Optimal dilution of contrast medium for quantitating parenchymal blood volume using a flat-panel detector

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Abstract

Objective

Similar to perfusion studies after acute ischemic stroke, measuring cerebral blood volume (CBV) via C-arm computed tomography before and after therapeutic interventions may help gauge subsequent revascularization. We tested serial dilutions of intra-arterial injectable contrast medium (CM) to determine the optimal CM concentration for quantifying parenchymal blood volume by flat-panel detector imaging (FD-PBV).

Methods

CM was diluted via saline power injector, instituting time delays for FD-PBV studies. A red/green/blue (RGB) color scale was employed to quantify/compare FD-PBV and magnetic resonance-derived CBV (MRCBV).

Results

Contrast values of right and left common carotid arteries did not differ significantly at CM dilutions of ≥20%. RGB analysis of FD-PBV imaging (relative to MR-CVB), showed CM dilution altered the colors (by 16%), increasing red and decreasing blue ratios.

Conclusion

Diluting CM to 20% resulted in no laterality differential of FD-PBV imaging, with left/right quantitative ratios approaching 1.1 (optimal for clinical use).

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Most cited references 18

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Dosing of contrast material to prevent contrast nephropathy in patients with renal disease.

Ricardo Cigarroa, Richard Lange, Russel H. Williams … (1989)

Contrast-induced renal dysfunction has been reported to occur in 15% to 42% of patients with underlying azotemia, but there is disagreement as to whether its incidence is reduced by limiting the amount of contrast material. To adjust the amount of contrast material to the severity of azotemia, we have utilized the following formula to calculate a contrast material "limit" in patients with renal disease: Contrast material limit = (formula; see text) Over a 10-year period, 115 patients (53 men, 62 women, aged 61 +/- 11 [mean +/- SD] years) with renal dysfunction (baseline serum creatinine level greater than or equal to 1.8 mg/dL) underwent cardiac catheterization and angiography, after which the level of serum creatinine was measured daily for five days. The amount of contrast material that was given adhered to the limit in 86 patients (Group I) and exceeded it in 29 (Group II). Contrast-induced renal dysfunction (an increase in serum creatinine greater than or equal to 1.0 mg/dL) occurred in two (2%) patients in Group I and in six (21%) patients in Group II (p less than 0.001). Of the 48 patients with concomitant diabetes mellitus, the contrast limit was surpassed in 16, six (38%) of whom had contrast nephropathy. Only two of the 32 (6%) diabetic patients in whom the contrast limit was not exceeded had contrast nephropathy (p less than 0.001). Thus, contrast-induced renal dysfunction occurs infrequently if the amount of contrast material is limited in accordance with the degree of azotemia. Diabetic patients have a high incidence of contrast nephropathy, particularly when they receive an excessive amount of contrast. In patients with diabetes and renal impairment, it may be preferable to perform angiography as a staged procedure or to utilize alternative (non-contrast) techniques to obtain the desired information rather than to exceed the prescribed contrast limit.

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Differences in CT perfusion maps generated by different commercial software: quantitative analysis by using identical source data of acute stroke patients.

Kohsuke Kudo, Makoto Sasaki, Kei Yamada … (2010)

To examine the variability in the qualitative and quantitative results of computed tomographic (CT) perfusion imaging generated from identical source data of stroke patients by using commercially available software programs provided by various CT manufacturers. Institutional review board approval and informed consent were obtained. CT perfusion imaging data of 10 stroke patients were postprocessed by using five commercial software packages, each of which had a different algorithm: singular-value decomposition (SVD), maximum slope (MS), inverse filter (IF), box modulation transfer function (bMTF), and by using custom-made original software with standard (sSVD) and block-circulant (bSVD) SVD methods. Areas showing abnormalities in cerebral blood flow (CBF), mean transit time (MTT), and cerebral blood volume (CBV) were compared with each other and with the final infarct areas. Differences among the ratios of quantitative values in the final infarct areas and those in the unaffected side were also examined. The areas with CBF or MTT abnormalities and the ratios of these values significantly varied among software, while those of CBV were stable. The areas with CBF or MTT abnormalities analyzed by using SVD or bMTF corresponded to those obtained with delay-sensitive sSVD, but overestimated the final infarct area. The values obtained from software by using MS or IF corresponded well with those obtained from the delay-insensitive bSVD and the final infarct area. Given the similarities between CBF and MTT, all software were separated in two groups (ie, sSVD and bSVD). The ratios of CBF or MTTs correlated well within both groups, but not across them. CT perfusion imaging maps were significantly different among commercial software even when using identical source data, presumably because of differences in tracer-delay sensitivity.

