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<meta name="DC.Title" content="C-Arm Flat Detector CT Parenchymal Blood Volume Thresholds for Identification of Infarcted Parenchyma in the Neurointerventional Suite" />
<meta name="DC.Identifier" content="10.3174/ajnr.A4339" />
<meta name="DC.Date" content="2015-09-01" />
<meta name="DC.Publisher" content="American Journal of Neuroradiology" />
<meta name="DC.Rights" content="© 2015 by American Journal of Neuroradiology" />
<meta name="DC.AccessRights" content="restricted" />
<meta name="DC.Description" content="BACKGROUND AND PURPOSE: C-arm flat detector CT parenchymal blood volume imaging allows functional assessment of the brain parenchyma in the neurointerventional suite. This study aimed to determine the optimal C-arm flat detector CT parenchymal blood volume thresholds for demarcating irreversibly infarcted brain parenchyma by using areas of restricted diffusion on MR imaging as a surrogate marker for infarction.

MATERIALS AND METHODS: Twenty-six patients with delayed cerebral ischemia following aneurysmal SAH underwent research C-arm CT parenchymal blood volume scans by using a biplane angiography system and contemporaneous MR imaging. Infarct and peri-infarct tissue VOIs and their homologous VOIs in the contralateral uninvolved hemisphere were delineated on the basis of the review of DWI, PWI, and ADC images. Voxel-based receiver operating characteristic curve analysis was performed to estimate the optimal absolute and normalized parenchymal blood volume values for demarcating the infarct voxels.

RESULTS: For 12 patients with areas of restricted diffusion (infarct volume, 6.38 ± 7.09 mL; peri-infarct tissue volume, 22.89 ± 21.76 mL) based on the voxel-based receiver operating characteristic curve analysis, optimal absolute and normalized parenchymal blood volume thresholds for infarction were 2.49 mL/100 g (area under curve, 0.76; sensitivity, 0.69; specificity, 0.71) and 0.67 (area under curve, 0.77; sensitivity, 0.69; specificity, 0.72), respectively ( P value &lt; .01). For the moderate-to-severely ischemic peri-infarct zone, mean parenchymal blood volume values of the involved hemisphere VOIs were lower compared with the uninvolved hemisphere VOIs ( P value &lt; .01). However, for the mild-to-moderately ischemic peri-infarct zone, there was no statistically significant difference between the mean parenchymal blood volume values of the involved and uninvolved hemisphere VOIs ( P value &gt; .05).

CONCLUSIONS: C-arm flat detector CT parenchymal blood volume maps in conjunction with optimal thresholds are sensitive and specific for the estimation of irreversibly infarcted parenchyma. Parenchymal blood volume maps allow reliable detection of moderate-to-severe ischemia; however, the potential for underestimation of mild-to-moderate ischemia exists.

