C-Arm Flat Detector CT Parenchymal Blood Volume Thresholds for Identification of Infarcted Parenchyma in the Neurointerventional Suite.

BACKGROUND AND PURPOSE: C-arm flat detector CT parenchymal blood volume imaging allows functional assessment of the brain parenchyma in the neurointerventional suite. This study aimed to determine the optimal C-arm flat detector CT parenchymal blood volume thresholds for demarcating irreversibly infarcted brain parenchyma by using areas of restricted diffusion on MR imaging as a surrogate marker for infarction. MATERIALS AND METHODS: Twenty-six patients with delayed cerebral ischemia following aneurysmal SAH underwent research C-arm CT parenchymal blood volume scans by using a biplane angiography system and contemporaneous MR imaging. Infarct and peri-infarct tissue VOIs and their homologous VOIs in the contralateral uninvolved hemisphere were delineated on the basis of the review of DWI, PWI, and ADC images. Voxel-based receiver operating characteristic curve analysis was performed to estimate the optimal absolute and normalized parenchymal blood volume values for demarcating the infarct voxels. RESULTS: For 12 patients with areas of restricted diffusion (infarct volume, 6.38 ± 7.09 mL; peri-infarct tissue volume, 22.89 ± 21.76 mL) based on the voxel-based receiver operating characteristic curve analysis, optimal absolute and normalized parenchymal blood volume thresholds for infarction were 2.49 mL/100 g (area under curve, 0.76; sensitivity, 0.69; specificity, 0.71) and 0.67 (area under curve, 0.77; sensitivity, 0.69; specificity, 0.72), respectively (P value < .01). For the moderate-to-severely ischemic peri-infarct zone, mean parenchymal blood volume values of the involved hemisphere VOIs were lower compared with the uninvolved hemisphere VOIs (P value < .01). However, for the mild-to-moderately ischemic peri-infarct zone, there was no statistically significant difference between the mean parenchymal blood volume values of the involved and uninvolved hemisphere VOIs (P value > .05). CONCLUSIONS: C-arm flat detector CT parenchymal blood volume maps in conjunction with optimal thresholds are sensitive and specific for the estimation of irreversibly infarcted parenchyma. Parenchymal blood volume maps allow reliable detection of moderate-to-severe ischemia; however, the potential for underestimation of mild-to-moderate ischemia exists.