Andreas Fieselmann

Deconvolution-based CT and MR brain perfusion measurement: theoretical model revisited and practical implementation details

Deconvolution-based analysis of CT and MR brain perfusion data is widely used in clinical practice and it is still a topic of ongoing research activities. In this paper, we present a comprehensive derivation and explanation of the underlying physiological model for intravascular tracer systems. We also discuss practical details that are needed to properly implement algorithms for perfusion analysis. Our description of the practical computer implementation is focused on the most frequently employed algebraic deconvolution methods based on the singular value decomposition. In particular, we further discuss the need for regularization in order to obtain physiologically reasonable results. We include an overview of relevant preprocessing steps and provide numerous references to the literature. We cover both CT and MR brain perfusion imaging in this paper because they share many common aspects. The combination of both the theoretical as well as the practical aspects of perfusion analysis explicitly emphasizes the simplifications to the underlying physiological model that are necessary in order to apply it to measured data acquired with current CT and MR scanners.

Cerebral CT Perfusion Using an Interventional C-Arm Imaging System: Cerebral Blood Flow Measurements

BACKGROUND AND PURPOSE: CTP imaging in the interventional suite could reduce delays to the start of image-guided interventions and help determine the treatment progress and end point. However, C-arms rotate slower than clinical CT scanners, making CTP challenging. We developed a cerebral CTP protocol for C-arm CBCT and evaluated it in an animal study. MATERIALS AND METHODS: Five anesthetized swine were imaged by using C-arm CBCT and conventional CT. The C-arm rotates in 4.3 seconds plus a 1.25-second turnaround, compared with 0.5 seconds for clinical CT. Each C-arm scan had 6 continuous bidirectional sweeps. Multiple scans each with a different delay to the start of an aortic arch iodinated contrast injection and a novel image reconstruction algorithm were used to increase temporal resolution. Three different scan sets (consisting of 6, 3, or 2 scans) and 3 injection protocols (3-mL/s 100%, 3-mL/s 67%, and 6-mL/s 50% contrast concentration) were studied. CBF maps for each scan set and injection were generated. The concordance and Pearson correlation coefficients (ρ and r) were calculated to determine the injection providing the best match between the following: the left and right hemispheres, and CT and C-arm CBCT. RESULTS: The highest ρ and r values (both 0.92) for the left and right hemispheres were obtained by using the 6-mL 50% iodinated contrast concentration injection. The same injection gave the best match for CT and C-arm CBCT for the 6-scan set (ρ = 0.77, r = 0.89). Some of the 3-scan and 2-scan protocols provided matches similar to those in CT. CONCLUSIONS: This study demonstrated that C-arm CBCT can produce CBF maps that correlate well with those from CTP.

C-Arm CT Measurement of Cerebral Blood Volume and Cerebral Blood Flow Using a Novel High-Speed Acquisition and a Single Intravenous Contrast Injection

BACKGROUND AND PURPOSE: Assessment of perfusion parameters is important in the selection of patients who are most likely to benefit from revascularization after an acute ischemic stroke. The aim of this study was to evaluate the feasibility of measuring cerebral perfusion parameters with the use of a novel high-speed C-arm CT acquisition in conjunction with a single intravenous injection of contrast. MATERIALS AND METHODS: Seven canines had experimentally induced focal ischemic regions confirmed by CT perfusion imaging. Four hours after ischemic injury creation, each subject underwent cerebral perfusion measurements with the use of standard perfusion CT, immediately followed by the use of C-arm CT. Cerebral blood flow and cerebral blood volume maps measured by C-arm CT were quantitatively and qualitatively compared with those measured by perfusion CT for 6 of the 7 canine subjects. RESULTS: Results from independent observer evaluations of perfusion CT and C-arm perfusion maps show strong agreement between observers for identification of ischemic lesion location. Significant percentage agreement between observers for lesion detection and identification of perfusion mismatch between CBV and CBF maps indicate that the maps for both perfusion CT and C-arm are easy to interpret. Quantitative region of interest–based evaluation showed a strong correlation between the perfusion CT and C-arm CBV and CBF maps (R2 = 0.68 and 0.85). C-arm measurements for both CBV and CBF were consistently overestimated when compared with perfusion CT. CONCLUSIONS: Qualitative and quantitative measurements of CBF and CBV with the use of a C-arm CT acquisition and a single intravenous injection of contrast agent are feasible. Future improvements in flat detector technology and software algorithms probably will enable more accurate quantitative perfusion measurements with the use of C-arm CT.

Interventional 4-D C-Arm CT Perfusion Imaging Using Interleaved Scanning and Partial Reconstruction Interpolation

Tissue perfusion measurement during catheter-guided stroke treatment in the interventional suite is currently not possible. In this work, we present a novel approach that uses a C-arm angiography system capable of computed tomography (CT)-like imaging (C-arm CT) for this purpose. With C-arm CT one reconstructed volume can be obtained every 4-6 s which makes it challenging to measure the flow of an injected contrast bolus. We have developed an interleaved scanning (IS) protocol that uses several scan sequences to increase temporal sampling. Using a dedicated 4-D reconstruction approach based on partial reconstruction interpolation (PRI) we can optimally process our data. We evaluated our combined approach (IS-PRI) with simulations and a study in five healthy pigs. In our simulations, the cerebral blood flow values (unit: ml/100 g/min) were 60 (healthy tissue) and 20 (pathological tissue). For one scan sequence the values were estimated with standard deviations of 14.3 and 2.9, respectively. For two interleaved sequences the standard deviations decreased to 3.6 and 1.5, respectively. We used perfusion CT to validate the in vivo results. With two interleaved sequences we achieved promising correlations ranging from r=0.63 to r=0.94. The results suggest that C-arm CT tissue perfusion imaging is feasible with two interleaved scan sequences.