DCI
:   delayed cerebral ischemia
FDCT
:   flat detector CT
PBV
:   parenchymal blood volume
ROC
:   receiver operating characteristic" />
<meta name="DC.Contributor" content="M. Kamran" />
<meta name="DC.Contributor" content="J.V. Byrne" />
<meta name="article:published_time" content="2015-09-01" />
<meta name="article:section" content="INTERVENTIONAL" />
<meta name="citation_title" content="C-Arm Flat Detector CT Parenchymal Blood Volume Thresholds for Identification of Infarcted Parenchyma in the Neurointerventional Suite" />
<meta name="citation_abstract" lang="en" content="&lt;h3&gt;BACKGROUND AND PURPOSE:&lt;/h3&gt;
&lt;p&gt;C-arm flat detector CT parenchymal blood volume imaging allows functional assessment of the brain parenchyma in the neurointerventional suite. This study aimed to determine the optimal C-arm flat detector CT parenchymal blood volume thresholds for demarcating irreversibly infarcted brain parenchyma by using areas of restricted diffusion on MR imaging as a surrogate marker for infarction.&lt;/p&gt;&lt;h3&gt;MATERIALS AND METHODS:&lt;/h3&gt;
&lt;p&gt;Twenty-six patients with delayed cerebral ischemia following aneurysmal SAH underwent research C-arm CT parenchymal blood volume scans by using a biplane angiography system and contemporaneous MR imaging. Infarct and peri-infarct tissue VOIs and their homologous VOIs in the contralateral uninvolved hemisphere were delineated on the basis of the review of DWI, PWI, and ADC images. Voxel-based receiver operating characteristic curve analysis was performed to estimate the optimal absolute and normalized parenchymal blood volume values for demarcating the infarct voxels.&lt;/p&gt;&lt;h3&gt;RESULTS:&lt;/h3&gt;
&lt;p&gt;For 12 patients with areas of restricted diffusion (infarct volume, 6.38 ± 7.09 mL; peri-infarct tissue volume, 22.89 ± 21.76 mL) based on the voxel-based receiver operating characteristic curve analysis, optimal absolute and normalized parenchymal blood volume thresholds for infarction were 2.49 mL/100 g (area under curve, 0.76; sensitivity, 0.69; specificity, 0.71) and 0.67 (area under curve, 0.77; sensitivity, 0.69; specificity, 0.72), respectively (&lt;i&gt;P&lt;/i&gt; value &amp;lt; .01). For the moderate-to-severely ischemic peri-infarct zone, mean parenchymal blood volume values of the involved hemisphere VOIs were lower compared with the uninvolved hemisphere VOIs (&lt;i&gt;P&lt;/i&gt; value &amp;lt; .01). However, for the mild-to-moderately ischemic peri-infarct zone, there was no statistically significant difference between the mean parenchymal blood volume values of the involved and uninvolved hemisphere VOIs (&lt;i&gt;P&lt;/i&gt; value &amp;gt; .05).&lt;/p&gt;&lt;h3&gt;CONCLUSIONS:&lt;/h3&gt;
&lt;p&gt;C-arm flat detector CT parenchymal blood volume maps in conjunction with optimal thresholds are sensitive and specific for the estimation of irreversibly infarcted parenchyma. Parenchymal blood volume maps allow reliable detection of moderate-to-severe ischemia; however, the potential for underestimation of mild-to-moderate ischemia exists.&lt;/p&gt;" />
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<meta name="citation_publication_date" content="2015/09/01" />
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<meta name="citation_author" content="M. Kamran" />
<meta name="citation_author_institution" content="aFrom the Nuffield Department of Surgical Sciences, University of Oxford, John Radcliffe Hospital, Headington, Oxford, United Kingdom." />
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<meta name="citation_author_institution" content="aFrom the Nuffield Department of Surgical Sciences, University of Oxford, John Radcliffe Hospital, Headington, Oxford, United Kingdom." />
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<meta name="twitter:title" content="C-Arm Flat Detector CT Parenchymal Blood Volume Thresholds for Identification of Infarcted Parenchyma in the Neurointerventional Suite" />
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<meta name="twitter:description" content="BACKGROUND AND PURPOSE: C-arm flat detector CT parenchymal blood volume imaging allows functional assessment of the brain parenchyma in the neurointerventional suite. This study aimed to determine the optimal C-arm flat detector CT parenchymal blood volume thresholds for demarcating irreversibly infarcted brain parenchyma by using areas of restricted diffusion on MR imaging as a surrogate marker for infarction.

MATERIALS AND METHODS: Twenty-six patients with delayed cerebral ischemia following aneurysmal SAH underwent research C-arm CT parenchymal blood volume scans by using a biplane angiography system and contemporaneous MR imaging. Infarct and peri-infarct tissue VOIs and their homologous VOIs in the contralateral uninvolved hemisphere were delineated on the basis of the review of DWI, PWI, and ADC images. Voxel-based receiver operating characteristic curve analysis was performed to estimate the optimal absolute and normalized parenchymal blood volume values for demarcating the infarct voxels.

RESULTS: For 12 patients with areas of restricted diffusion (infarct volume, 6.38 ± 7.09 mL; peri-infarct tissue volume, 22.89 ± 21.76 mL) based on the voxel-based receiver operating characteristic curve analysis, optimal absolute and normalized parenchymal blood volume thresholds for infarction were 2.49 mL/100 g (area under curve, 0.76; sensitivity, 0.69; specificity, 0.71) and 0.67 (area under curve, 0.77; sensitivity, 0.69; specificity, 0.72), respectively ( P value &lt; .01). For the moderate-to-severely ischemic peri-infarct zone, mean parenchymal blood volume values of the involved hemisphere VOIs were lower compared with the uninvolved hemisphere VOIs ( P value &lt; .01). However, for the mild-to-moderately ischemic peri-infarct zone, there was no statistically significant difference between the mean parenchymal blood volume values of the involved and uninvolved hemisphere VOIs ( P value &gt; .05).

CONCLUSIONS: C-arm flat detector CT parenchymal blood volume maps in conjunction with optimal thresholds are sensitive and specific for the estimation of irreversibly infarcted parenchyma. Parenchymal blood volume maps allow reliable detection of moderate-to-severe ischemia; however, the potential for underestimation of mild-to-moderate ischemia exists.

