Value Of CT Perfusion Imaging Research Articles

Prognostic value of CT perfusion imaging, serum D-D and MMP-9 on hemorrhage transformation after thrombolysis in patients with acute cerebral infarction

Prognostic value of CT perfusion imaging, serum D-D and MMP-9 on hemorrhage transformation after thrombolysis in patients with acute cerebral infarction

Abstract 144: Value of CT Perfusion Imaging Among Patients With Minor Stroke

Introduction: CTP has increasingly been incorporated into the evaluation of all patients with suspected acute ischemic stroke (AIS), including those with minor symptoms. We aimed to assess the incremental value of CTP in acute treatment decision-making among patients with low NIHSS. Methods: We performed a retrospective cohort study of all patients who underwent CTP upon presentation to the ED at three academic, urban hospitals in Philadelphia, PA between January 1, 2022 and December 31, 2022. We collected data on initial NIHSS score, AIS treatment decisions, subsequent neuroimaging, and final diagnosis. Results: There were 531 patients with a median age of 64.5 years (IQR 54-73) and 56% were women. 73% were Black or African American, 20% White, and 4% Asian. Frequency of CTP imaging by initial NIHSS score is presented in the Figure. Among 90 patients (16.9%) with NIHSS≤2, CTP imaging was cited as justification for AIS treatment (thrombolysis, thrombectomy, or both) in 0 (0%, 95% CI: 0-4%). Specifically, among 41 patients (7.7%) with NIHSS≤1, 0 received thrombolysis or thrombectomy, and 12 (29.2%) were ultimately diagnosed with AIS on CT/MRI. Among 49 with NIHSS=2 (9.2%), 2 patients received thrombolysis (based on clinical exam, CTP was normal) and one later underwent thrombectomy based on clinical decompensation with repeat NIHSS=7, and 28.6% had AIS on CT/MRI. Meanwhile, among 33 patients with NIHSS=3, acute treatment was given to 3 and CTP influenced AIS treatment decisions in 2 (6.1%). Among 59 patients with NIHSS=4, acute treatment was given to 4 and CTP influenced decision-making in 3 (5.1%). CTP mismatch ratio was > 1.7 in all 5 patients who received acute treatment and had NIHSS of 3 or 4. Conclusions: CTP is frequently performed in patients with low NIHSS. It had limited impact on acute treatment decisions, notably none among those with NIHSS≤2, suggesting that CTP may be over-utilized in this subset of patients with AIS.

Retracted: Predictive Value of CT Perfusion Imaging on the Basis of Automatic Segmentation Algorithm to Evaluate the Collateral Blood Flow Status on the Outcome of Reperfusion Therapy for Ischemic Stroke

Retracted: Predictive Value of CT Perfusion Imaging on the Basis of Automatic Segmentation Algorithm to Evaluate the Collateral Blood Flow Status on the Outcome of Reperfusion Therapy for Ischemic Stroke

Retracted: A Cohort Study to Evaluate the Efficacy and Value of CT Perfusion Imaging in Patients with Metastatic Osteosarcoma after Chemotherapy.

[This retracts the article DOI: 10.1155/2022/5417753.].

A Cohort Study to Evaluate the Efficacy and Value of CT Perfusion Imaging in Patients with Metastatic Osteosarcoma after Chemotherapy.

Objective A case-control study was conducted to explore the efficacy of cohort study and value of CT perfusion imaging in patients with metastatic osteosarcoma after chemotherapy. Methods Eighty patients with metastatic osteosarcoma treated in our hospital from March 2020 to December 2021 were divided into two groups. According to their different treatment methods, the chemotherapy+antiangiogenesis group had 36 cases and the chemotherapy group had 44 cases. All patients were scanned by 64-slice spiral CT before and after treatment. The differences of tumor volume and perfusion parameters before and after treatment were compared, and the correlation between perfusion parameters and tumor microvessel density (MVD) was analyzed. The receiver working curve (ROC curve) was used to evaluate the efficacy of the two groups after chemotherapy. Results Blood flow (BF), blood volume (BV), Pallak blood volume (PBV), and time to start (TTS) in the antitumor angiogenesis+chemotherapy group were significantly lower than those before treatment (P < 0.05). Microvessel density was positively correlated with PS, BF, BV, and PBV (P < 0.05). The reduction rate of BV and BF in the remission group after treatment was significantly higher than that in the nonremission group. When the BV and BF decline rates were 47.37% and 21.53% and the areas under the curve were 0.968 and 0.916, respectively, the diagnostic effect was the best. When the decrease rate of BV was 47.48% and the decrease rate of BF was 21.55%, the sensitivity was 94.72% and 89.56% and the specificity was 91.31% and 91.31%. Conclusion The reduction rate of BV and BF in CT perfusion imaging is of high value in evaluating the efficacy of radiotherapy and chemotherapy in patients with NSCLC and can provide more objective basis for observing the changes and judging the prognosis of osteosarcoma after treatment.

