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AJNR - American Journal of Neuroradiology

Published ahead of print on April 15, 2009
doi: 10.3174/ajnr.A1592

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American Journal of Neuroradiology 30:1366-1370, August 2009
© 2009 American Society of Neuroradiology

BRAIN

Optimal Duration of Acquisition for Dynamic Perfusion CT Assessment of Blood-Brain Barrier Permeability Using the Patlak Model

J. Hom^a, J.W. Dankbaar^a,c, T. Schneider^a,e, S.-C. Cheng^b, J. Bredno^a,d and M. Wintermark^a

^a Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, Calif
^b Department of Neuroradiology Section, and Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, Calif
^c Department of Radiology, University Medical Center, Utrecht, the Netherlands
^d Philips Research North America, Clinical Sites Research Program, Briarcliff Manor, NY
^e Philips Healthcare, CT Clinical Science Group, Cleveland, Ohio

Please address correspondence to Max Wintermark, MD, University of California, San Francisco, Department of Radiology, Neuroradiology Section, 505 Parnassus Ave, Box 0628, San Francisco, CA 94143-0628; e-mail: Max.Wintermark{at}radiology.ucsf.edu

BACKGROUND AND PURPOSE: A previous study demonstrated the need to use delayed acquisition rather than first-pass data for accurate blood-brain barrier permeability surface product (BBBP) calculation from perfusion CT (PCT) according to the Patlak model, but the optimal duration of the delayed acquisition has not been established. Our goal was to determine the optimal duration of the delayed PCT acquisition to obtain accurate BBBP measurements while minimizing potential motion artifacts and radiation dose.

MATERIALS AND METHODS: We retrospectively identified 23 consecutive patients with acute ischemic anterior circulation stroke who underwent a PCT study with delayed acquisition. The Patlak model was applied for the full delayed acquisition (90–240 seconds) and also for truncated analysis windows (90–210, 90–180, 90–150, 90–120 seconds). Linear regression of Patlak plots was performed separately for the full and truncated analysis windows, and the slope of these regression lines was used to indicate BBBP. The full and truncated analysis windows were compared in terms of the resulting BBBP values and the quality of the Patlak fitting.

RESULTS: BBBP values in the infarct and penumbra were similar for the full 90- to 240-second acquisition (95% confidence intervals for the infarct and penumbra: 1.62–2.47 and 1.75–2.41 mL x100 g^–1 x min^–1, respectively) and the 90- to 210-second analysis window (1.82–2.76 and 2.01–2.74 mL x 100 g^–1 x min^–1, respectively). BBBP values increased significantly with shorter acquisitions. The quality of the Patlak fit was excellent for the full 90- to 240-second and 90- to 210-second acquisitions, but it degraded with shorter acquisitions.

CONCLUSIONS: The duration for the delayed PCT acquisition should be at least 210 seconds, because acquisitions shorter than 210 seconds lead to significantly overestimated BBBP values.