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Projection space denoising with bilateral filtering and CT noise modeling for dose reduction in CT.

Armando Manduca, G. Fletcher, Natalia Khaylova … (2009)

To investigate a novel locally adaptive projection space denoising algorithm for low-dose CT data. The denoising algorithm is based on bilateral filtering, which smooths values using a weighted average in a local neighborhood, with weights determined according to both spatial proximity and intensity similarity between the center pixel and the neighboring pixels. This filtering is locally adaptive and can preserve important edge information in the sinogram, thus maintaining high spatial resolution. A CT noise model that takes into account the bowtie filter and patient-specific automatic exposure control effects is also incorporated into the denoising process. The authors evaluated the noise-resolution properties of bilateral filtering incorporating such a CT noise model in phantom studies and preliminary patient studies with contrast-enhanced abdominal CT exams. On a thin wire phantom, the noise-resolution properties were significantly improved with the denoising algorithm compared to commercial reconstruction kernels. The noise-resolution properties on low-dose (40 mA s) data after denoising approximated those of conventional reconstructions at twice the dose level. A separate contrast plate phantom showed improved depiction of low-contrast plates with the denoising algorithm over conventional reconstructions when noise levels were matched. Similar improvement in noise-resolution properties was found on CT colonography data and on five abdominal low-energy (80 kV) CT exams. In each abdominal case, a board-certified subspecialized radiologist rated the denoised 80 kV images markedly superior in image quality compared to the commercially available reconstructions, and denoising improved the image quality to the point where the 80 kV images alone were considered to be of diagnostic quality. The results demonstrate that bilateral filtering incorporating a CT noise model can achieve a significantly better noise-resolution trade-off than a series of commercial reconstruction kernels. This improvement in noise-resolution properties can be used for improving image quality in CT and can be translated into substantial dose reduction.

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Author and article information

Journal

Journal ID (nlm-ta): J Int Med Res

Journal ID (iso-abbrev): J. Int. Med. Res

Journal ID (publisher-id): IMR

Journal ID (hwp): spimr

Title: The Journal of International Medical Research

Publisher: SAGE Publications (Sage UK: London, England )

ISSN (Print): 0300-0605

ISSN (Electronic): 1473-2300

Publication date (Electronic): 31 July 2017

Publication date (Print): January 2018

Volume: 46

Issue: 1

Pages: 464-474

Affiliations

[1 ]Division of Radiological Technology, Institute of Biomedical Research and Innovation, Kobe, Japan

[2 ]Division of Neuro-endovascular Therapy, Institute of Biomedical Research and Innovation, Kobe, Japan

[3 ]Division of Neurosurgery, Kobe City Medical Center General Hospital, Kobe, Japan

[4 ]AT Innovation Department, Advanced Therapies Business Area, Siemens Healthcare K.K., Tokyo, Japan

[5 ]Division of Integrated Oncology, Institute of Biomedical Research and Innovation, Kobe, Japan

Author notes

[*]Takumi Kuriyama, Division of Radiological Technology, Institute of Biomedical Research and Innovation, 2-2 Minatojima-Minamimachi, Chuo-ku, Kobe 650-0047, Japan. Email: t.kuriyama@ 123456nagoya-u.jp

Article

Publisher ID: 10.1177_0300060517715165

DOI: 10.1177/0300060517715165

PMC ID: 6011294

PubMed ID: 28760084

SO-VID: 5729e8c9-3bee-42e8-ac92-ea4a0c90589c

License:

This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 3.0 License ( http://www.creativecommons.org/licenses/by-nc/3.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages ( https://us.sagepub.com/en-us/nam/open-access-at-sage).

History

Date received : 21 October 2016

Date accepted : 23 May 2017

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Optimal dilution of contrast medium for quantitating parenchymal blood volume using a flat-panel detector

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Abstract

Objective

Methods

Results

Conclusion

Related collections

International Journal of Medicine and Medical Research

Most cited references 18

Dosing of contrast material to prevent contrast nephropathy in patients with renal disease.

Differences in CT perfusion maps generated by different commercial software: quantitative analysis by using identical source data of acute stroke patients.

Projection space denoising with bilateral filtering and CT noise modeling for dose reduction in CT.

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