Subtraction Perfusion CT: A Technical Note


It is challenging to attempt to obtain CT perfusion (CTP) images of the hyperdense tissues, which could conceal the density of contrast material during perfusion study. We report a new technique of subtraction CTP (SCTP) to compensate the shortcomings. SCTP post-processed by perfusion software for the data of post-perfusion images subtracting pre-perfusion corresponding images slice by slice in CTP source images is technically feasible without any adverse effects on patients. It provides a new functional imaging with quantitatively hemodynamic indexes of tissue microcirculation and reflects accurately the change of blood flow in tissues and organs.

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Yang, X. , Li, W. and Zee, C. (2013) Subtraction Perfusion CT: A Technical Note. Advances in Computed Tomography, 2, 91-95. doi: 10.4236/act.2013.23016.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] K. A. Miles, M. Hayball and A. K. Dixon, “Colour Perfusion Imaging: A New Application of Computed Tomography,” Lancet, Vol. 337, No. 8742, 1991, pp. 643-645. doi:10.1016/0140-6736(91)92455-B
[2] E. G. Hoeffner, I. Case, R. Jain, S. K. Gujar, G. V. Shah, J. P. Deveikis, R. C. Carlos, B. G. Thompson, M. R. Harrigan and S. K. Mukherji, “Cerebral Perfusion CT: Technology and Clinical Applications,” Radiology, Vol. 231, No. 3, 2004, pp. 632-644. doi:10.1148/radiol.2313021488
[3] V. A. Nagar, A. M. McKinney, A. T. Karagulle and C. L. Truwit, “Reperfusion Phenomenon Masking Acute and Subacute Infarcts at Dynamic Perfusion CT: Confirmation by Fusion of CT and Diffusion-Weighted MR Images,” American Journal of Roentgenology, Vol. 193, No. 6, 2009, pp. 1629-1638. doi:10.2214/AJR.09.2664
[4] M. Koenig, M. Kraus, C. Theek, E. Klotz, W. Gehlen and L. Heuser, “Quantitative Assessment of the Ischemic Brain by Means of Perfusion-Related Parameters Derived from Perfusion CT,” Stroke, Vol. 32, No. 2, 2001, pp. 431-437. doi:10.1161/01.STR.32.2.431
[5] S. Diekmann, E. Siebert, R. Juran, M. Roll, W. Deeg, H. C. Bauknecht, F. Diekmann, R. Klingebiel and G. Bohner, “Dose Exposure of Patients Undergoing Comprehensive Stroke Imaging by Multidetector-Row CT: Comparison of 320-Detector Row and 64-Detector Row CT Scanners,” American Journal of Neuroradiology, Vol. 31, No. 6, 2010, pp. 1003-1009. doi:10.3174/ajnr.A1971
[6] A. R. Kambadakone and D. V. Sahani, “Body Perfusion CT: Technology, Clinical Applications, and Advances,” Radiologic Clinics of North America, Vol. 47, No. 1, 2009, pp. 161-178. doi:10.1016/j.rcl.2008.11.003
[7] M. Kazuhiro, K. Kazuhiro, N. Masato, H. Toyama, H. Anno, M. Hayakawa, D. S. Ruiz and K. J. Murphy, “Whole-Brain Perfusion CT Performed with a Prototype 256-Detector Row CT System: Initial Experience,” Radiology, Vol. 250, No. 1, 2009, pp. 202-211. doi:10.1148/radiol.2501071809
[8] R. Gupta, A. C. Cheung, S. H. Bartling, J. Lisauskas, M. Grasruck, C. Leidecker, B. Schmidt, T. Flohr and T. J. Brady, “Flat-Panel Volume CT: Fundamental Principles, Technology, and Applications,” Radiographics, Vol. 28, No. 7, 2008, pp. 2009-2022. doi:10.1148/rg.287085004
