Biased visualization of hypoperfused tissue by computed tomography due to short imaging duration: improved classification by image down-sampling and vascular models.

OBJECTIVES: Lesion detection in acute stroke by computed-tomography perfusion (CTP) can be affected by incomplete bolus coverage in veins and hypoperfused tissue, so-called bolus truncation (BT), and low contrast-to-noise ratio (CNR). We examined the BT-frequency and hypothesized that image down-sampling and a vascular model (VM) for perfusion calculation would improve normo- and hypoperfused tissue classification. METHODS: CTP datasets from 40 acute stroke patients were retrospectively analysed for BT. In 16 patients with hypoperfused tissue but no BT, repeated 2-by-2 image down-sampling and uniform filtering was performed, comparing CNR to perfusion-MRI levels and tissue classification to that of unprocessed data. By simulating reduced scan duration, the minimum scan-duration at which estimated lesion volumes came within 10% of their true volume was compared for VM and state-of-the-art algorithms. RESULTS: BT in veins and hypoperfused tissue was observed in 9/40 (22.5%) and 17/40 patients (42.5%), respectively. Down-sampling to 128 × 128 resolution yielded CNR comparable to MR data and improved tissue classification (p = 0.0069). VM reduced minimum scan duration, providing reliable maps of cerebral blood flow and mean transit time: 5 s (p = 0.03) and 7 s (p < 0.0001), respectively). CONCLUSIONS: BT is not uncommon in stroke CTP with 40-s scan duration. Applying image down-sampling and VM improve tissue classification. KEY POINTS: • Too-short imaging duration is common in clinical acute stroke CTP imaging. • The consequence is impaired identification of hypoperfused tissue in acute stroke patients. • The vascular model is less sensitive than current algorithms to imaging duration. • Noise reduction by image down-sampling improves identification of hypoperfused tissue by CTP.

Lipid content in the musculature of the lower leg: evaluation with high-resolution spectroscopic imaging.

A novel spectroscopic imaging method with high spectral and spatial resolution was developed for the specific goal of assessing muscle fat. Sensitivity to the methylene and methyl protons of fatty acids was improved by the use of a binomial 1 1 excitation pulse instead of the standard radiofrequency (RF) pulse. Acceptable measurement time is achieved by using a narrow spectral bandwidth (6 ppm). The spectral resolution is sufficient to resolve extramyocellular (EMCL) and intramyocellular (IMCL) lipids. A post-detection data processing scheme that permits correction of spectral artifacts caused by chemical shifts, spectral line aliasing, and magnetic field inhomogeneities is suggested. The lipid content in different lower leg muscles was evaluated. Muscle fiber orientation was taken into account in assessing quantities of EMCL and IMCL. The proposed technique allows small amounts of inhomogeneously distributed muscle lipids to be quantified.