Application Value of CT Perfusion Imaging in Patients with Posterior Circulation Hyperacute Cerebral Infarction

Objectives: This study aims to evaluate the application value of computed tomography perfusion (CTP) imaging in patients with posterior circulation cerebral infarction in the hyperacute phase. Methods: The changes in CTP parameters, such as time to peak (TTP), mean transfer time (MTT), cerebral blood flow (CBF) and the cerebral blood volume (CBV) of ischemic region, as well as the ischemic penumbra, infarction core at the affected side and normal brain tissue at the uninjured side, of 168 patients with suspected posterior circulation acute ischemic stroke were analyzed. The sensitivity, specificity, accuracy, positive predictive value and negative predictive value of each parameter map of CTP in displaying the cerebral infarction size in each part of the posterior circulation were evaluated. Results: The CTP results revealed that CBF and CBV in the infarction area significantly decreased, and MTT and TTP in the blood supply area of cerebellum, thalamus and posterior cerebral artery (PCA) were significantly delayed. These were statistically different from those in the surrounding penumbra and normal brain tissue (P &lt; 0.05). Furthermore, the CBF of the penumbra in each part slightly decreased, and the delay of MTT and TTP was statistically different from that in normal brains (P &lt; 0.05). The CBV of the penumbra in the pons, midbrain and thalamus decreased, which was statistically different from that in normal brain tissue and simple cerebral ischemia tissue (P &lt; 0.05). The changes in CBF and MTT of the simple cerebral ischemia in each part, and TTP, except for the cerebellum, were statistically different from those of cerebral infarction and normal brain tissue (P &lt; 0.05). The total sensitivity, specificity and accuracy for the posterior circulation cerebral infarction was 77.2%, 98.6% and 94.9%, respectively, according to the CTP evaluation. Conclusion: The CTP parameter map can reflect the difference between an ischemic penumbra and an infraction core in the posterior circulation. It has high sensitivity, specificity and accuracy in the CTP evaluation of posterior circulation cerebral infarctions.

Predictive Value of CT Perfusion Imaging on the Basis of Automatic Segmentation Algorithm to Evaluate the Collateral Blood Flow Status on the Outcome of Reperfusion Therapy for Ischemic Stroke.

Our objective was to study the predictive value of CT perfusion imaging based on automatic segmentation algorithm for evaluating collateral blood flow status in the outcome of reperfusion therapy for ischemic stroke. All data of 30 patients with ischemic stroke reperfusion in our hospital were collected and examined by CT perfusion imaging. Convolutional neural network (CNN) algorithm was used to segment perfusion imaging map and evaluate the results. The patients were grouped by regional leptomeningeal collateral score (rLMCs). Binary logistic regression was used to analyze the independent influencing factors of collateral blood flow on brain CT perfusion. The modified Scandinavian Stroke Scale was used to evaluate the prognosis of patients, and the effects of different collateral flow conditions on prognosis were obtained. The accuracy of CNN segmentation image is 62.61%, the sensitivity is 87.42%, the similarity coefficient is 93.76%, and the segmentation result quality is higher. Blood glucose (95% CI = 0.943, P=0.028) and ischemic stroke history (95% CI = 0.855, P=0.003) were independent factors affecting the collateral blood flow status of stroke patients. CBF (95% CI = 0.818, P=0.008) and CBV (95% CI = 0.796, P=0.016) were independent influencing factors of CT perfusion parameters. After 3 weeks of onset, the prognostic function defect score of the good collateral flow group (11.11%) was lower than that of the poor group (41.67%) (P < 0.05). The automatic segmentation algorithm has more accurate segmentation ability for stroke CT perfusion imaging and plays a good auxiliary role in the diagnosis of clinical stroke reperfusion therapy. The collateral blood flow state based on CT perfusion imaging is helpful to predict the treatment outcome of patients with ischemic stroke and further predict the prognosis of patients.

