of slice thickness on relative values was very small.
Conclusions: This study shows that thin slice reconstruction for CTP with unaltered acquisition protocol gives relative perfusion values without clinically relevant bias. It does however affect absolute perfusion values, of which CBF and CBV are most sensitive. Partial volume effects in large arteries and veins lead to overestimation of these values. The effects of reconstruction slice thickness should be taken into account when absolute perfusion values are used for clinical decision making.
Trial registration: ClinicalTrials.gov NCT00880113.
Conflict of interest statement
Competing Interests: The authors have declared that no competing interests exist.
Figures
References
- Burton KR, Dhanoa D, Aviv RI, Moody AR, Kapral MK, Laupacis A. Perfusion CT for Selecting Patients with Acute Ischemic Stroke for Intravenous Thrombolytic Therapy. Radiology. Radiological Society of North America; 2015;274: 103–114. 10.1148/radiol.14140728
- Bivard A, Levi C, Spratt N, Parsons M. Perfusion CT in Acute Stroke: A Comprehensive Analysis of Infarct and Penumbra. Radiology. Radiological Society of North America; 2013;2: 543–550. 10.1148/radiol.12120971
- Bivard A, Spratt N, Levi C, Parsons M. Perfusion computer tomography: imaging and clinical validation in acute ischaemic stroke. Brain. Oxford Univ Press; 2011;134: 3408–3416. 10.1093/brain/awr257
- Campbell BC, Christensen S, Levi CR, Desmond PM, Donnan GA, Davis SM, et al. Cerebral blood flow is the optimal CT perfusion parameter for assessing infarct core. Stroke. Am Heart Assoc; 2011;42: 3435–3440. 10.1161/STROKEAHA.111.618355
- Kamalian S, Kamalian S, Konstas A, Maas M, Payabvash S, Pomerantz S, et al. CT perfusion mean transit time maps optimally distinguish benign oligemia from true “at-risk” ischemic penumbra, but thresholds vary by postprocessing technique. Am J Neuroradiol. Am Soc Neuroradiology; 2012;33: 545–549. 10.3174/ajnr.A2809
- Kamalian S, Kamalian S, Maas MB, Goldmacher GV, Payabvash S, Akbar A, et al. CT cerebral blood flow maps optimally correlate with admission diffusion-weighted imaging in acute stroke but thresholds vary by postprocessing platform. Stroke. Am Heart Assoc; 2011;42: 1923–1928. 10.1161/STROKEAHA.110.610618
- Koenig M, Kraus M, Theek C, Klotz E, Gehlen W, Heuser L. Quantitative assessment of the ischemic brain by means of perfusion-related parameters derived from perfusion CT. Stroke. Am Heart Assoc; 2001;32: 431–437. 10.1161/01.STR.32.2.431
- Murphy B, Fox A, Lee D, Sahlas D, Black S, Hogan M, et al. Identification of penumbra and infarct in acute ischemic stroke using computed tomography perfusion-derived blood flow and blood volume measurements. Stroke. Am Heart Assoc; 2006;37: 1771–1777. 10.1161/01.STR.0000227243.96808.53
- Murphy BD, Fox AJ, Lee DH, Sahlas DJ, Black SE, Hogan MJ, et al. White Matter Thresholds for Ischemic Penumbra and Infarct Core in Patients with Acute Stroke: CT Perfusion Study. Radiology. Radiological Society of North America; 2008;247: 818–825. 10.1148/radiol.2473070551
- Schaefer P, Roccatagliata L, Ledezma C, Hoh B, Schwamm L, Koroshetz W, et al. First-pass quantitative CT perfusion identifies thresholds for salvageable penumbra in acute stroke patients treated with intra-arterial therapy. Am J Neuroradiol. Am Soc Neuroradiology; 2006;27: 20–25. Available:
- Wintermark M, Flanders AE, Velthuis B, Meuli R, Van Leeuwen M, Goldsher D, et al. Perfusion-CT assessment of infarct core and penumbra receiver operating characteristic curve analysis in 130 patients suspected of acute hemispheric stroke. Stroke. Am Heart Assoc; 2006;37: 979–985. 10.1161/01.STR.0000209238.61459.39
- Wintermark M, Reichhart M, Thiran J-P, Maeder P, Chalaron M, Schnyder P, et al. Prognostic accuracy of cerebral blood flow measurement by perfusion computed tomography, at the time of emergency room admission, in acute stroke patients. Ann Neurol. Wiley Online Library; 2002;51: 417–432. 10.1002/ana.10136
