Presentation is loading. Please wait.

Presentation is loading. Please wait.

EP-98 Immediate Peristenting Cerebral Perfusion Imaging by Conebeam CTA: Pilot Study in Patients with Carotid Stenosis Taipei Veterans General Hospital;

Published byWhitney Holland Modified over 7 years ago

Similar presentations

Presentation on theme: "EP-98 Immediate Peristenting Cerebral Perfusion Imaging by Conebeam CTA: Pilot Study in Patients with Carotid Stenosis Taipei Veterans General Hospital;"— Presentation transcript:

1 eP-98 Immediate Peristenting Cerebral Perfusion Imaging by Conebeam CTA: Pilot Study in Patients with Carotid Stenosis Taipei Veterans General Hospital; School of Medicine, National YangMing University, Taipei, Taiwan, Department of Biomedical Imaging and Radiological Sciences, National YangMing University, Taipei, Taiwan, Siemens Healthcare Ltd. Taiwan, Taipei, Taiwan, Taipei Veterans General Hospital, Taipei, Taiwan, Siemens Healthcare GmbH, Forchheim, Germany W Guo 1, C Lin 2, F Chang 1, K Chen 3, F Wu 4, S Hung 1, W Chu 5, D Zheng 6

2 Disclosure ■Nothing to disclose personally. ■The presentation materials are, in part, from a research collaboration between Taipei Veterans General Hospital, Taiwan and Siemens Healthcare (Project # T10001). 22016/11/16

3 ■Cone beam computed tomography (CT) perfusion imaging (CB-CTP) is feasibly used in acute stroke management. ■The current study is aimed to study immediate peri-stenting cerebral perfusion in patients with mal-fused brain due to carotid stenosis by using CB-CTP. 32016/11/16 Purpose

4 Cerebral PBV measurement using FDCT-DSA (Artis Zee ® Siemens Healthcare) 42016/11/16 CBF, (cerebral blood flow) MTTTTP CBV Time-resolved DynaCTA and CTP I.V. injection Arterial Input Function

5 52016/11/16 (Patient recruitment) Material and Method-1 ■Under approval of institutional review board, 12 patients (8 males and 4 females, mean age 66 years, range from 46-88 years old) who exhibited at least 70% extracranial internal carotid artery stenosis were recruited. ■6 of which were developed stenosis due to atherosclerosis (group 1, age 73 years, 62-88 years old, four symptomatic). ■the rest 6 were induced by previous radiation therapy for head and neck cancers (group 2, age 59 years, range 46-77 years old, five symptomatic).

6 62016/11/16 (Reconstructed volumes & ROI analysis) Material and Method-2 1.Reconstruction of four volumes that correspond to four perfusion parameters: CBF, CBV, MTT, and TTP. 2.Reslice each volume and select a representative slice. 3.Apply global, hemispheric, and MCA territorial ROIs to measure corresponding perfusion parameter values. 4.Wilcoxon signed rank test was adopted to evaluate the peri-stenting hemodynamic change of all patients, group 1, and group 2, respectively. (Statistical significance = 0.05.)

7 Quantification Age/ Gender ICA Stenosis % Contra- lateral ICA CausesGlobal Pre CBF CBV MTT TTP Global Post CBF CBV MTT TTP Ipsi-lateral Pre CBF CBV MTT TTP Ipsi-lateral Post CBF CBV MTT TTP Contra-lateral Pre CBF CBV MTT TTP Contra-lateral Post CBF CBV MTT TTP 87/ML. 97% R. Total Occluded Athero- sclerosis 315041653246426033604467 215260221204304214250191154248255198 57/ML 96% R. NormalAthero- sclerosis 393543493732414641364650 120106681021591028610711310082104 61/MR 99% L. NormalAthero- sclerosis 7510799141731361001837611491194 9423189128108229981249221792119 76/FR 90% L. NormalAthero- sclerosis 282758763937528140246383 59125134 23411521812368385155129 54/ML. 90% (CCA) R. 40%NPC R/T 14 yr ago 624963595848625668536460 5012073137511231281347811583129 53/MR. 85% L. normalTongue Ca, R/T 13 yr ago 568170925781698852776791 9718896179155182142172130185169176 88/MR >90% L. 50%Athero- sclerosis 243023292334263123312329 711737217995194681788118774185 43/FL. 70% R. normalThyroid cancer, R/T 202324 1923242620232427 661255811469130631196412565122 73/FL 90% R. normalAthero- sclerosis 414426324943263043452634 671487112569152691236714873128 61/FR LR/T 243538332535393424343732 811875018682192491878118551186 43/MR R/T 21.83124.422.222.331.824.123.921.530.32522.9 79.418961.5161.479.5188.162.3162.280.1192.560.9162.4 57/ML R/T 36.356.233.931.334.854.832.333.437.757.635.629.2 90.2187.858.6181.291.1189.366.3184.588.8185.550.5177