Value of CT perfusion imaging in differential diagnosis between Borrmann types II( and III( gastric cancer

To investigate the value of CT perfusion imaging in differential diagnosis between Borrmann types II( and III( gastric cancer. All the patients were proven as ulcerated gastric cancer by preoperative gastroscopy and underwent CT perfusion scanning with Aquilion ONE 320 spiral CT from October 2013 to June 2014 in The First Affiliated Hospital of Zhengzhou University, including 19 patients as Borrmann type II( gastric cancer and 23 patients as Borrmann type III( gastric cancer by pathology. Lesions were divided into three parts by two tangent lines perpendicular to the gastric wall of the ulcer edge, including proximal part (close to cardia), ulcer part and distal part (close to pylorus). All the perfusion images were analyzed in the Toshiba 4.7 post processing workstation. Blood flow (BF), blood volume (BV), and clearance (CL) were measured according to Patlak-plot mode, and arterial flow (AF) was measured according to Single-input maximum mode. Differences in all the parameters between Borrmann type II( and III( groups were analyzed. Receiver operating characteristic (ROC) curve was used to determine the threshold of perfusion parameters for differentiating Borrmann type II( and III( gastric cancer. There were no significant differences in AF, BV and BF of ulcer part between the two groups (all P>0.05). While the CL of ulcer part in Borrmann type III( group was (7.17±2.41) L/s, which was significantly higher than (4.82±2.26) L/s in Borrmann type II( group (P=0.00). There were no significant differences for all the parameters at proximal part and distal part between the two types (all P>0.05). According to the ROC curve, area under the curve of CL was 0.78. Taking 0.59 L/s as the threshold of CL value, the corresponding sensitivity and specificity for diagnosing Borrmann type III( were 70% and 80%, respectively. The CL value has certain diagnostic value in differential diagnosis between Borrmann types II( and III( gastric cancer.

A study of CT perfusion imaging before and after radiotherapy for solid lung cancer

Objective To analyze the perfusion status of lung cancer before radiotherapy and the relationship between changes in CT perfusion parameters after radiotherapy and the efficacy of radiotherapy. Methods Twenty-eight patients clinically and pathologically diagnosed with lung cancer were enrolled as subjects. Those patients received CT perfusion imaging scan and perfusion parameters including blood flow (BF), blood volume (BV), mean transit time (MTT), and permeability surface (PS) were calculated. We use linear correlation analysis for relation between value of CT perfusion imaging and the target volume of lung cancer before radiotherapy, t-test for difference between the remission groups and non-remission groups, compared paired sample t-test for value of CT perfusion imaging before and after radiotherapy. Results According to the efficacy of radiotherapy, 28 patients with lung cancer were divided into response group (n=16) and non-response group (n=12). The response group had significantly smaller tumor sizes before and after radiotherapy than the non-response group (58.72±22.95 cm3vs.24.53±13.79 cm3, P=0.000). However, there was no significant correlation of target volume before radiotherapy with any perfusion parameter (P=0.628). The response group had significantly larger BF and BV than the non-response group before radiotherapy (1.23±1.36 vs.6.42±2.57, P=0.024 and 1.23±0.31 vs.0.59±0.18, =0.041), suggesting a low perfusion state of tumor tissue in the non-response group. However, there were no significant differences in MTT and PS between the two groups (0.93±0.58 vs.0.93±0.66, P=0.851 and 1.46±0.83 vs.1.17±0.56, P=0.141). All the 28 patients had significantly smaller BF, BV, MTT, and PS after radiotherapy (9.81±3.56 vs.7.48±3.31, P=0.006; 0.96±0.41 vs.0.64±0.38, P=0.003; 0.93±0.60 vs.0.53±0.30, P=0.007; 1.34±0.73 vs.0.74±0.44, P=0.001). Conclusions CT perfusion imaging can predict the efficacy of radiotherapy for lung cancer, which may guide the planning and implementation of precise radiotherapy for lung cancer. Key words: Perfusion imaging; Blood flow; Lung neoplasms/radiotherapy

