Mudassar Kamran, Presenter: Nothing to Disclose

Yu Deuerling-Zheng MD, Abstract Co-Author: Employee, Siemens AG

James V. Byrne, Abstract Co-Author: Advisor, Siemens AG Instructor, Boston Scientific Corporation Scientific Advisory Board, Johnson & Johnson

1. To explore the feasibility and utility of perfused blood volume (PBV) measurements with C-arm angiographic systems in the interventional suite for neuro-ITU patients with vasospasm following aneurysmal SAH. 2. To estimate the agreement of C-arm PBV with MR-CBV values and to explore its relationship with MR perfusion parameters  

23 patients from the neuro-intensive treatment unit (ITU) with suspected vasospasm following aneurysmal subarachnoid haemorrhage (SAH) were scanned using a biplane angiography system (Axiom Artis dBA; Siemens Healthcare, Germany). The imaging protocol included two 8-seconds rotational acquisitions, each comprising approximately 400 projection images at 0.50 steps. CBV maps were constructed using a dedicated prototype software (Siemens AG, Healthcare). Contemporaneous MR-PWI scan was obtained for comparison. Using standardized regions of interest (ROIs), C-arm and MR perfusion parameters were measured for white matter (WM) and grey matter (GM) structures. Statistical agreement between C-arm PBV and MR-CBV was explored with Pearson correlation and Bland-Altman tests. Correct identification of haemodynamically significant vasospasm was used as endpoint to evaluate the diagnostic utility of C-arm PBV maps for management of vasospasm. Relationship between MR perfusion parameters and C-arm PBV was explored with multiple regression analysis.  

Angiographic vasospasm was present in 18 patients, of whom 15 had haemodynamic abnormalities detectable on MR-PWI examination (criterion standard). C-arm PBV maps correctly identified haemodynamic abnormalities in all patients. MR CBV and C-arm PBV showed good correlation (GM r=0.81, WM r=0.90) and were in agreement (95% limits of agreement range for GM ROIs, -0.16 to 0.25; WM ROIs, -0.14 to 0.20). Bias in measurements was minimal and the limits of agreement included clinically significant MR CBV discrepancies. Voxel intensities of C-arm PBV maps showed consistent relationship with MR CBV, CBF, and MTT maps for various regions of interest.  

Our results demonstrate the feasibility and accuracy of C-arm PBV measurements for neuro-ITU patients with vasospasm following aneurysmal SAH.  

Comprehensive non-invasive assessment of vasospasm in optimized interventional environment improves the workflow by avoiding patient transfer between the diagnostic and interventional set-ups.

Kamran, M, Deuerling-Zheng, Y, Byrne, J, Non-invasive Assessment of Cerebral Vasospasm Following Aneurysmal Subarachnoid Haemorrhage Using C-arm Angiographic-CT-based PBV Measurements in the Neurointerventional Suite.  Radiological Society of North America 2011 Scientific Assembly and Annual Meeting, November 26 - December 2, 2011 ,Chicago IL. http://archive.rsna.org/2011/11017058.html