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Neuroradiology (2012) 54:467474 DOI 10.1007/s00234-011-0905-8
DIAGNOSTIC NEURORADIOLOGY
CT and MR perfusion can discriminate severe cerebral hypoperfusion from perfusion absence: evaluationof different commercial software packagesby using digital phantoms
Ikuko Uwano & Kohsuke Kudo & Makoto Sasaki &
Soren Christensen & Leif stergaard &
Kuniaki Ogasawara & Akira Ogawa
Received: 31 March 2011 /Accepted: 23 June 2011 /Published online: 8 July 2011 # Springer-Verlag 2011
AbstractIntroduction Computed tomography perfusion (CTP) and magnetic resonance perfusion (MRP) are expected to be usable for ancillary tests of brain death by detection of complete absence of cerebral perfusion; however, the detection limit of hypoperfusion has not been determined. Hence, we examined whether commercial software can visualize very low cerebral blood flow (CBF) and cerebral blood volume (CBV) by creating and using digital phantoms.
Methods Digital phantoms simulating 04% of normal CBF (60 mL/100 g/min) and CBV (4 mL/100 g/min) were analyzed by ten software packages of CT and MRI manufacturers. Region-of-interest measurements were per-
formed to determine whether there was a significant difference between areas of 0% and areas of 14% of normal flow.
Results The CTP software detected hypoperfusion down to 23% in CBF and 2% in CBV, while the MRP software detected that of 13% in CBF and 14% in CBV, although the lower limits varied among software packages. Conclusion CTP and MRP can detect the difference between profound hypoperfusion of <5% from that of 0% in digital phantoms, suggesting their potential efficacy for assessing brain death.
Keywords Cerebral blood flow. Cerebral blood volume . CT perfusion . MR perfusion . Brain death
Introduction
Diagnostic criteria for brain death, death of the entire brain including the brainstem, include deep coma, loss of all brainstem reflexes, continuing apnea, and other supportive findings using ancillary tests such as imaging techniques for indicating the absence of cerebral blood flow (CBF) [1]. For this purpose, several imaging methods such as conventional cerebral angiography, single-photon emission computed tomography (SPECT), xenon computed tomography (CT), CT angiography (CTA), and magnetic resonance (MR) angiography (MRA) have been applied [27]. Among these, CTA and MRA are less invasive and more readily available for patients with serious conditions of suspected brain death in many hospitals, but these techniques may miss CBF levels that are close to zero because they...