Optimal duration of acquisition for dynamic perfusion CT assessment of blood-brain barrier permeability using the Patlak model

Abstract

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.

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.