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

Slides:

Advertisements

Similar presentations

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

Advertisements

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.

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,

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,

Diagnostic Imaging on Intracranial Atherosclerotic Stenosis Eduardo Freire Mello Department of Interventional Neuroradiology Hospital Espanhol, Salvador.

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,

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.

New ways of imaging Stroke/TIA Dr Suzanne O’Leary Neuroradiology SpR Frenchay Hospital.

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.

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: ,

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

Acute Stroke Management

Fractional Flow in Cerebrovascular Disorders

Acute Carotid Occlusions

CTA-Source Images: Volume or Flow Weighted?

CAS in acute stroke C. Roth‡, P. Papanagiotou‡, A. M. Politi‡, K. W. Reith‡ Department of diagnostic.

K Chen1, W Guo2, C Lin3, W Chu3, F Wu4

Risk of post-operative stroke in patients with known extra-cranial carotid artery disease undergoing Non-Cardiac Surgery Heart and Vascular.

Perfusion-weighted magnetic resonance imaging in patients with carotid artery disease before and after carotid endarterectomy Arnd Doerfler, MDa, Hans.

Icahn School of Medicine Mount Sinai Hospital

Urgent carotid intervention is safe after thrombolysis for minor to moderate acute ischemic stroke Hernan A. Bazan, MD, FACS, Nicolas Zea, MD, Bethany.

Cerebral hyperperfusion syndrome after endovascular covered stent grafting for a giant extracranial aneurysm of the internal carotid artery Sakyo Hirai,

Brain computed tomography perfusion may help to detect hemodynamic reconstitution and predict intracerebral hemorrhage after carotid stenting Shy-Chyi.

Seizure - European Journal of Epilepsy

Xe-CT CBF maps in a patient with Moyamoya disease.

Case 10: 61-year-old man with hyperacute ischemic stroke with arterial occlusion and increased CBV. A, T2-weighted image (3500/90) is normal except for.

A 30-year-old man with PSA

A 66-year-old male patient with symptomatic left intracranial carotid artery stenosis treated with balloon-mounted stenting. A 66-year-old male patient.

Peter Jan Van Laar, MD, Jeroen Hendrikse, MD, PhD, Willem P. Th. M

VW-MR imaging to identify symptomatic, nonstenotic intracranial atherosclerotic plaque. VW-MR imaging to identify symptomatic, nonstenotic intracranial.

42-year-old male patient with follow-up neck CT for lymphoma at 70 kVp (A) and corresponding previous CT at 120 kVp (B). 42-year-old male patient with.

T2-weighted images of a patient with an infarction within the anterior MCA branch territory on day 5 (patient 15) show high SI changes within the ipsilateral.

Three perfusion sections.

Contralateral hyperacute intracerebral hemorrhage after carotid artery stenting with contralateral internal carotid artery occlusion Hirokazu Takami,

A 76-year-old man presenting with acute right-sided symptoms.

Case 8: 77-year-old woman with hyperacute ischemic stroke with arterial occlusion and decreased CBV. A, T2-weighted MR image (3500/90) is normal except.

Patient 3. Patient 3. A, Ninety-nine percent right internal carotid artery stenosis. A left external carotid stent is also visualized. The left internal.

A 74-year-old man who presented to the emergency department after a fall with left-sided weakness. A 74-year-old man who presented to the emergency department.

A 58-year-old woman with left-sided weakness.

Pial vasodilation. Pial vasodilation. A, Axial GRE T2 image shows a left frontal sulcal SAH (black arrowhead), possibly located in the “watershed” territory.

Trends in the use of head CT and advanced imaging in patients treated with IV thrombolysis from 2008 to Trends in the use of head CT and advanced.

CTP. CTP. Chronic left internal carotid artery occlusion. A, Baseline. B, After ACZ administration. There is significant hypoperfusion in the left hemisphere.

An 87-year-old woman presenting with acute dysarthria, left facial droop, and left-sided weakness. An 87-year-old woman presenting with acute dysarthria,

Images obtained in an 83-year-old man with cerebral hyperperfusion after carotid stent placement. Images obtained in an 83-year-old man with cerebral hyperperfusion.

Bar graph of ADC values (s/mm2) for tumor, contralateral normal tissue, ipsilateral normal tissue, and edema for the group of 15 patients with high-grade.

Perfusion-weighted magnetic resonance imaging in patients with carotid artery disease before and after carotid endarterectomy Arnd Doerfler, MDa, Hans.