Value of CT perfusion imaging in pressure modulation after ventriculoperitoneal shunt

Objective To investigate the value of CT perfusion imaging(CTP) in pressure modulation after ventriculoperitoneal shunt (VP) and determine the relationship between consciousness variation and cerebral perfusion. Methods Thirty cases in a vegetative or minimally conscious state after VP for posttraumatic hydrocephalus were included. There were 26 males and 4 females, aged (56.4±9.2) years. Duration of disease was (88.7±38.0)d. Consciousness evaluation and CT perfusion scan were performed before and two weeks after pressure modulation. Based on the consciousness state, the patients were allocated into consciousness unimproved (n=17) and improved groups (n=13). Relative cerebral blood flow (rCBF), relative cerebral blood volume (rCBV), relative mean transit time (rMTT) and relative time to peak (rTTP) were evaluated before and after pressure modulation. Results In consciousness improved group rCBF in the alba around anterior horn of lateral ventricle was significantly improved after pressure modulation compared to that before pressure modulation (1.08±0.55 vs. 0.75±0.32, P 0.05). In consciousness improved group all the measures showed no significant changes in other regions such as encephalomalacia focus, forehead lobe, temporal lobe, basal ganglia and occipital lobe (P>0.05). However, none was significantly different in consciousness unimproved group (P>0.05). Conclusions CTP has some reference value on pressure modulation of posttraumatic hydrocephalus patients treated with VP. Consciousness improvement is related to the increased cerebral perfusion in the alba around anterior horn of lateral ventricle. Key words: Perfusion imaging; Hydrocephalus; Ventriculoperitoneal shunt

A Correlative Study between CT Perfusion Parameters and Angiogenesis in Rabbit VX2 Liver Tumors

Objective: The purpose of this study was to evaluate the correlation between CT perfusion parameters and the hypoxia-inducible factor-1 alpha (HIF-1α), vascular en-dothelial growth factor (VEGF), matrix metalloproteinase-2 (MMP-2) and microvessel density (MVD) marked by CD34 molecular of rabbit VX2 liver tumors and to investigate the value of CT perfusion imaging in evaluating tumor angiogenesis. Material and methods: Twenty-four cases of rabbit VX2 liver tumor were performed by CT perfusion scanning. Hepatic artery perfusion (HAP), portal vein perfusion (PVP), total hepatic blood flow (THBF) and hepatic perfusion index (HPI) were measured by perfusion software. HIF-1α, VEGF and MMP-2 expression and MVD were detected in the 24 rabbit VX2 liver tumor tissue samples using immunohistochemical method. The correlation between the HIF-1α, VEGF, MMP-2 expression and MVD and CT perfusion parameters were analyzed. Results: Correlation analysis revealed that the expression of HIF-1α, MMP-2, MVD were positively related to the HAP, THBF, HPI (p 0.05); and correlation analysis revealed that the expression of VEGF was positively related to the HAP, HPI (p 0.05). There was a positive relationship between the expression of HIF-1α, VEGF, MMP-2 and MVD (p < 0.01). Conclusions: CT perfusion imaging can reflect the blood perfusion of the rabbit VX2 liver tumors and evaluate the information of angiogenesis about tumors.

Analysis of changes of cerebral perfusion in surrounding brain parenchyma after aneurismal subarachnoid hemorrhage

