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P-040 AIS perfusion imaging in the angiographic suite: initial experiences and workflow assessment
  1. B Aagaard-Kienitz1,
  2. A Ahmed2,
  3. D Niemann2,
  4. M Ellertson1,
  5. G Chen3,
  6. S Schafer4,
  7. M Manhart4,
  8. C Strother1
  1. 1Radiology, University of Wisconsin Hospitals and Clinics, Madison, WI
  2. 2Neurosurgery, University of Wisconsin Hospitals and Clinics, Madison, WI
  3. 3Medical Physics, University of Wisconsin, Madison, WI
  4. 4Siemens Healthineers, Hoffman Estates, IL


Introduction The importance of time to revascularization is critical in determining the clinical outcome of patients treated for AIS. Studies of patients seen within 6 hours as well as within 6–16 hours after stroke onset have shown that perfusion imaging improves the clinical outcome following revascularization as compared to trials using other selection strategies. Our motivation for performing perfusion imaging in the angiographic suite was to provide an assessment of ischemic core and penumbra size while minimizing the time from picture to puncture. Data from the perfusion acquisition also allows reconstruction of a multi-phase CT that is useful in LVO detection and collateral scoring.

Methods and materials In an ongoing IRB approved study 11 patients with AIS were enrolled. Patient enrollment criteria were: NIH SS≥6, >18 years of age, and anterior circulation large vessel occlusion. Patients were triaged following hospital guidelines including perfusion imaging with multi-detector CT (MDCT). Following intervention decision, patients were transferred to the angiography suite. Prior to groin access, a C-Arm multi-rotation acquisition was performed. Contrast (60 cc) was injected through an anti-cubital vein. A total of ten rotations were performed over the course of one minute. C-Arm perfusion maps were derived and reconstructed using prototype software. These were compared qualitatively to MDCT perfusion maps. Time stamps from CT and C-Arm multi-rotation imaging were recorded. Time from perfusion image acquisition to time of the first arterial DSA acquisition was also recorded.

Findings Qualitative review showed that the perfusion maps derived from MDCT and C-Arm had the same diagnostic value for ten of eleven patients. Extreme patient motion during one C-Arm data acquisition lead to insufficient image quality. As recorded on the image time stamps the delay between MDCT acquisition and C-Arm multi-rotation imaging was 64±30 min. The time from perfusion acquisition to first arterial acquisition was 18±6 min.

Abstract P-040 Figure 1

Functional maps as derived from C-arm multi-rotation acquisition and from MDCT. Mismatch areas in maps from both modalities correlated well. Time between MDCT and C-arm images was 40 minutes resulting in an increased affected area

Conclusion First experience with C-Arm based perfusion acquisition in the angiographic suite confirmed feasibility of the One Stop Shop concept. In this small series eliminating MDCT imaging from triaging would have resulted in at least one hour time saving. The study is ongoing an enrollment is continuing.

Disclosures B. Aagaard-Kienitz: 1; C; NIH. A. Ahmed: None. D. Niemann: None. M. Ellertson: None. G. Chen: 1; C; NIH, Siemens Healthineers. S. Schafer: 5; C; Siemens Healthineers. M. Manhart: 5; C; Siemens Healthineers. C. Strother: 1; C; NIH, Siemens Healthineers.

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