A 44-year-old male patient with symptomatic left intracranial vertebral artery stenosis treated with balloon predilation plus self-expanding stenting.

A 61-year-old male patient with right hemiparesis imaged at 2

Endovascular coil occlusion of an enlarging carotid artery pseudoaneurysm. Endovascular coil occlusion of an enlarging carotid artery pseudoaneurysm. Sagittal.

A maximum intensity projection (MIP) image reconstructed from CT-angiographic data shows the high-grade stenosis of the right ICA as well as associated.

Comparison between angle-corrected and uncorrected flow velocities and angiographic findings in a 54-year-old woman with MCA stenosis. Comparison between.

Giant cavernous carotid aneurysm, with the patient presenting with third and sixth nerve palsy due to mass effect (patient 16, On-line Table and Tables.

A 55-year-old woman (the same patient as in Fig 1) with RCVS complicated by ischemic infarcts. A 55-year-old woman (the same patient as in Fig 1) with.

A 61-year-old man presenting with an acute right Wallenberg syndrome.

Brain MR imaging on DOL 2 in patient 5 while he was treated with induced hypothermia; comparison between the perfusion map and images obtained from conventional.

Region-of-interest technique for perfusion determination.

Clustered box-and-whisker graphs show the differences in the mean values of hemodynamic parameters according to the presence of BMVs in each vascular territory.

Comprehensive imaging of a patient with recent stroke depicting left MCA stenosis. Comprehensive imaging of a patient with recent stroke depicting left.

Case 3.A, CT angiography revealing bilateral asymptomatic middle cerebral artery (MCA) bifurcation aneurysms and an additional aneurysm at the left distal.

Magnified lateral projections of bilateral ICA angiography (A, right; -B, left) show only minimal collateral flows (arrows) from lenticulostriates over.

A 55-year-old male patient who presented with tetraparesis and decreased consciousness for 6 hours. A 55-year-old male patient who presented with tetraparesis.

CT perfusion maps in a 51-year-old patient presenting with right-sided hemiparesis who was diagnosed with Moyamoya disease, demonstrating bilateral supraclinoid.

Procedural and follow-up angiograms of a 28-year-old female patient with a history of subarachnoid hemorrhage due to rupture of a contralateral MCA bifurcation.

Presentation transcript:

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

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) /11/16

■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 /11/16 Purpose

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

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 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, years old, four symptomatic). ■the rest 6 were induced by previous radiation therapy for head and neck cancers (group 2, age 59 years, range years old, five symptomatic).

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.)

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 /ML 96% R. NormalAthero- sclerosis /MR 99% L. NormalAthero- sclerosis /FR 90% L. NormalAthero- sclerosis /ML. 90% (CCA) R. 40%NPC R/T 14 yr ago /MR. 85% L. normalTongue Ca, R/T 13 yr ago /MR >90% L. 50%Athero- sclerosis /FL. 70% R. normalThyroid cancer, R/T /FL 90% R. normalAthero- sclerosis /FR LR/T /MR R/T /ML R/T

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)

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 CBV MTT TTP Global- PostIpsi-lateral- PostContra-lateral- PostIpsi-lateral MCA- Post Median Q1-Q3 Median Q1-Q3 Median Q1-Q3 Median Q1-Q3 CBF CBV MTT TTP P - value CBF CBV MTT TTP

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)

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 CBV MTT TTP Global- PostIpsi-lateral- PostContra-lateral- PostIpsi-lateral MCA- Post Median Q1-Q3 Median Q1-Q3 Median Q1-Q3 Median Q1-Q3 CBF CBV MTT TTP P - value CBF CBV MTT TTP

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 CBV MTT TTP Global- PostIpsi-lateral- PostContra-lateral- PostIpsi-lateral MCA- Post Median Q1-Q3 Median Q1-Q3 Median Q1-Q3 Median Q1-Q3 CBF CBV MTT TTP P - value CBF CBV MTT TTP

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 /11/16

■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: ■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: ■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: ■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: /11/16 References

Quantification Student T test – all patients Global - PreIpsi-lateral - PreContra-lateral - PreIpsi-lateral MCA- Pre Mean SD Median SD Median SD Median SD CBF CBV MTT TTP Global- PostIpsi-lateral- PostContra-lateral- PostIpsi-lateral MCA- Post Mean SD Median SD Median SD Median SD CBF CBV MTT TTP P - value CBF CBV MTT TTP