Purpose: The purpose of our work is to present a method that utilizes high-quality non-contrast CT (NCCT) images to reduce the noise of CT perfusion (CTP) baseline images to improve the visibility of infarct core in cerebral blood volume (CBV) maps.
Methods: First, a theoretical analysis of the CTP imaging system was performed to demonstrate that for both deconvolution- and non-deconvolution-based CTP systems. The noise of CBV maps is profoundly influenced by the baseline image noise. Consequently, baseline noise reduction is extremely effective in improving the contrast-to-noise ratio (CNR) of ischemic lesions in CBV maps. Second, a method was proposed to fuse the freely available NCCT images with the original CTP baseline images. An optimal weighting scheme was derived such that the noise of the fused baseline image is minimized. Third, the impact of the proposed NCCT-baseline fusion method was investigated using five in vivo canine subjects with different infarct core sizes. NCCT and CTP scans were performed following a clinical stroke CT imaging protocol using a 64-slice MDCT. Two of the subjects also received a diffusion-weighted imaging scan using a 3T-MRI scanner to establish the reference diagnosis for the infarct core.
Results: For all five canine subjects, the proposed method led to lower CBV noise and better conspicuity of the infarct core. Compared with a standard CTP postprocessing method, the proposed method reduced the CBV noise standard deviation by 70 % ± 24 % and increased the CNR of infarct core by 23 % ± 11 % (p < 0.01).
Conclusions: By utilizing the high-quality NCCT images to reduce CTP baseline image noise, the quality of CBV maps and the conspicuity of ischemic infarct core can be effectively improved. The proposed method can be readily implemented with minimal interruption to the existing clinical workflow.
Cerebral CT perfusion (CTP) imaging is widely used to guide the selection of acute ischemic stroke patients who are most likely to benefit from endovascular reperfusion therapy, as parametric CTP maps can assist physicians to identify the existence of hypoperfused but salvageable tissue upon reperfusion, and to differentiate this tissue from irreversibly damaged tissue for which reperfusion is futile. CTP is usually performed together with a noncontrast head CT (NCCT) for ruling out intracranial hemorrhage. Even for post stroke treatment follow-up and other neurological diseases, a CTP is often prescribed together with a NCCT to provide more comprehensive and mutually complementary diagnostic information. Despite these clinical utilities, the current CTP imaging technology still faces a major challenge: the poor contrast-to-noise ratio (CNR) of parametric CTP maps that hinders reliable stroke diagnosis for individual patients. Previous works have demonstrated that CNRs of some CTP maps such as cerebral blood volume (CBV) are predominately determined by the baseline CT images, and thus reducing the baseline image noise is very effective in improving the CNRs of CBV maps. The purpose of this work is to present a method that utilizes the high quality NCCT image to reduce the noise of baseline images and improve the detectability of ischemic core in CBV maps. The proposed method was evaluated using an in vivo canine subject where by utilizing the NCCT image the CNR was improved by 55%.
KEYWORDS: Signal to noise ratio, Computed tomography, Arteries, Sensors, Photon counting, Angiography, Signal detection, X-ray computed tomography, Spatial resolution, Head
Cerebral CT angiography (CTA) is widely used for the diagnosis of various cerebrovascular diseases, including strokes, vasculitis, aneurysms, and etc.2–4 For the diagnosis of ischemic strokes, the availability of high quality CTA images not only helps in identifying the presence/location of large vessel occlusion but also facilitates the assessment of collateral blood supply. As another example, accurate rendering of the superficial temporal arteries is valuable in identifying vessel inflammations induced by giant cell arteritis.5 While CTA is an established clinical gold standard for imaging large cerebral arteries and veins,1 an important challenge that currently remains for MDCT-based CTA is its limited performance in imaging small perforating arteries with a diameter below 0.5 mm.4 As a consequence, the relativley invasive artery biopsy procedure remains the current clinical gold standard for the diagnosis of giant cell arteritis.6 The use of indirect conversion energy integrating detectors puts intrinsic limit on the spatial resolution of MDCT, both in-plane and along the z direction. Severe partial volume averaging effect (PVE) and the preferential weighting of high energy photons7 are among major reasons for the relatively poor performance of MDCT-based CTA for imaging iodinated small vessels. Photon counting detector-based CT (PCD-CT) offers potential technological solutions to these challenges MDCT systems face for CTA. When compared to MDCT, the direct conversion design of PCD reduces limitations on both in-plane and through-plane spatial resolution, and the inherent equal weighting of high and low energy photons of PCD-CT systems offers an improvement in the CNR of iodinated vessels. The purpose of this work was to theoretically and experimentally study the potential impacts of the PCD-CT technology to an important component of CTA image package: the maximum intensity projection (MIP) image. MIP is a simple 3D image visualization method to display CTA data sets. Based on source images alone, it can be very challenging to evaluate occlusion conditions since most vessels extend to different z positions. In comparison, a MIP image that extracted information from a much longer z range can provide clearer evidence for an occlusion; in addition, it can effectively enhance the visibility of small collateral vessels. This work first derived the statistical properties of the MIP image, then analyzed how each of the benefits of PCD (improved z resolution; reduced noise autocovariance along z) propagates from the source CT images to the final MIP image. Finally, experiments were performed using a benchtop PCD-CT system and an anthropomorphic CTA phantom to showcase the significantly improved visibility of small perforating arteries.
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