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Research ArticleBRAIN
Open Access

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

J. Hom, J.W. Dankbaar, T. Schneider, S.-C. Cheng, J. Bredno and M. Wintermark
American Journal of Neuroradiology August 2009, 30 (7) 1366-1370; DOI: https://doi.org/10.3174/ajnr.A1592
J. Hom
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J.W. Dankbaar
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T. Schneider
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S.-C. Cheng
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J. Bredno
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M. Wintermark
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    Fig 1.

    Absolute and relative permeability maps for the gold standard 90- to 240-second acquisition and for the truncated acquisitions (90–210, 90–180, 90–150, and 90–120 seconds). Absolute and relative BBBP values are overlapping for the gold standard 90- to 240-second delayed acquisition and for the 90- to 210-second truncated analysis window. For shorter analysis windows (90–180 seconds and, especially, 90–150 and 90–120 seconds), absolute and relative BBBP values are overestimated. The map depicting PCT-determined infarct and penumbra at the same level is also presented for reference.

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    Table 1:

    Study patient characteristics

    CharacteristicsPatients with Stroke
    No. of patients23
    No. of men (%)8 (35%)
    Median age (years)74
        Interquartile range59.5–82.5
        Range26–92
    Median time from stroke to PCT (hours)2.25
        Interquartile range1.5–5
        Range1–11.75
    Stroke location
        ACA, MCA territories3
        MCA territory20
        ACA territory0
        PCA territory0
    • Note:—ACA indicates anterior cerebral artery; MCA, middle cerebral artery; PCA, posterior cerebral artery; PCT, perfusion CT.

    • View popup
    Table 2:

    Correlation of BBBP values from the truncated analysis windows with BBBP values from the gold standard 90- to 240-second delayed acquisition*

    90–120 Seconds90–150 Seconds90–180 Seconds90–210 Seconds
    Overall0.89 (0.81–0.97) P = .0120.93 (0.89–0.98) P = .0220.98 (0.96–0.99) P = .420.99 (0.99–1.00) P = 1.000
    Infarct0.85 (0.71–0.99) P = .0350.94 (0.89–0.98) P = .0280.98 (0.97–1.00) P = .690(0.99–1.00) P = 1.000
    Penumbra0.90 (0.80–1.00) P = .0580.93 (0.87–1.00) P = .0700.98 (0.96–0.99) P = .3500.99 (0.99–1.00) P = 1.000
    Nonischemic0.91 (0.84–0.99) P = .0480.94 (0.88–0.99) P = .0610.98 (0.96–1.00) P = .4000.99 (0.99–1.00) P = 1.000
    • Note:—BBBP indicates blood-brain barrier permeability surface product.

    • * For different regions of interest and different analysis windows, correlation coefficients and their 95% CIs are given. The P values provided are for a 1-sided test for H0: correlation ≥ .980.

    • View popup
    Table 3:

    Absolute permeability measurements for the gold standard 90- to 240-second delayed acquisition and for the truncated analysis windows*

    90–120 Seconds90–150 Seconds90–180 Seconds90–210 Seconds90–240 Seconds
    Nonischemic4.62 (4.09–5.22)3.28 (2.85–3.79)2.51 (2.14–2.94)2.05 (1.73–2.42)1.82 (1.53–2.17)
    Infarct4.92 (4.30–5.62)3.51 (2.97–4.16)2.72 (2.24–3.31)2.24 (1.82–2.76)2.00 (1.62–2.47)
    Penumbra5.45 (4.81–6.17)3.87 (3.36–4.46)2.91 (2.50–3.39)2.35 (2.01–2.74)2.05 (1.75–2.41)
    • * Mean absolute permeability (milliliters per 100 grams per minute) values and corresponding 95% CIs are shown for different regions of interest and different acquisition-time datasets.

    • View popup
    Table 4:

    Relative permeability measurements for the gold standard 90- to 240-second delayed acquisition and for the truncated analysis windows*

    90–120 Seconds90–150 Seconds90–180 Seconds90–210 Seconds90–240 Seconds
    Nonischemic12% (10%–15%)9% (7%–11%)7% (5%–8%)5% (4%–7%)5% (4%–6%)
    Infarct53% (45%–64%)38% (31%–47%)30% (23%–37%)24% (19%–31%)22% (17%–28%)
    Penumbra26% (22%–32%)19% (15%–23%)14% (11%–18%)11% (9%–14%)10% (8%–13%)
    • * Mean relative permeability values and corresponding 95% CIs are shown for different regions of interest and different acquisition-time datasets.

    • View popup
    Table 5:

    √MSE calculated for the fitting of the Patlak line for the gold standard 90- to 240-second delayed acquisition and the truncated delayed acquisitions

    90–120 Seconds90–150 Seconds90–180 Seconds90–210 Seconds90–240 Seconds
    Nonischemic4.84 (3.95–5.95)3.13 (2.65–3.71)2.16 (1.84–2.54)1.66 (1.41–1.95)1.35 (1.14–1.59)
    Infarct5.17 (4.10–6.52)3.38 (2.73–4.19)2.31 (1.87–2.84)1.75 (1.43–2.15)1.41 (1.15–1.73)
    Penumbra5.31 (4.31–6.55)3.42 (2.86–4.09)2.35 (1.99–2.78)1.79 (1.51–2.12)1.44 (1.21–1.72)
    • Note:—√MSE indicates root-mean-square error.

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American Journal of Neuroradiology: 30 (7)
American Journal of Neuroradiology
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J. Hom, J.W. Dankbaar, T. Schneider, S.-C. Cheng, J. Bredno, M. Wintermark
Optimal Duration of Acquisition for Dynamic Perfusion CT Assessment of Blood-Brain Barrier Permeability Using the Patlak Model
American Journal of Neuroradiology Aug 2009, 30 (7) 1366-1370; DOI: 10.3174/ajnr.A1592

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Optimal Duration of Acquisition for Dynamic Perfusion CT Assessment of Blood-Brain Barrier Permeability Using the Patlak Model
J. Hom, J.W. Dankbaar, T. Schneider, S.-C. Cheng, J. Bredno, M. Wintermark
American Journal of Neuroradiology Aug 2009, 30 (7) 1366-1370; DOI: 10.3174/ajnr.A1592
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