4-D Imaging in Cerebrovascular Disorders by Using 320-Slice CT: Feasibility and Preliminary Clinical Experience

Klingebiel, Randolf; Siebert, Eberhard; Diekmann, Susanne; Wiener, Edzard; Masuhr, Florian; Wagner, Moritz; Bauknecht, Hans-Christian; Dewey, Marc; Bohner, G.

doi:10.1016/j.acra.2008.11.004

« Previous Next »Academic Radiology
Volume 16, Issue 2 , Pages 123-129, February 2009

4-D Imaging in Cerebrovascular Disorders by Using 320-Slice CT:

Feasibility and Preliminary Clinical Experience

Randolf Klingebiel, MD
- Department of Neuroradiology, Charité, University Medicine Berlin, CharitéCentrum 6, Charitéplatz 1, 10117 Berlin, Germany
- Address correspondence to: R.K.
Eberhard Siebert, MD
- Department of Neuroradiology, Charité, University Medicine Berlin, CharitéCentrum 6, Charitéplatz 1, 10117 Berlin, Germany
Susanne Diekmann, MD
- Department of Neuroradiology, Charité, University Medicine Berlin, CharitéCentrum 6, Charitéplatz 1, 10117 Berlin, Germany
Edzard Wiener, MD
- Department of Neuroradiology, Charité, University Medicine Berlin, CharitéCentrum 6, Charitéplatz 1, 10117 Berlin, Germany
Florian Masuhr, MD
- Department of Neurology, Charité, University Medicine Berlin, CharitéCentrum 6, Charitéplatz 1, 10117 Berlin, Germany
Moritz Wagner, MD
- Department of Radiology, Charité, University Medicine Berlin, CharitéCentrum 6, Charitéplatz 1, 10117 Berlin, Germany
Hans-Christian Bauknecht, MD
- Department of Neuroradiology, Charité, University Medicine Berlin, CharitéCentrum 6, Charitéplatz 1, 10117 Berlin, Germany
Marc Dewey, MD
- Department of Radiology, Charité, University Medicine Berlin, CharitéCentrum 6, Charitéplatz 1, 10117 Berlin, Germany
G. Bohner, MD
- Department of Neuroradiology, Charité, University Medicine Berlin, CharitéCentrum 6, Charitéplatz 1, 10117 Berlin, Germany

Received 27 October 2008; accepted 9 November 2008.

Rationale and Objectives

The authors report study protocols and initial clinical experience in assessing patients with acute and chronic cerebrovascular disorders using the recently introduced technique of volume computed tomography (VCT).

Materials and Methods

Thirteen patients with presumptive cerebrovascular insufficiency underwent VCT using a 320-slice scanner (detector width, 160 mm), including time-resolved whole-brain perfusion and cerebral angiography (four-dimensional computed tomographic angiography [CTA] and computed tomographic perfusion [CTP]). Unenhanced cranial CT (cCT) and helical cervicocranial CT (three-dimensional CTA) were added according to clinical requirements. Study protocols are presented, and image quality, data management, and radiation exposure issues are discussed.

Results

In 12 of 13 patients, the procedure was performed successfully on admission; in the other patient, the study was aborted for clinical reasons and repeated. Total scan time amounted to about 5 minutes, and data reconstruction times were up to 10 minutes. About 9000 primary images were generated, partially in the enhanced Digital Imaging and Communications in Medicine format, thus requiring new data postprocessing and management strategies. Image artifacts restricted the use of single-rotation cCT and incremental VCT (three-dimensional CTA). Overall exposure figures (computed tomographic dose index and dose-length product) were increased by 65% on average when three-dimensional CTA was added to volume cCT and four-dimensional CTA and CTP (5.0 mSv and 2178 mGy · cm, respectively).

Conclusion

Preliminary clinical experience indicates that whole-brain four-dimensional CTA and CTP is a robust technique that provides relevant clinical information with respect to whole-brain perfusion as well as cerebral hemodynamics. The exposure benefit of deriving time-resolved perfusion and vessel images from one source data set is compromised when adding three-dimensional CTA to the protocol. Other acquisition techniques specific to VCT, such as single-rotation cCT and incremental three-dimensional CTA, suffer from restrictions in terms of image quality at present.

Key Words: CT, CT angiography, volume CT, brain, ischemia