From *Siemens Medical Solutions Inc, Malvern, PA; †Siemens Healthcare GmbH, Forchheim, Germany; ‡Stanford University School of Medicine; §Stanford Healthcare, Stanford, CA.
Invest Radiol. 2017 Aug;52(8):456-461. doi: 10.1097/RLI.0000000000000368.
Objective intraprocedural measurement of hepatic blood flow could provide a quantitative treatment end point for locoregional liver procedures. This study aims to validate the accuracy and reproducibility of cone-beam computed tomography perfusion (CBCTp) measurements of arterial liver perfusion (ALP) against clinically available computed tomography perfusion (CTp) measurements in a swine embolization model.
Triplicate CBCTp measurements using a selective arterial contrast injection were performed before and after complete embolization of the left lobe of the liver in 5 swine. Two CBCTp protocols were evaluated that differed in sweep duration (3.3 vs 4.5 seconds) and the number of acquired projection images (166 vs 248). The mean ALP was measured within identical volumes of interest selected in the embolized and nonembolized regions of the perfusion map generated from each scan. Postembolization CBCTp values were also compared with CTp measurements.
The 2 CBCTp protocols demonstrated high concordance correlation (0.90, P < 0.001). Both CBCTp protocols showed higher reproducibility than CTp in the nontarget lobe, with an intraclass correlation of 0.90 or greater for CBCTp and 0.83 for CTp (P < 0.001 for all correlations). The ALP in the embolized lobe was nearly zero and hence excluded for reproducibility. High concordance correlation was observed between the CTp and each CBCTp protocol, with the shorter CBCTp protocol reaching a concordance correlation of 0.75 and the longer achieving 0.87 (P < 0.001 for both correlations).
Dynamic blood flow measurement using an angiographic C-arm system is feasible and produces quantitative results comparable to CTp.
术中实时测量肝血流可以为局部肝脏手术提供定量的治疗终点。本研究旨在验证锥形束 CT 灌注（CBCTp）测量动脉肝灌注（ALP）的准确性和可重复性，与猪栓塞模型中临床可用的 CT 灌注（CTp）测量进行比较。
在 5 头猪的左肝叶完全栓塞前和栓塞后，使用选择性动脉造影剂进行了 3 次 CBCTp 测量。评估了两种 CBCTp 方案，其差异在于扫描持续时间（3.3 秒与 4.5 秒）和采集投影图像的数量（166 与 248）。在从每个扫描生成的灌注图的栓塞和非栓塞区域内选择相同的感兴趣区域内测量平均 ALP。还比较了栓塞后 CBCTp 值与 CTp 测量值。
两种 CBCTp 方案显示出高度的一致性相关系数（0.90，P < 0.001）。两种 CBCTp 方案在非目标叶中均表现出比 CTp 更高的可重复性，CBCTp 的组内相关系数为 0.90 或更高，而 CTp 的为 0.83（所有相关性的 P < 0.001）。栓塞叶中的 ALP 几乎为零，因此排除用于可重复性分析。CTp 与每个 CBCTp 方案之间观察到高度的一致性相关系数，较短的 CBCTp 方案达到 0.75 的一致性相关系数，较长的方案达到 0.87（两种相关性的 P < 0.001）。
使用血管造影 C 臂系统进行动态血流测量是可行的，并可产生与 CTp 相当的定量结果。