8 82016/11/16 Results - 1 ■Globally, cerebral blood flow (CBF) and Time to Peak (TTP) of stenotic hemisphere exhibited significant improvement after stenting in all 12 patients. ■Regional analysis revealed mean transient time (MTT) and TTP of improved perfusion status of ipsilateral MCA. ■Group 2 patients were younger than group 1 with modest significance (p=0.06). (All patients)

9 Quantification All patients Global - PreIpsi-lateral - PreContra-lateral - PreIpsi-lateral MCA- Pre Median Q1-Q3 Median Q1-Q3 Median Q1-Q3 Median Q1-Q3 CBF 33.6524-48.535.924-5338.8523.5-473725-48 CBV 39.530.5-534033-51.440.531-5941.631-56 MTT 80.266.5-959374-15784.979-12191.975-105 TTP 180 125-188 185.5 126-193 185 120-189 183 127-186 Global- PostIpsi-lateral- PostContra-lateral- PostIpsi-lateral MCA- Post Median Q1-Q3 Median Q1-Q3 Median Q1-Q3 Median Q1-Q3 CBF 39.525-604026-5740.525-63.533.1529-69 CBV 40.526-704031-704229-7532.4530-73 MTT 71.560-9277.565-1357863-12371.359-105 TTP 149.2 126-180 148 123-181 145.7 125-181 148.2 116-172 P - value CBF 0.05470.040.10640.0923 CBV 0.48140.3130.3320.5566 MTT 0.48140.05370.51950.0269 TTP 0.08060.0410.20360.0049

10 102016/11/16 Results - 2 ■Group 1 (Atherosclerosis) □CBF and cerebral blood flow (CBV) on global scale, and both hemisphere show improvements, with MTT of ipsilateral MCA being the only significant parameter in terms of regional comparison. □Overall, patients exhibit improved perfusion status on all 4 parameters. ■Group 2 (Radiation Therapy) □TTP of whole brain and ipsilateral hemisphere is found to be significant. MTT is found to be significant on contralateral hemisphere and ipsilateral MCA instead. □Despite the significane of MTT and TTP, the patients actually exhibit deteriorated CBV, MTT, and TTP. The only improved perfusion parameter is CBF ■Higher autoregulation reservation might explain the difference that involved between groups of patients. (Sub-group analysis)

11 Quantification Group 1 - Atherosclerosis Global - PreIpsi-lateral - PreContra-lateral - PreIpsi-lateral MCA- Pre Median Q1-Q3 Median Q1-Q3 Median Q1-Q3 Median Q1-Q3 CBF 4031-413832-4940.533-4339.530-42 CBV 39.530-504034-4640.531-604031-51 MTT 82.567-12013395-234102.581-15494.578-131 TTP 160.5 125-231 173 115-214 167.5 100-217 169 108-220 Global- PostIpsi-lateral- PostContra-lateral- PostIpsi-lateral MCA- Post Median Q1-Q3 Median Q1-Q3 Median Q1-Q3 Median Q1-Q3 CBF 4226-5841.526-524526-6343.528-54 CBV 5732-765331-8158.534-835530-77 MTT 80.571-1349269-2188774-15579.574-167 TTP 131 125-179 123.5 123-178 128.5 119-185 135.5 109-192 P - value CBF 0.0670.040.04590.1542 CBV 0.03670.04150.03320.2751 MTT 0.31820.06010.36750.0469 TTP 0.0860.0780.17560.0849

12 Quantification Group 2 – Radiation Therapy Global - PreIpsi-lateral - PreContra-lateral - PreIpsi-lateral MCA- Pre Median Q1-Q3 Median Q1-Q3 Median Q1-Q3 Median Q1-Q3 CBF 3022-563022-573122-5232.523-58 CBV 4231-5641.532-5442.530-574131-55 MTT 8066-908169-9180.578-897872-89 TTP 60.5 58-73 185 130-189 185 125-192 182 121-189 Global- PostIpsi-lateral- PostContra-lateral- PostIpsi-lateral MCA- Post Median Q1-Q3 Median Q1-Q3 Median Q1-Q3 Median Q1-Q3 CBF 4434-633624-623625-6437.523-68 CBV 3224-5933.526-5630.527-603127-54 MTT 60.558-7364.562-12862.551-836259-86 TTP 171 137-179 167 134-184 169 129-177 166 135-192 P - value CBF 0.05720.18540.21560.1248 CBV 0.08180.09120.48120.32 MTT 0.11040.0630.03590.0314 TTP 0.02570.0410.18250.0812