DCI
:   delayed cerebral ischemia
FDCT
:   flat detector CT
PBV
:   parenchymal blood volume
ROC
:   receiver operating characteristic" />
<meta name="og-title" property="og:title" content="C-Arm Flat Detector CT Parenchymal Blood Volume Thresholds for Identification of Infarcted Parenchyma in the Neurointerventional Suite" />
<meta name="og-url" property="og:url" content="http://ajnr-stage2.stage.highwire.org/content/36/9/1748" />
<meta name="og-site-name" property="og:site_name" content="American Journal of Neuroradiology" />
<meta name="og-description" property="og:description" content="BACKGROUND AND PURPOSE: C-arm flat detector CT parenchymal blood volume imaging allows functional assessment of the brain parenchyma in the neurointerventional suite. This study aimed to determine the optimal C-arm flat detector CT parenchymal blood volume thresholds for demarcating irreversibly infarcted brain parenchyma by using areas of restricted diffusion on MR imaging as a surrogate marker for infarction.

MATERIALS AND METHODS: Twenty-six patients with delayed cerebral ischemia following aneurysmal SAH underwent research C-arm CT parenchymal blood volume scans by using a biplane angiography system and contemporaneous MR imaging. Infarct and peri-infarct tissue VOIs and their homologous VOIs in the contralateral uninvolved hemisphere were delineated on the basis of the review of DWI, PWI, and ADC images. Voxel-based receiver operating characteristic curve analysis was performed to estimate the optimal absolute and normalized parenchymal blood volume values for demarcating the infarct voxels.

RESULTS: For 12 patients with areas of restricted diffusion (infarct volume, 6.38 ± 7.09 mL; peri-infarct tissue volume, 22.89 ± 21.76 mL) based on the voxel-based receiver operating characteristic curve analysis, optimal absolute and normalized parenchymal blood volume thresholds for infarction were 2.49 mL/100 g (area under curve, 0.76; sensitivity, 0.69; specificity, 0.71) and 0.67 (area under curve, 0.77; sensitivity, 0.69; specificity, 0.72), respectively ( P value &lt; .01). For the moderate-to-severely ischemic peri-infarct zone, mean parenchymal blood volume values of the involved hemisphere VOIs were lower compared with the uninvolved hemisphere VOIs ( P value &lt; .01). However, for the mild-to-moderately ischemic peri-infarct zone, there was no statistically significant difference between the mean parenchymal blood volume values of the involved and uninvolved hemisphere VOIs ( P value &gt; .05).

CONCLUSIONS: C-arm flat detector CT parenchymal blood volume maps in conjunction with optimal thresholds are sensitive and specific for the estimation of irreversibly infarcted parenchyma. Parenchymal blood volume maps allow reliable detection of moderate-to-severe ischemia; however, the potential for underestimation of mild-to-moderate ischemia exists.

DCI
:   delayed cerebral ischemia
FDCT
:   flat detector CT
PBV
:   parenchymal blood volume
ROC
:   receiver operating characteristic" />
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    <div class="highwire-article-citation highwire-citation-type-highwire-article node14150--5" data-node-nid="14150" id="top-node-14150--6582814509" data-pisa="ajnr;36/9/1748" data-pisa-master="ajnr;ajnr.A4339" data-apath="/ajnr/36/9/1748.atom" data-hw-author-tooltip-instance="highwire_author_tooltip"><div class="highwire-cite highwire-cite-highwire-article highwire-citation-jcore-article-title-complete clearfix has-author-tooltip highwire-citation-highwire-article-top-a">
  
  
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      <h1 class="highwire-cite-title" id="page-title">C-Arm Flat Detector CT Parenchymal Blood Volume Thresholds for Identification of Infarcted Parenchyma in the Neurointerventional Suite</h1>  
    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0">M. Kamran</span> and <span class="highwire-citation-author" data-delta="1">J.V. Byrne</span></span></div>
  
    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">September 2015,  </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">36 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(9) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">1748-1755; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata">DOI: https://doi.org/10.3174/ajnr.A4339 </span></div>
  
  
  
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<div id="hw-article-author-popups-top-node-14150--6582814509" style="display: none;"><div class="author-tooltip-0"><div class="author-tooltip-name">M. Kamran </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Nuffield Department of Surgical Sciences, University of Oxford, John Radcliffe Hospital, Headington, Oxford, United Kingdom.</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=M.%2BKamran%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Kamran%20M&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AM.%2BKamran%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-1"><div class="author-tooltip-name">J.V. Byrne </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Nuffield Department of Surgical Sciences, University of Oxford, John Radcliffe Hospital, Headington, Oxford, United Kingdom.</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=J.V.%2BByrne%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Byrne%20J&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AJ.V.%2BByrne%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div></div></div>  </div>

