Page 26

1697_AX_Kundenmagazin_CC.indd

Intra-Arterial CBV Imaging for Whole Brain Supported by Intra-Arterial syngo DynaPBV Neuro Courtesy of Ruxiang Xu, MD, and Qiang Zhang, MD Affiliated Bayi Brain Hospital, Military General Hospital of Beijing PLA, Beijing, China Image Analysis Cerebral blood volume (CBV), which is an important perfusion parameter indicating brain hemodynamics in the capillary level and viability of the brain parenchyma, was obtained from both techniques and compared. From Fig. 2 and Fig. 3, both CTPI and syngo DynaPBV Neuro images demonstrated a similar decrease of CBV value at the right basal ganglia, left temporal lobe and bilateral frontal lobe. A minor difference was only observed at the bilateral frontal lobe, where a low perfusion region in the syngo DynaPBV Neuro images was shown to be smaller than in the CTPI images. In addition, it can be seen that a major encephalomalacia lesion, starting from the right basal ganglia and extending to the right temporal lobe in the CT image (Fig. 1B) was even more precisely captured in the syngo DynaPBV Neuro image (Fig. 3B) in terms of its shape and size. Patient History A 40-year-old male patient with a ten year history of hypertension and hyperlipemia experienced hypertensive intracerebral hemorrhage at the right basal ganglia two years ago. He was treated using brain hematoma puncture drainage and medication. After the treatment he showed remaining symptoms of left limb weakness. Diagnosis The patient’s muscle strength (level 0-5, with 0 complete paralysis and 5 normal) was tested to be level four for the left upper limb, level five for left lower limb and right limbs. The muscle tension was increased for left limb tendon, together with hyperreflexia and positive pathological reflex detected for the left limb. Computed tomography (CT) examination showed two encephalomalacia lesions at right basal ganglia and right temporal lobe, respectively (Fig. 1). Conventional intravenous CT perfusion imaging (CTPI) and an intra-arterial syngo DynaPBV Neuro examination were performed. In order to generate syngo DynaPBV Neuro images, visualization of a 3D mask was acquired first. Then a pigtail catheter was placed at the ascending aorta and 24 cc of 75% diluted contrast agent (CA) (Iohexol 350, Beijing BEILU Pharmaceutical Co., Ltd.) was injected over 24 sec. at an injection rate of 3 cc/sec.. To ensure that the brain tissue was sufficiently perfused, a syngo DynaPBV Neuro run was performed by an Artis zeego system with 16 sec. delay. Comments syngo DynaPBV Neuro offered a way to acquire brain functional information immediately in the catheter lab, which indicated disorders of brain perfusion. From the results shown in this case report, in general, CBV value obtained with this technique matched well with the results from conventional CTPI, proving the capability of syngo DynaPBV Neuro for displaying normal brain tissue and detecting lesions with good accuracy. In particular, this technique demonstrated higher sensitivity than CTPI for detecting a large encephalomalacia lesion, which corresponded better to the findings in CT images. Moreover, compared with intravenous injection, the intra-arterial CA injection protocol adopted in this study required only 15% of CA. This helped to minimize the CA induced side effects. Contact qi_sun@siemens.com Angiography syngo DynaPBV Neuro Qiang Zhang, MD (left) and Ruxiang Xu, MD (right). 26  AXIOM Innovations | December 2013 | www.siemens.com/angiography


1697_AX_Kundenmagazin_CC.indd
To see the actual publication please follow the link above