CTA HEAD Perfusion AqONE without and with IV Contrast

Transcription

1 CTA HEAD Perfusion AqONE without and with IV Contrast Patient Position Adult Contrast Adult Injection Rate Supine IOML perpendicular to table top. IV: 100 ml with helical head CTA 50 ml without helical head CTA Saline: 80 ml with helical head CTA 40 ml without helical head CTA Contrast: 5 ml/sec MANDATORY Saline: 3 ml/sec Minimum 20g PIV. Right antecubital preferred. See guidelines for other IV access lines. Pediatric Contrast Up to 20 lbs lbs lbs Contrast 10 ml Saline 10 ml Rate 1ml/sec Hand Inj Min 24g PIV 20 ml 20 ml 2ml/sec Power 22g PIV 30 ml 30 ml 3ml/sec Power 20g PIV C Helical Head CTA is not needed if perfusion acquisition shows no motion. Pre Diamox Imaging A Helical Head without Contrast Large kv 120 ALG/RECON Head Brain HCT Acquisition thickness 0.5 x 64 Rotation time 0.5 ma 350 Recon 5.0 mm Recon 5.0 mm B Volume Mode 16 cm coverage 4D Head CTA Use for Brain Perfusion Maps And Stack CTA Contrast IV: 50 ml Saline: 40 ml Injection Rate Contrast: 5 ml/sec MANDATORY Saline: 3 ml/sec No scan delay. Simultaneous inj/scan Small kv 80 ma see chart below ALG/RECON Head 4D CBP Acquisition thickness mm volume USE FOR ALL Recon slice thickness 0. Recon slice spacing 0.

2 Note: Helical Head CTA is not needed if perfusion acquisition shows no motion. Proceed to E- Delay Helical Head. C Helical Head CTA Contrast IV: 50 ml Saline: 40 ml Injection Rate Contrast: 5 ml/sec Saline: 3 ml/sec Large kv 120 ALG/RECON CTA Brain Acquisition thickness 0.5 x 64 Rotation time 0.5 ma 400 Recon slice thickness 0. Recon slice spacing 0.3 mm BT Bolus track at level of hyoid Manual start on blush of contrast in carotid artery E Helical Head with Contrast Delay 3 minutes Large kv 120 ALG/RECON Head Brain HCT Acquisition thickness 0.5 x 64 Rotation time 0.5 ma 350 Recon slice thickness 5.0 mm Recon slice spacing 5.0 mm Head Reconstruction- Approximate

3 ACQUISITION Post Diamox Imaging A Volume Mode 16 cm coverage 4D Head CTA Use for Brain Perfusion Maps And Stack CTA Contrast IV: 50 ml Saline: 40 ml Injection Rate Contrast: 5 ml/sec MANDATORY Saline: 3 ml/sec No scan delay. Simultaneous inj/scan Small kv 80 ma see chart below ALG/RECON Head 4D CBP Acquisition thickness mm volume USE FOR ALL Recon slice thickness 0. Recon slice spacing 0.

4 REFORMATION-MIP --Generated from C -Axial Helical CTA if scanned. Head CTA MIP C Skull base to vertex Axial C Cover brain Coronal C Cover brain Sagittal

5 STACK, SUBTRACTED STACK, MIP GENERATION 1. Brain Stack Volume Generation Transfer to PACS and PACS_TS Open the Brain Time Stack Tool in Autoview S, Tools, Tab 2. From the perfusion series, select the peak arterial volume and the volume just prior. Use the Time-Intensity Graph on the workstation to determine the volume with peak arterial filling. (Use just two volume sets for stack generation.) These volumes can have NO motion. Start the Stack tool. o A new Stacked Volume will be saved to the patient File. 2. Subtraction Volume Generation Programmed to auto transfer to PACS and PACS_TS Open the Brain Subtraction Tool in Autoview S, Tools, Tab 2. Select the Stacked Volume as the Contrast Volume. Select the first volume from the Perfusion series as the non-contrast volume (mask for subtraction). If there is motion on the first volume, select the next available volume with NO motion and NO contrast. Click Start. The New Stacked Subtracted Volume will be saved to the patient file. 3. Stack and Subtracted Stack MIP Generation Transfer to PACS and PACS_TS REFORMATION-MIPs --Generated from Stack and Subtracted Stack Head Skull base to vertex Axial Cover brain Coronal Cover brain Sagittal

6 Workstation Perfusion Map Generation In the directory page open the patient series list - Select the perfusion folder. Left click on Load Volumes. From the Gallery page Select 4D Perfusion. The artery and vein selection are automatic. Check that these are correct! Modify if necessary. o Artery Should be earliest filling artery. o Vein Superior Sagital Sinus or Transverse Sinus are good. o The curves should be smooth and the artery and veins well separated. Snapshot the graph. Bad Good Change Screen to 6 Up collage format. Change left upper axial image to MIP. MIP thickness should be 5mm. Optimize WW / WL for proper visualization of vessels. Correct WW/WL will visually differentiate vessel from bone structures. Optimize Map WW / WL. o The color scale should be distributed evenly for each map. o Each map should contain some red and some blue. See example below. Right Click to open the MAP Generation Menu Select Batch MPR Collage o All 5 Maps and the CT image will be saved as a volume collage. In the report page, export saved images and collage.

7 Console Perfusion Map Generation Click Clinical Tab Click 4D Perfusion Load 4D volume sets The Set Tab will be highlighted Set Artery Indicator Click artery icon- set artery- Basilar artery if possible Set SSS Indicator Click SSS icon- set SSS Graph should demonstrate sharp peak and smooth valley Click Analyze Message will appear: Now Generating Functional Maps -this should take about 6 minutes Click Settings Check that settings are proper. See settings on next page. Click OK Wait for Auto Export to become available. Click Auto Export Axial MIP Generation for Collage Select volume set that represents early maximum arterial flow and minimal venous return. Axial MIPS Perfusion: 5.0 x 5.0 Important: Start location for axial MIPS: -80 and end: +80 for a total of 32 images. Do not change the name on these. The collage builder only recognizes the set label. These are automatically combined with the perfusion images in the PACS_TS for the anatomical reference collage.

8 Settings Auto SSS IMPORTANT: Make sure that this is not checked. Analysis Flow SVD+ Analysis Matrix 256 O 128 Vessel Elimination On O Off Volume Number for mask (1-8) Color Scale Rainbow CBP 1 Auto Color Scale CBF CBV MTT TTP DLY Color Scale CBF [ml/100cc/min] CBV [ml/100cc] MTT [s] TTP[s] DLY[s] Upper Lower Default Image TTP O DLY O CT Image Auto Export plane maps Axial CBF TTP 5.0 Sagital CBV DLY Coronal MTT Auto Transfer έ Anet. DVD Anet. VCD PACS.PACS TS_PACS.TS_PACS