- Bisdas S, Hartel M, Cheong L, Koh T, Vogl T. Prediction of subsequent hemorrhage in acute ischemic stroke using permeability CT imaging and a distributed parameter tracer kinetic model. J Neuroradiol. Elsevier; 2007;34: 101–108. 10.1016/j.neurad.2007.02.003
- Sawada Y, Patlak CS, Blasberg RG. Kinetic analysis of cerebrovascular transport based on indicator diffusion technique. Am J Physiol–Heart C. Am Physiological Soc; 1989;256: H794–H812. Available:
- Riordan A, Bennink E, Viergever M, Velthuis B, Dankbaar J, Jong H de. CT brain perfusion protocol to eliminate the need for selecting a venous output function. Am J Neuroradiol. Am Soc Neuroradiology; 2013;34: 1353–1358. 10.3174/ajnr.A3397
- Fahmi F, Marquering H, Streekstra G, Beenen L, Velthuis B, VanBavel E, et al. Differences in CT perfusion summary maps for patients with acute ischemic stroke generated by 2 software packages. Am J Neuroradiol. Am Soc Neuroradiology; 2012;33: 2074–2080. 10.3174/ajnr.A3110
- Fiorella D, Heiserman J, Prenger E, Partovi S. Assessment of the reproducibility of postprocessing dynamic CT perfusion data. Am J Neuroradiol. Am Soc Neuroradiology; 2004;25: 97–107. Available:
- Wintermark M, Fischbein NJ, Smith WS, Ko NU, Quist M, Dillon WP. Accuracy of dynamic perfusion CT with deconvolution in detecting acute hemispheric stroke. Am J Neuroradiol. Am Soc Neuroradiology; 2005;26: 104–112. Available:
- Sacco S, Marini C, Totaro R, Russo T, Cerone D, Carolei A. A population-based study of the incidence and prognosis of lacunar stroke. Neurology. AAN Enterprises; 2006;66: 1335–1338. 10.1212/01.wnl.0000210457.89798.0e
- Schaaf I van der, Vonken EJ, Waaijer A, Velthuis B, Quist M, Osch T van. Influence of partial volume on venous output and arterial input function. Am J Neuroradiol. Am Soc Neuroradiology; 2006;27: 46–50. Available:
- Tomasi C, Manduchi R. Bilateral filtering for gray and color images. Proc ICCV. IEEE; 1998. pp. 839–846. 10.1109/ICCV.1998.710815
- Seeters T van, Biessels GJ, Schaaf IC van der, Dankbaar JW, Horsch AD, Luitse MJ, et al. Prediction of outcome in patients with suspected acute ischaemic stroke with CT perfusion and CT angiography: the Dutch acute stroke trial (DUST) study protocol. BMC Neurol. BioMed Central Ltd; 2014;14: 37 10.1186/1471-2377-14-37
- Barber PA, Demchuk AM, Zhang J, Buchan AM. Validity and reliability of a quantitative computed tomography score in predicting outcome of hyperacute stroke before thrombolytic therapy. Lancet. Elsevier; 2000;355: 1670–1674. 10.1016/S0140-6736(00)02237-6
- Klein S, Staring M, Murphy K, Viergever MA, Pluim J. Elastix: a toolbox for intensity-based medical image registration. IEEE T Med Imaging. IEEE; 2010;29: 196–205. 10.1109/TMI.2009.2035616
- Axel L. A Method of Calculating Brain Blood Flow With a CT Dynamic Scanner. Adv Neurol. 1981;30: 67–71. Available:
- Bennink E, Riordan AJ, Horsch AD, Dankbaar JW, Velthuis BK, Jong HW de. A fast nonlinear regression method for estimating permeability in CT perfusion imaging. J Cereb Blood Flow Metab. Nature Publishing Group; 2013;33: 1743–1751. 10.1038/jcbfm.2013.122
- Konstas AA, Goldmakher GV, Lee TY, Lev MH. Theoretic basis and technical implementations of CT perfusion in acute ischemic stroke, part 1: theoretic basis. Am J Neuroradiol. Am Soc Neuroradiology; 2009;30: 662–668. 10.3174/ajnr.A1487
- Rempp KA, Brix G, Wenz F, Becker CR, Gückel F, Lorenz WJ. Quantification of regional cerebral blood flow and volume with dynamic susceptibility contrast-enhanced MR imaging. Radiology. Radiological Society of North America; 1994;193: 637–641. 10.1148/radiology.193.3.7972800
- Krejza J, Arkuszewski M, Kasner SE, Weigele J, Ustymowicz A, Hurst RW, et al. Carotid artery diameter in men and women and the relation to body and neck size. Stroke. Am Heart Assoc; 2006;37: 1103–1105. 10.1161/01.STR.0000206440.48756.f7
- Müller H, Brunhölzl C, Radü E, Buser M. Sex and side differences of cerebral arterial caliber. Neuroradiology. Springer; 1991;33: 212–216. Available:
Source: PubMed