Dynamic Iterative Reconstruction for Interventional 4-D C-Arm CT Perfusion Imaging

Tissue perfusion measurement using C-arm angiography systems capable of CT-like imaging (C-arm CT) is a novel technique with potentially high benefit for catheter guided treatment of stroke in the interventional suite. However, perfusion C-arm CT (PCCT) is challenging: the slow C-arm rotation speed only allows measuring samples of contrast time attenuation curves (TACs) every 5-6 s if reconstruction algorithms for static data are used. Furthermore, the peak values of the TACs in brain tissue typically lie in a range of 5-30 HU, thus perfusion imaging is very sensitive to noise. We present a dynamic, iterative reconstruction (DIR) approach to reconstruct TACs described by a weighted sum of basis functions. To reduce noise, a regularization technique based on joint bilateral filtering (JBF) is introduced. We evaluated the algorithm with a digital dynamic brain phantom and with data from six canine stroke models. With our dynamic approach, we achieve an average Pearson correlation (PC) of the PCCT canine blood flow maps to co-registered perfusion CT maps of 0.73. This PC is just as high as the PC achieved in a recent PCCT study, which required repeated injections and acquisitions.

A dynamic reconstruction approach for cerebral blood flow quantification with an interventional C-arm CT

Tomographic perfusion imaging is a well accepted method for stroke diagnosis that is available with current CT and MRI scanners. A challenging new method, which is currently not available, is perfusion imaging with an interventional C-arm CT that can acquire 4-D images using a C-arm angiography system. This method may help to optimize the workflow during catheter-guided stroke treatment. The main challenge in perfusion C-arm CT is the comparably slow rotational speed of the C-arm (approximately 5 seconds) which decreases the overall temporal resolution. In this work we present a dynamic reconstruction approach optimized for perfusion C-arm CT based on temporal estimation of partially backprojected volumes. We use numerical simulations to validate the algorithm: For a typical configuration the relative error in estimated arterial peak enhancement decreases from 14.6% to 10.5% using the dynamic reconstruction. Furthermore we present initial results obtained with a clinical C-arm CT in a pig model.

Full-field digital mammography with grid-less acquisition and software-based scatter correction: Investigation of dose saving and image quality*

Anti-scatter grids used in full-field digital mammography not only attenuate scattered radiation but also attenuate primary radiation. Dose saving could be achieved if the effect of scattered radiation is compensated with a software-based scatter correction not attenuating the primary radiation. In this work, we have carried out phantom studies in order to investigate dose saving and image quality of grid-less acquisition in combination with software-based scatter correction. The results show that similar image quality (contrast-to-noise ratio and contrast-detail visibility) can be obtained with this alternative acquisition and post-processing scheme at reduced dose. The relative dose reduction is breast-thickness-dependent and is >20% for typical breast thicknesses. We have carried out a clinical study with 75 patients that showed non-inferior image quality at reduced dose with our novel approach compared to the standard method.

A model for filtered backprojection reconstruction artifacts due to time-varying attenuation values in perfusion C-arm CT

Filtered backprojection is the basis for many CT reconstruction tasks. It assumes constant attenuation values of the object during the acquisition of the projection data. Reconstruction artifacts can arise if this assumption is violated. For example, contrast flow in perfusion imaging with C-arm CT systems, which have acquisition times of several seconds per C-arm rotation, can cause this violation. In this paper, we derived and validated a novel spatio-temporal model to describe these kinds of artifacts. The model separates the temporal dynamics due to contrast flow from the scan and reconstruction parameters. We introduced derivative-weighted point spread functions to describe the spatial spread of the artifacts. The model allows prediction of reconstruction artifacts for given temporal dynamics of the attenuation values. Furthermore, it can be used to systematically investigate the influence of different reconstruction parameters on the artifacts. We have shown that with optimized redundancy weighting function parameters the spatial spread of the artifacts around a typical arterial vessel can be reduced by about 70%. Finally, an inversion of our model could be used as the basis for novel dynamic reconstruction algorithms that further minimize these artifacts.

Esophagus Segmentation by Spatially-Constrained Shape Interpolation

The segmentation and visualization of the esophagus is helpful during planing and performing atrial ablation therapy to avoid esophageal injury. Only very few studies have addressed this segmentation problem which is challenging because the esophagus has a low contrast in medical images. In this work we present a technique to segment the esophagus based on the interpolation of Fourier descriptors of manually drawn contours. The interpolation is spatially-constrained using a dedicated correction term to avoid intersections with the convex shaped left atrial posterior wall. Our technique is fast, modality independent and achieves optimal results if at least three input contours are used. We validated our technique successfully with patient data and discuss the use of our technique in the clinical workflow.

C-arm CT Perfusion Imaging in the Interventional Suite

Diagnostic perfusion imaging using CT or MRI has been available for several years. One of its applications is acute stroke diagnosis. Interventional perfusion imaging using C-arm CT is a novel field of research. It could provide perfusion information during catheter-guided stroke treatment in order to optimize patient management. In this survey article, the clinical and technical background of this topic are described and first results from in-vivo measurements are presented.