Objective To study cerebral perfusion in surroundin gbrain parenchyma within 24 hours and 6-8 days after aneurysmal subarachnoid hemorrhage (aSAH) by CT perfusion imaging,to explore the applied value of CT perfusion imaging in predicting delayed cerebral ischemia (DCI).Methods Imaging data of 32 consecutive aSAH patients of our hospital during December 2011 to December 2012 were retrospectively reviewed.All patients underwent non-contrast CT,CT angiography (CTA) and CT perfusion (CTP) imaging within 24 hours of onset.6-8 days after SAH,only non-contrast CT and CTP could be performed.The perfusion parameters values in hypoperfusion area or surrounding brain parenchyma of SAH and the mirror parenchyma were measured for the first and follow-up CTP,including cerebral blood flow (CBF),cerebral blood volume (CBV),mean transit time (MTT).To calculate the ratio of the two parts to get the relative cerebral blood flow(rCBF),relative cerebral blood volume (rCBV) and relative mean transit time (rMTT).According to presence of DCI,32 patients were divided into DCI group (8 patients) and no-DCI group(24 patients).The differences of rCBF、rCBV and rMTT of the two examination between the two group were compared with independent-sample t test.Results For the DCI group,rCBF was 1.0 ± 0.3、rCBV was 1.1 ±0.5 and rMTT was 1.1 ±0.2 in the first CTP,rCBF was 0.7 ±0.2、rCBV was 0.9 ±0.2 and rMTT was 1.5 ±0.3 in the follow-up CTP.For the no-DCI group,rCBF was0.9 ±0.3 、rCBV was 1.0 ±0.2 and rMTT was1.1 ±0.2 in the first CTP,rCBF was 0.9 ±0.2、rCBV was 0.9 ±0.2 and rMTT was 1.1 ± 0.2 in the follow-up CTP.Compared with the first CTP,there was lower rCBF、stable rCBV and higher rMTT in the follow-up CTP for the DCI group.Although perfusion was improved in some patients,but there were no significant changes overall for the rCBF、rCBV and rMTT for the twice CTP.There was significant statistical difference in the differences of rCBF and rMTT of the two examination between the two group (t rCBF =2.659,P rCBF =0.012 ; t rMTT =--3.747,P rCBF =0.001).But there were no significant statistical difference in rCBV of the two examination between the two group (t rCBv =1.031,P rCBF =0.311).Conclusion The CTP parameters of rCBF and rMTT has higher sensitivity and is important to predict the occurrnce of the DCI. Key words: Subarachnoid hemorrhage ; Tomography,X-ray compated ; Perfusion ; Delayed cerebral ischemia

Diagnostic value of CT perfusion imaging for parotid neoplasms

To assess the value of CT perfusion imaging in the differentiation of different histological categorization of benign tumours from malignant tumours in patients with parotid neoplasms. CT perfusion was successfully performed in 62 patients with parotid neoplasms whose diagnoses were confirmed by surgery or biopsy. The software generated a tissue time-density curve (TDC) and measured blood volume, blood flow, mean transit time and capillary permeability surface product. One-way ANOVA and receiver operating characteristic curves were used to analyse the difference and diagnostic efficacies of all perfusion data between each one of the benign tumours and malignancies. Statistical significance was assigned at the 5% level. Pleomorphic adenomas mainly had a gradually ascending TDC. Warthin tumours showed a fast ascent followed by a fast descent. The TDC of basal cell adenomas had a fast ascension followed by a plateau, then a gradual descent. Malignant tumours mainly showed a rapidly ascending curve with a stable plateau. Significant differences were observed in blood flow, blood volume and mean transit time between pleomorphic adenomas and malignant tumours (p < 0.05) as well as in blood flow and blood volume between the Warthin tumours, the basal cell adenomas and the malignant tumours (p < 0.05). Differences in permeability surface between the basal cell adenomas and malignant tumours were significant (p < 0.01). CT perfusion of parotid gland could provide TDC and perfusion data, which were useful in the differentiation of different histological benign tumours and malignant tumours in the parotid gland.

Correlation of blood flow assessed by CT perfusion imaging and microvascular ultrastructure in non-small cell lung cancer: a preliminary study

To investigate the correlation between blood flow assessed by CT perfusion imaging and characteristics of microvascular ultrastructure in non-small cell lung cancer (NSCLC). twenty-eight patients with non-small cell lung cancer proven surgically and pathologically underwent perfusion CT examination. The patients were divided into a hyper-perfusion group and a hypo-perfusion group by the median value of blood flow, and then the differences of microvascular ultrastructure in the two groups were analyzed. The median BF value of the 28 patients was 36.40 ml×100 g(-1)×min(-1). Take this median value as the boundary, the group with hypo-perfusion showed a significantly lower BF value than the group with hyper-perfusion [(30.84 ± 4.79) ml×100 g(-1)×min(-1) vs. (49.67 ± 10.89) ml×100 g(-1)×min(-1), t = -5.925, P < 0.001]. The group with lymph node metastasis showed a significantly lower BF value than the group without lymph node metastasis [(30.78 ± 5.24) ml×100 g(-1)×min(-1) vs. (50.73 ± 11.16) ml×100 g(-1)×min(-1), t = 3.490, P = 0.015]. The maturity of microvessels of the hyper-perfusion group was higher than that of the hypo-perfusion group. Under the electron microscope, the microvessels in the hypo-perfusion group showed a more narrow lumen, poorer integrity of basement membrane, a more close relationship between cancer cells and microvascular wall, and cancer cells were more easily seen in the microvascular lumen. The blood flow value of CT perfusion imaging may be related with the abnormal microvascular ultrastructure, and may be helpful to the prediction of metastasis risk in NSCLC.

