Whole brain perfusion and CT angiography in a single exam

Clinical Case

Patient History

A man in his 70s was referred to CT for suspicion of carotid lesion.
Head and neck angiography and whole brain perfusion were acquired to assess anatomy and function in a single exam.

Acquisition

Head & NeckCT angiography

  • Helical pitch 0.992:1, 80 mm collimation

  • 120 kV, Noise Index 12

  • 0.5 sec rotation

  • BMI: 25 

  • ASiR*-V1 50% 

  • DLP 303 mGy-cm

  • 1.48 mSv2

  • Coverage: 300 mm

  • Acquisition time: 1.9 sec

Brain Perfusion & 4D CT angiography

  • Dynamic acquisition

  • Axial 140mm for whole organ coverage

  • 50 cc of contrast media (350 mg I/mL)

  • BMI: 25 

  • ASiR-V 80% 

  • DLP 760 mGy-cm

  • 1.74 mSv3

  • Group 1: wash-in (15 passes)

    • 80 kV & 240 mA

    • 0.5 sec rotation speed

    • 2.5 sec between passes

    Group 2: wash-out (5 passes)

    • 80 kV & 180 mA

    • 0.5 sec rotation speed

    • 4 sec between passes

Results

Head & NeckCT Angiography

Brain Perfusion & 4D CTA



This study shows that the intermediate stenosis at the base of the right carotid bulb and the severe stenosis at the origin of the right external carotid have no impact on the perfusion of the right hemisphere.

The whole brain perfusion maps show no perfusion abnormality. The total examination dose is 3.2 mSv for both head and neck angiography (1.7 mSv) and brain dynamic perfusion (1.5 mSv).


Conclusion

This case study demonstrates the feasibility of combining anatomical assessment of supra aortic trunks and accurate functional assessment of brain perfusion in one single study thanks to the whole organ coverage. Brain perfusion is performed without table motion, helping ensure homogeneous image quality. Furthermore, ASiR-V dose reduction capabilities and flexible sampling rate and tube current make it possible to perform the study at the dose of a conventional head examination.


Testimonial

« Revolution CT allows acquiring anatomical and functional information in one examination, at low dose. This capability has the potential to reduce the need for additional investigations. In cardiac, this will help us evaluate the impact of a stenosis on the myocardial perfusion and therefore improve the specificity of Cardiac CT. In oncology, perfusion imaging has the potential to help characterize lesion, and to better evaluate the response under specific treatments, such as anti-angiogenics. In early stroke management, identifying penumbra and necrosis can be critical for treatment decision and patient management.”

Jean-Louis Sablayrolles


Enabling Technologies

  • The Revolution CT allows for whole organ dynamic acquisition with up to 160 mm of coverage, with no table motion. This enables perfusion study of the heart, brain, liver, kidneys and other organ and tissues. It also provides you with 4D imaging capabilities for all anatomies to visualize vascular flow, organ motion or kinetic properties.

  • Revolution CT introduces the groundbreaking Gemstone* Clarity Detector, with focally-aligned, miniaturized modules and 3D collimator that is designed to ensure contrast uniformity and excellent image quality across the whole detector and overcome challenges such as cone beam or beam hardening artifacts associated with wide coverage.

  • The next generation of iterative reconstruction, ASiR-V, the flexible collimation (between 5 mm to 160 mm), the variable sampling rate and tube current during dynamic perfusion acquisition help you to optimize radiation dose of such studies. 


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