13 Conclusion ■Conebeam CTP provides the niche for first moment assessment of hemodynamics within the angio suite that is equipped with CBCTP, and facilitates patient management and clinical outcome in stenting treatment of carotid arterial stenosis, ■Difference of carotid stenosis might involve various degree of auto regulation, vascular response and compliance to stenting concerning hemodynamics. 132016/11/16

14 ■Struffert T, DeuerlingZheng Y, Kloska S, Engelhorn T, Strother CM, Kalender WA, et al. Flat detector ct in the evaluation of brain parenchyma, intracranial vasculature, and cerebral blood volume: A pilot study in patients with acute symptoms of cerebral ischemia. AJNR Am J Neuroradiol. 2010;31:14621469 ■Lin CJ, Hung SC, Guo WY, Chang FC, Luo CB, Beilner J, et al. Monitoring peritherapeutic cerebral circulation time: A feasibility study using colorcoded quantitative dsa in patients with stenoocclusive arterial disease. AJNR Am J Neuroradiol. 2012;33:16851690 ■Hung SC, Lin CJ, Guo WY, Chang FC, Luo CB, Teng MMH, et al. Toward the era of a onestop Imaging service using an angiography suite for neurovascular disorders. BioMed Research International. 2013;2013:17 ■Ahmed AS, Zellerhoff M, Strother CM, Pulfer KA, Redel T, DeuerlingZheng Y, et al. Carm ct measurement of cerebral blood volume: An experimental study in canines. AJNR. American journal of neuroradiology. 2009;30:917922 ■Bley T, Strother CM, Pulfer K, Royalty K, Zellerhoff M, DeuerlingZheng Y, et al. Carm ct measurement of cerebral blood volume in ischemic stroke: An experimental study in canines. AJNR. American journal of neuroradiology. 2010;31:536540 142016/11/16 References

15 Quantification Student T test – all patients Global - PreIpsi-lateral - PreContra-lateral - PreIpsi-lateral MCA- Pre Mean SD Median SD Median SD Median SD CBF 38.0217.630.0916.939.9318.0337.7114.78 CBV 47.3524.6350.1330.8748.7926.2547.2325.09 MTT 90.843.49124.7276.27142.66172.2199.7740.19 TTP 169.9846.95167.5341.59164.4249.6168.4450.25 Global- PostIpsi-lateral- PostContra-lateral- PostIpsi-lateral MCA- Post Mean SD Median SD Median SD Median SD CBF 45.2823.2344.7822.8845.4721.5843.5920.9 CBV 51.9637.8457.6944.859.9348.0850.3830.43 MTT 87.6847.62108.365.27100.8761.4181.3927.8 TTP 152.5533.1150.3931.41151.2832.46146.3833.14 P - value CBF 0.06870.12530.10130.0799 CBV 0.50180.23020.2250.5027 MTT 0.74040.14220.37810.1353 TTP 0.09540.07810.22310.0584

Download ppt "EP-98 Immediate Peristenting Cerebral Perfusion Imaging by Conebeam CTA: Pilot Study in Patients with Carotid Stenosis Taipei Veterans General Hospital;"

Similar presentations

Y. Duan et al. European Journal of Radiology (2011) Changes in cerebral hemodynamics after carotid stenting of symptomatic carotid artery.

Y. Duan et al. European Journal of Radiology (2011) Changes in cerebral hemodynamics after carotid stenting of symptomatic carotid artery.
Advances in Emergency Brain Imaging Andrew W. Asimos, MD Director of Emergency Stroke Care Carolinas Medical Center Charlotte, NC.

Advances in Emergency Brain Imaging Andrew W. Asimos, MD Director of Emergency Stroke Care Carolinas Medical Center Charlotte, NC.
EP 119 Serial Evaluation in Cerebral Perfusion after Indirect Revascularizatition for Children with Moyamoya Disease Using Dynamic Susceptibility Contrast.

