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CT perfusion physics and its application in Neuroimaging
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What is a Brain CT Imaging Perfusion Study?

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Computed tomography perfusion (aka CTP) imaging shows which areas of the brain are supplied or perfused adequately with blood and provides detailed information on delivery of blood or blood flow to the brain. Here are 10 things you need to know about the procedure.

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What is a Brain CT Imaging Perfusion Study?

  1. 1. Clinical University | Brain CT Perfusion study What is a Brain CT Perfusion study? The 10 things you have to know Dario Arfelli Senior Sales Enablement Manager Ron Muscosky Product Line Manager of Clinical Solutions 1 - WHAT IS A BRAIN CT PERFUSION STUDY? Computed tomography perfusion (aka CTP) imaging shows which areas of the brain are supplied or perfused adequately with blood and provides detailed information on delivery of blood or blood flow to the brain. CT perfusion scanning is a noninvasive medical test that helps physicians diagnose and treat medical conditions. CT scanning combines special x-ray equipment with sophisticated computers to produce multiple images or pictures of the inside of the body. These cross- sectional images of the area being studied can then be examined on a computer monitor, printed or transferred to a CD. CT scans of internal organs, bones, soft tissue and blood vessels provide greater clarity and reveal more details than regular x-ray exams. Although MRI is more sensitive to the early parenchymal changes of infarction its clinical application has been limited by difficulties in accessing MRI in a timely fashion in many institutions; this is especially important in this clinical setting as rapid imaging and treatment are crucial to successful intervention. 2 - WHAT ARE SOME COMMON USES OF CTP? CT perfusion is typically used to: • Evaluate acute stroke. • Assist with selecting patients for thrombolytic therapy following a stroke by identifying brain tissue at risk of infarction, or death by lack of an adequate blood supply. • Evaluate vasospasm, or a sudden blood vessel constriction that may arise from a subarachnoid hemorrhage, in which bleeding occurs in the space between the two membranes surrounding the brain, known as the dura mater and arachnoid membrane. • Assess patients who are candidates for surgical or neuroendovascular treatments. The technique employs special catheters (long, thin tubes), some containing special instruments, that can be manipulated into the area of vessel blockage to dissolve or dislodge a blood clot. • Diagnose and assess treatment response in patients with a variety of tumors. The treatment decisions for ischemic stroke can be: (1) No treatment (2) Thrombolysis (3) Manual extraction. 3 - WHAT DOES THE EQUIPMENT LOOK LIKE? CT perfusion is performed on a CT scanner. 4 - WHAT HAPPENS DURING A CTP STUDY? The technologist begins by positioning you on the CT examination table, usually lying flat on your back. Straps and pillows may be used to help you maintain the correct position and to help you remain still during the exam. Next, the table will move quickly through the scanner to determine the correct starting position for the scans. Then, the table will move slowly through the machine as the actual CT scanning is performed. Depending on the type of CT scan, the machine may make several passes.
  2. 2. Clinical University | Brain CT Perfusion study www.carestream.com ©Carestream Health, Inc., 2016. CARESTREAM is a trademark of Carestream Health. The contrast material will then be injected through an intravenous line (IV) while additional scans are obtained. In most cases, the contrast material is injected by a special machine attached to the IV line, which ensures precise delivery of the contrast agent at a rate and time period prescribed by the radiologist. Such accuracy in injection is required for a successful perfusion CT scan. You may be asked to hold your breath during the scanning. Any motion, whether breathing or body movements, can lead to artifacts on the images. This loss of image quality can resemble the blurring seen on a photograph taken of a moving object. When the examination is completed, you will be asked to wait until the technologist verifies that the images are of high enough quality for accurate interpretation. 5 - HOW LONG DOES A CTP STUDY TAKE? A CT perfusion scan of the head is usually completed in 25 minutes. 