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Session: Poster Session 1 (Even numbers)
Session starts: Thursday 26 January, 16:00
Presentation starts: 16:00

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Liselot Goris (Multi-Modality Medical Imaging group, University of Twente)
Marije Kamphuis ()
Abdallah Zaid Al-Kaylani ()
Henny Kuipers ()
Johan van Hespen ()
Richte Schuurman ()
Reinoud Bokkers ()
Srirang Manohar ()

Abstract:
Purpose Time from symptom onset to treatment is one of the most important modifiable factors affecting functional outcome in patients with acute ischemic stroke.1 Computed tomography perfusion (CTP) imaging is an integral part of the standard diagnostic workup. Using cone-beam computed tomography (CBCT) perfusion imaging in a direct-to-angio approach might significantly reduce workflow times and improve outcome.2 However, the diagnostic accuracy of CBCT perfusion must first be comparable to CTP.2 There is a scarcity of real-patient data regarding the diagnostic accuracy of CBCT perfusion in acute ischemic stroke.2 This study aims to develop a cerebral perfusion phantom setup to facilitate ground-truth evaluation of CTP, and to compare between a validated CTP standard and CBCT. Methods The phantom is designed for 3-D printing and comprises a vessel structure that branches into two microcirculation compartments. The compartments can be filled with a material of choice which mimics the flow dynamics of the contrast. The flow can be measured with flow sensors and controlled with three-way valves to simulate a perfusion defect. As an intermediate step, the reproducibility is evaluated by acquiring 2-D perfusion images with a C-arm system and analysing the differences in the time-intensity curve (TIC) parameters. Proof-of-concept tests are performed with CTP and its associated clinical software to test whether the phantom can achieve realistic HU densities, arterial input function (AIF) and microcirculation similar to those found in normal human brain tissue. Results The maximum standard deviation of TIC-parameters between repeated measurements is 4.4%. In CTP measurements the AIF's TTP range is 5-10 seconds. Baseline-to-peak intensity is 250 HU. The TIC of the microcirculation has a TTP of 20 seconds and baseline-to-peak intensity of 60 HU. CBF ranges from 155-440 mL/100gr tissue/min. The computed and measured flow were directly related (ρ = -0.98, p=0.01). Discussion and Conclusions Future work is needed to tune the setup to obtain CBF values more similar to human cerebral perfusion, 10, 20 and 60 mL/100gr tissue/min in ischemic core, penumbra and healthy tissue respectively. Thereafter, a validated CTP standard will be defined, and the setup will be used to evaluate perfusion imaging in CBCT.