EP 119 Serial Evaluation in Cerebral Perfusion after Indirect Revascularizatition for Children with Moyamoya Disease Using Dynamic Susceptibility Contrast.
THE CORRELATIONS OF 3D PSEUDO-CONTINUOUS ARTERIAL SPIN LABELING AND DYNAMIC SUSCEPTIBILITY CONTRAST PERFUSION MRI IN BRAIN TUMORS Delgerdalai Khashbat,

THE CORRELATIONS OF 3D PSEUDO-CONTINUOUS ARTERIAL SPIN LABELING AND DYNAMIC SUSCEPTIBILITY CONTRAST PERFUSION MRI IN BRAIN TUMORS Delgerdalai Khashbat,
Simple CBF grading based on MR perfusion to anticipate long-term clinical outcome in severe stroke patients due to the carotid artery occlusion Mori T,

Simple CBF grading based on MR perfusion to anticipate long-term clinical outcome in severe stroke patients due to the carotid artery occlusion Mori T,
EP- 41 - Discordance of CTA and Digital Subtraction Angiography in Diagnosing Vasospasm Following Subarachnoid Hemorrhage ASNR 53 rd Annual Meeting – April.

EP Discordance of CTA and Digital Subtraction Angiography in Diagnosing Vasospasm Following Subarachnoid Hemorrhage ASNR 53 rd Annual Meeting – April.
New embolic cerebral lesions detected with diffusion-weighted imaging after carotid artery and intracranial stent placement YH Chen, CJ Chen, DC Chen,

New embolic cerebral lesions detected with diffusion-weighted imaging after carotid artery and intracranial stent placement YH Chen, CJ Chen, DC Chen,
Diagnostic Imaging on Intracranial Atherosclerotic Stenosis Eduardo Freire Mello Department of Interventional Neuroradiology Hospital Espanhol, Salvador.

Diagnostic Imaging on Intracranial Atherosclerotic Stenosis Eduardo Freire Mello Department of Interventional Neuroradiology Hospital Espanhol, Salvador.
before thrombolysis in acute stroke

before thrombolysis in acute stroke
A multimodal step-up approach as rescue therapy of ischemic stroke L. Verganti, S. Vallone, C. Moratti, M. Malagoli, P. Carpeggiani Department of Neuroscience,

A multimodal step-up approach as rescue therapy of ischemic stroke L. Verganti, S. Vallone, C. Moratti, M. Malagoli, P. Carpeggiani Department of Neuroscience,
Kamran M 1, Deuerling-Zheng 2, Mueller-Allissat B 2, Grunwald IQ 1, Byrne JV 1 1. Oxford Neurovascular and Neuroradiology Research Unit, University of.

Kamran M 1, Deuerling-Zheng 2, Mueller-Allissat B 2, Grunwald IQ 1, Byrne JV 1 1. Oxford Neurovascular and Neuroradiology Research Unit, University of.
Certainty of Stroke Diagnosis: Incremental Benefit with CT Perfusion over NC-CT & CTA Richard I. Aviv, Julia Hopyan, Anthony Ciarallo, et al (including.

Certainty of Stroke Diagnosis: Incremental Benefit with CT Perfusion over NC-CT & CTA Richard I. Aviv, Julia Hopyan, Anthony Ciarallo, et al (including.
New ways of imaging Stroke/TIA Dr Suzanne O’Leary Neuroradiology SpR Frenchay Hospital.

New ways of imaging Stroke/TIA Dr Suzanne O’Leary Neuroradiology SpR Frenchay Hospital.
Abstract No: eEdE-103 Submission Number: 2420. Disclosure There is no disclosure.

Abstract No: eEdE-103 Submission Number: Disclosure There is no disclosure.
Therapeutic hypothermia is a powerful neuroprotective method for the treatment and prevention of cerebral ischemia. With the challenges of current systemic.

Therapeutic hypothermia is a powerful neuroprotective method for the treatment and prevention of cerebral ischemia. With the challenges of current systemic.
Endovascular Surgical Neuroradiology

Endovascular Surgical Neuroradiology
Combined Use of Color Duplex Ultrasonography and B-flow Imaging for Evaluation of Patients with Carotid Artery Stenosis AJNR Am J Neuroradiol 25: 1856-1860,

Combined Use of Color Duplex Ultrasonography and B-flow Imaging for Evaluation of Patients with Carotid Artery Stenosis AJNR Am J Neuroradiol 25: ,
Ultra-Low Contrast Volumes Reduces Contrast-Induced Nephropathy in Patients With Chronic Kidney Disease Undergoing Neurointerventional Procedures eP-150.

Ultra-Low Contrast Volumes Reduces Contrast-Induced Nephropathy in Patients With Chronic Kidney Disease Undergoing Neurointerventional Procedures eP-150.
Acute Stroke Management

Acute Stroke Management
Fractional Flow in Cerebrovascular Disorders

Fractional Flow in Cerebrovascular Disorders

Similar presentations

Ads by Google