2023 ARRS ANNUAL MEETING - ABSTRACTS

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E2895. Are We Good Enough to Perform CT Perfusion (CTP)? Technical Perspective and Roadmap for Troubleshooting
Authors
  1. Salama Chaker; Mercy Catholic Medical Center
  2. Ahmed Moawad; Mercy Catholic Medical Center
  3. Mahmoud Shalaby; Mercy Catholic Medical Center
  4. Basem Jaber; Mercy Catholic Medical Center
  5. Madiha Aslam; Mercy Catholic Medical Center
  6. Sergiy Kushchayev; Moffitt Cancer Center
  7. Oleg Teytelboym; Mercy Catholic Medical Center
Background
Introduction to CT perfusion, diagnostic criteria for stroke, image processing and workflow, acquisition pitfalls, and processing pitfalls.

Educational Goals / Teaching Points
Illustrate the acquisition protocols for CTP in stroke patients, introduce the perfusion parameters and thresholds for identifying core infarction and penumbra, highlight different image processing algorithms, demonstrate workflow for post processing software, and case based review of technical pitfalls of CT perfusion processing and acquisition.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
Introduction about acquisition of CTP and its parameters, diagnostic criteria for stroke/penumbra and threshold for each parameter, different types of image processing: Maximum slope technique and Deconvolution, general workflow for automated post-processing software, and technical pitfalls during acquisition. Patient motion (effect of patient interscan motion on image registration, streak artifact as a result of intrascan motion, and motion correction algorithms). Head position (perfusion asymmetry due to head tilt). Types of technical pitfalls in CTP processing (different CT perfusion thresholds for infarction, image alignment and registration pitfalls, and skull stripping and brain segmentation algorithm. Arterial inflow (AIF) selection pitfalls (arteries to use an input Criteria of correctly selected AIF, troubleshooting AIF selection). Region of interest (ROI) selection pitfalls (optimum position of the venous ROI, troubleshooting ROI selection). Time attenuation curves (TAC) pitfalls (normal characteristics of the TAC, bolus arrival time and first moment time, and curve truncation).

Conclusion
This exhibit illustrated the acquisition protocols for CTP in stroke patients, introduced the perfusion parameters and thresholds for identifying core infarction and penumbra, highlighted different image processing algorithms, demonstrated workflow for post processing software, and provided a case-based review of technical pitfalls of CT perfusion processing and acquisition.