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