  
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    <div class="highwire-markup"><div xmlns="http://www.w3.org/1999/xhtml" data-highwire-cite-ref-tooltip-instance="highwire_reflinks_tooltip" class="content-block-markup" xmlns:xhtml="http://www.w3.org/1999/xhtml"><div class="article abstract-view "><span class="highwire-journal-article-marker-start"></span><div class="section abstract" id="abstract-1"><h2>Abstract</h2><div id="sec-1" class="subsection"><p id="p-1"><strong>BACKGROUND AND PURPOSE:</strong> C-arm flat detector CT parenchymal blood volume imaging allows functional assessment of the brain parenchyma in the neurointerventional suite. This study aimed to determine the optimal C-arm flat detector CT parenchymal blood volume thresholds for demarcating irreversibly infarcted brain parenchyma by using areas of restricted diffusion on MR imaging as a surrogate marker for infarction.</p></div><div id="sec-2" class="subsection"><p id="p-2"><strong>MATERIALS AND METHODS:</strong> Twenty-six patients with delayed cerebral ischemia following aneurysmal SAH underwent research C-arm CT parenchymal blood volume scans by using a biplane angiography system and contemporaneous MR imaging. Infarct and peri-infarct tissue VOIs and their homologous VOIs in the contralateral uninvolved hemisphere were delineated on the basis of the review of DWI, PWI, and ADC images. Voxel-based receiver operating characteristic curve analysis was performed to estimate the optimal absolute and normalized parenchymal blood volume values for demarcating the infarct voxels.</p></div><div id="sec-3" class="subsection"><p id="p-3"><strong>RESULTS:</strong> For 12 patients with areas of restricted diffusion (infarct volume, 6.38 ± 7.09 mL; peri-infarct tissue volume, 22.89 ± 21.76 mL) based on the voxel-based receiver operating characteristic curve analysis, optimal absolute and normalized parenchymal blood volume thresholds for infarction were 2.49 mL/100 g (area under curve, 0.76; sensitivity, 0.69; specificity, 0.71) and 0.67 (area under curve, 0.77; sensitivity, 0.69; specificity, 0.72), respectively (<em>P</em> value &lt; .01). For the moderate-to-severely ischemic peri-infarct zone, mean parenchymal blood volume values of the involved hemisphere VOIs were lower compared with the uninvolved hemisphere VOIs (<em>P</em> value &lt; .01). However, for the mild-to-moderately ischemic peri-infarct zone, there was no statistically significant difference between the mean parenchymal blood volume values of the involved and uninvolved hemisphere VOIs (<em>P</em> value &gt; .05).</p></div><div id="sec-4" class="subsection"><p id="p-4"><strong>CONCLUSIONS:</strong> C-arm flat detector CT parenchymal blood volume maps in conjunction with optimal thresholds are sensitive and specific for the estimation of irreversibly infarcted parenchyma. Parenchymal blood volume maps allow reliable detection of moderate-to-severe ischemia; however, the potential for underestimation of mild-to-moderate ischemia exists.</p></div></div><div class="section glossary" id="glossary-1"><h2 class="">ABBREVIATIONS:</h2><dl id="def-list-1"><dt id="def-item-1">DCI<span class="def-item-dt-sep"></span></dt><dd>delayed cerebral ischemia<span class="def-item-dd-sep"></span></dd><dt id="def-item-2">FDCT<span class="def-item-dt-sep"></span></dt><dd>flat detector CT<span class="def-item-dd-sep"></span></dd><dt id="def-item-3">PBV<span class="def-item-dt-sep"></span></dt><dd>parenchymal blood volume<span class="def-item-dd-sep"></span></dd><dt id="def-item-4">ROC<span class="def-item-dt-sep"></span></dt><dd>receiver operating characteristic</dd></dl></div><ul class="copyright-statement"><li class="fn" id="copyright-statement-1">© 2015 by American Journal of Neuroradiology</li></ul><span class="highwire-journal-article-marker-end"></span></div><span class="related-urls"></span></div><a href="http://ajnr-stage2.stage.highwire.org/content/36/9/1748.full" class="hw-link hw-link-article-full-text" data-icon-position="" data-hide-link-title="0">View Full Text</a></div>  </div>

  
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        	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-volume highwire-cite-metadata">Vol. 36</span>, <span  class="highwire-cite-metadata-issue highwire-cite-metadata">Issue 9 </span><div  class="highwire-cite-metadata-pubdate highwire-cite-metadata">1 Sep 2015 </div></div>
      
      
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