[9] S. Kandel, C. Kloeters, H. Meyer, P. Hein, A. Hilbig and P. Rogalla, “Whole-Organ Perfusion of the Pancreas Using Dynamic Volume CT in Patients with Primary Pancreas Carcinoma: Acquisition Technology, Post-Processing and Initial Results,” European Journal of Radiology, Vol. 19, No. 11, 2009, pp. 2641-2646. doi:10.1007/s00330-009-1453-z
[10] M. Page, D. Nandurkar, M. P. Crossett, S. L. Stuckey, K. P. Lau, N. Kenning and J. M. Troupis, “Comparison of 4 cm Z-Axis and 16 cm Z-Axis Multidetector CT Perfusion,” European Journal of Radiology, Vol. 20, No. 6, 2010, pp. 1508-1514. doi:10.1007/s00330-009-1688-8
[11] C. S. Reiner, R. Goetti, D. Eberli, E. Klotz, A. Boss, T. Pfammatter, T. Frauenfelder, H. Moch, T. Sulser, H. Alkadhi, “CT Perfusion of Renal Cell Carcinoma: Impact of Volume Coverage on Quantitative Analysis,” Investigative Radiology, Vol. 47, No. 1, 2012, pp. 33-40. doi:10.1097/RLI.0b013e31822598c3
[12] P. Zhang, Y. Liang, H. Kim and H. Yokota, “Evaluation of a Pig Femoral Head Osteonecrosis Model,” Journal of Orthopaedic Surgery and Research, Vol. 5, 2010, p. 15. doi:10.1186/1749-799X-5-15
[13] C. Herweh, E. Jüttler, P. D. Schellinger, E. Klotz and P. Schramm, “Perfusion CT in Hyperacute Cerebral Hemorrhage within 3 Hours after Symptom Onset: Is There an Early Perihemorrhagic Penumbra?” Journal of Neuroimaging, Vol. 20, No. 4, 2010, pp. 350-353. doi:10.1111/j.1552-6569.2009.00408.x
[14] K. H. Lee, K. B. Sung, D. Y. Lee, S. J. Park, K. W. Kim and J. S. Yu, “Transcatheter Arterial Chemoembolization for Hepatocellular Carcinoma: Anatomic and Hemodynamic Considerations in the Hepatic Artery and Portal Vein,” Radiographics, Vol. 22, No. 5, 2002, pp. 1077-1091
[15] S. H. Choi, J. W. Chung, H. C. Kim, J. H. Baek, C. M. Park, S. Jun, M. U. Kim, E. S. Lee, H. R. Cho, H. J. Jae, W. Lee and J. H. Park, “The Role of Perfusion CT as a Follow-Up Modality after Transcatheter Arterial Chemoembolization: An Experimental Study in a Rabbit Model,” Investigative Radiology, Vol.45, No.7, 2010, pp. 427-436. doi:10.1097/RLI.0b013e3181e07516
[16] Z. Kan, S. Kobayashi, S. Phongkitkarun and C. Charnsangavej, “Functional CT Quantification of Tumor Perfusion after Transhepatic Arterial Embolization in a Rat Model,” Radiology, Vol. 237, No. 1, 2005, pp. 144-150. doi:10.1148/radiol.2371040526
[17] D. Ippolito, P. A. Bonaffini, L. Ratti, L. Antolini, R. Corso, F. Fazio and S. Sironi, “Hepatocellular Carcinoma Treated with Transarterial Chemoembolization: Dynamic Perfusion-CT in the Assessment of Residual Tumor,” World Journal of Gastroenterology, Vol. 16, No. 47, 2010, pp. 5993-6000
[18] E. Squillaci, G. Manenti, C. Cicciò, F. Nucera, P. Bove, G. Vespasiani, L. Russolillo and G. Simonetti, “Perfusion-CT Monitoring of Cryo-Ablated Renal Cells Tumors,” Journal of Experimental & Clinical Cancer Research, Vol. 28, 2009, p.138. doi:10.1186/1756-9966-28-138
[19] C. S. Ng, A. G. Chandler, W. Wei, E. F. Anderson, D. H. Herron, C. Charnsangavej and R. Kurzrock, “Reproducibility of Perfusion Parameters Obtained from Perfusion CT in Lung Tumors,” American Journal of Roentgenology, Vol. 197, No. 1, 2011, pp. 113-121. doi:10.2214/AJR.10.5404

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