6 - WHO INTERPRETS THE RESULTS? A radiologist with expertise in supervising and interpreting radiology examinations (or a specialized neuro-radiologist) will analyze the images and send an official report to your primary care physician or physician. 7 - WHAT IS THE READING WORKFLOW FOR CTP? The key to interpret CTP is understanding and identifying the lesion (non-recoverable areas) and the hypoperfused (recoverable areas) tissues. Convolution algorithms process raw data to generate perfusion maps and quantitative data (as listed below) to aid in identifying/analyzing the lesion and hypo perfusion tissues. • Cerebral Blood Volume (CBV) • Cerebral Blood Flow (CBF) • Mean Transit Time that contrast stays in tissue (MTT) • Time To Peak tissue enhancement (TTP) • Residue function time to peak (TMAX) 8 - WHAT ARE THE RISKS OF THE STUDY? Brain CT Perfusion Studying does not normally carry risk. However, main risks are: • There is always a slight chance of cancer from excessive exposure to radiation. However, the benefit of an accurate diagnosis far outweighs the risk. • The effective radiation dose for this procedure varies. • Every effort is made to use the lowest radiation dose possible, while not sacrificing the quality of the CT images necessary to effectively diagnose a disease process. Nearly all CT scanners now have special computer programs that help to increase image quality at lower radiation doses. • Women should always inform their physician and x-ray or CT technologist if there is any possibility that they are pregnant. • Nursing mothers should wait for 24 hours after contrast material injection before resuming breast- feeding. • The risk of serious allergic reaction to contrast materials that contain iodine is extremely rare, and radiology departments are well-equipped to deal with them. 9 - WHAT ARE THE BENEFITS? Brain CT perfusion studies are excellent for locating areas of the brain that have reduced blood flow and are therefore not functioning normally. Main benefits are: • CT perfusion is a useful technique for measuring perfusion in the brain. Measuring perfusion may be important for treating stroke, other blood vessel diseases of the brain and brain tumors. • CT scanning is painless, noninvasive and accurate. • A major advantage of CT is its ability to image bone, soft tissue and blood vessels all at the same time. • Unlike conventional x-rays, CT scanning provides very detailed images of many types of tissue as well as the lungs, bones, and blood vessels.
  3. 3. Clinical University | Brain CT Perfusion study www.carestream.com ©Carestream Health, Inc., 2016. CARESTREAM is a trademark of Carestream Health. • CT examinations are fast and simple; in emergency cases, they can reveal internal injuries and bleeding quickly enough to help save lives. • CT has been shown to be a cost-effective imaging tool for a wide range of clinical problems. • CT can be performed if you have an implanted medical device of any kind. • A diagnosis determined by CT scanning may eliminate the need for exploratory surgery and surgical biopsy. • No radiation remains in a patient's body after a CT examination. • X-rays used in CT scans should have no immediate side effects. 10 - WHAT ARE THE KEY CAPABILITIES OF CARESTREAM? It is important to note that the Vue Client algorithms were developed mainly for ischemic stroke assessment as opposed to the other issues described. Here the main functionalities supported: • Automatic identification of the Arterial Input Function (artery), Venous Output Function (vein) and brain centerline to carry out the perfusion analysis with ability to edit and select additional vessels • Automatic generation of CBV, CBF, TTP, MTT, TMAX, and TMIP perfusion maps and tables of quantitative data: − sSVD, cSVD, and oSVD deconvolution methods/algorithms . − Lesion and hypoperfused tissues automatically calculated. − Ability to modify the lesion and hypoperfused segmentation parameters on the fly. − Quantitative data depicted in tables. • Motion correction to minimize motion artifacts. • Single and symmetrical ROI tools for further investigation of perfusion parameters. • Save and Export results for distribution.
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Computed tomography perfusion (aka CTP) imaging shows which areas of the brain are supplied or perfused adequately with blood and provides detailed information on delivery of blood or blood flow to the brain. Here are 10 things you need to know about the procedure.

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