Intraprocedural parenchymal blood volume as a marker of reperfusion status in acute ischemic stroke intervention

Abstract

Parenchymal blood volume (PBV) mapping with flat panel detectors may provide real-time estimates of tissue perfusion during endovascular ischemic stroke procedures. We present two cases of acute middle cerebral artery (MCA) occlusion to demonstrate how PBV may: (1) be used in acute stroke; (2) influence intraprocedural decision-making; and (3) potentially serve as a predicator of clinical outcome. Both cases were successfully recanalized with endovascular embolectomy. Intraprocedural PBV maps were obtained immediately before and after recanalization. Pre-intervention reductions in PBV were seen throughout the MCA territory in both cases, with significant improvement in PBV in one case with good radiographic and clinical outcome and a lack of improvement in PBV in the second case with a large infarct volume. PBV deficit normalization may occur with recanalization of the parent artery and probably represents successful reperfusion. Baseline PBV maps should therefore be interpreted with caution and not interpreted to represent irreversible core infarct.

Feasibility of FDCT Early Brain Parenchymal Blood Volume Maps in Predicting Short-Term Prognosis in Patients With Aneurysmal Subarachnoid Hemorrhage

“…PBV map and CTP-CBV/MRP-CBV have good consistency in terms of both visual comparison of perfusion pseudo-color maps and the quantitative analysis of ROI ( 26 , 29 , 30 , 50 , 51 ). In addition to PBV's application in AIS evaluation ( 24 – 26 , 28 ) and initial practice in the prediction of DCI after aneurysmal SAH ( 23 , 30 ), our study broadens the clinical application of PBV in stroke management.…”

“…The reliability of PBV maps was demonstrated by the good correlation between PBV and conventional CT perfusion through both qualitative and quantitative comparative studies (29,33,41). By extending the imaging capabilities of the angio-suite, the PBV technique has been used in the assessment of ischemic cerebrovascular diseases and brain tumors in the brain during the procedure in the angio-suite for better patient management, and has gained significant value in clinical practice in recent years (24)(25)(26)(27)(28)42) but not much value in SAH yet. Our study demonstrated PBV's feasibility in assessing the perfusion status in aneurysmal SAH, as well as the convenience of one-stop imaging evaluation.…”

“…The C-arm flat-panel detector CT (FDCT) syngo DynaPBV Neuro is a 3D imaging application that provides the cerebral blood volume parameter intraoperatively for perfusion status assessment developed with the advancement of computer and imaging technology in recent years (23)(24)(25)(26)(27)(28). The application visualizes the contrast-enhanced blood volume distribution of the whole brain in 3D color-coded cross-sectional images based on a steady-state contrast injection.…”

“…Several authors reported that the cerebral blood volume calculated by PBV software compared favorably with that measured with CTP, and PBV's ability in cerebral perfusion evaluations is similar to CTP (26,29). PBV has been found useful in evaluating perfusion in patients with acute ischemic stroke (AIS) (24)(25)(26)28), yet its application in aneurysmal SAH is still in its infancy (23,30).…”