CT perfusion imaging in the diagnosis of hepatocellular carcinoma

Objective To evaluate the value of CT perfusion imaging (CTPI) in the diagnosis of hepatocellular carcinoma (HCC). Method CTPI was carried out on 21 patients with 26 lesions to obtain the following perfusion parameters: hepatic blood flow (HBF), hepatic blood volume (HBV),mean transit time (MTT), permeability surface area product (PS), and hepatic arterial fraction (HAF). The parameters from the lesion and non-lesion areas were compared. In addition, serum AFP was measured in the HCC patients and a linear correlation analysis between the alpha-fetoprotein (AFP) level and the CTPI parameters was performed. Result CTPI failed in 3 patients with 3 lesions and was successful in 18 patients with 23 lesions which included 18 HCC, 4 hemangioma of the liver,and 1 hepatic focal nodular hyperplasia (FNH). On comparison of the HCC parameters in the lesion and non-lesion areas, significant differences were found in the HAF which was 4.11 times higher in the lesion than the non-lesion areas, while the MTT and PS were significantly lower. There was no significant difference in the HBF and HBV. Correlation between the serum AFP level and the CTPI parameters of the HCC lesion was insignificant. The differences of all the parameters between the lesion and the non-lesion in hemangioma were similar to those in HCC, except for a higher HBF in the lesion than in HCC. There was no significant difference between the parameters of FNH and the non-nodular part of the liver. Conclusion CTPI played an important role in the diagnosis and differential diagnosis of HCC, especially when the AFP was negative and/or the imaging manifestation was atypical on contrast CT. Key words: CT perfusion imaging; Diagnosis; Hepatocellular carcinoma

Evaluation of CT perfusion imaging for the hemodynamics on liver ischemia reperfusion injury

Objective To evaluate the value of CT perfusion imaging (CTPI) on liver ischemia reperfusion injury. Methods Twenty-one adult dogs were divided into three groups randomly: CON group, IV group and SMA group, each group consisted of 7 dogs. Under general anesthesia and laparotomy, porta hepatis were occluded for 45 minutes and reperfused 60 minutes later to establish IR injury models. Lipo-PGE1 administration was conducted 5 minutes before porta occlusion and 60 minutes after reperfusion in Ⅳsodium chloride administration was slowly conducted 5 minutes before porta occlusion and 60 minutes after reperfusion in CON group as control, the rate of injection was 2 ml/kg. CTPI free portal pressure measurement (FPP) and pathological sampling were performed in succession and compared before and after IlL Paired-sample t test was used for self control study on parameters of liver perfusion before and after IR in each group, and One-way ANOVA was used for comparison of different values of each parameter of liver perfusion among groups. Results (1) Each liver blood perfusion value decreased in different levels after IR. The different values of hepatic arterial perfusion (HAP), portal vein perfusion (PVP), total liver group , respectively. There were significant difference in each parameter of liver perfusion among groups (F=5.286, 2. 894, 4. 705 ;P 0. 05). (3) Microscopically, the structures of liver were poorly defined with cloudy swelling of hepatocytes, stasis of erythrocytes in hepatic sinusoid, and neutrophilic granulocyte infiltration of portal area in control group. Evidence of liver injury was moderately improved in IV group and markedly improved in SMA group. Conclusion CT perfusion imaging can objectively and quantitatively estimate the alterations on liver hemodynamics on IR injury following administration of medication. Key words: Reperfusion injury; Tomography; X-ray computed; Perfusion