Mapping the Perfusion Territory of Internal Carotid Artery with Digital Distraction Angiography

Abstract

Digital subtraction angiography (DSA) is an irreplaceable diagnostic and therapeutic method in cerebral vascular diseases. It is more sensitive to large vessel disease, but not to distal perfusion. In order to quantitatively evaluate cerebral perfusion territory from a feeding artery, we presented an approach relied on deconvolution and cross-correlation (CC) algorithm in the present study. DSA was performed by routine timed contrast-bolus passage technique. Tmax estimation was calculated by bolus tracking algorithms. Normalized CC measures scale-free similarity of two time series after time shifting. To study the stability and generalizability of our correlation map, we enrolled two subjects with normal anterior circulation and randomly selected regions of interest for arterial input functions. Pixel-wise root-mean-square-error for CC maps and Tmax of both two subjects were significantly low, and mean errors of Tmax were below the temporal resolution of DSA. We then applied this approach in four common clinical scenarios to report its clinical implications. Results of four scenarios suggest the CC maps and Tmax accurately showed the changes of perfusion territory and the correlation to the feeding artery. The approach of CC map and Tmax based on DSA was reliable with manually selected arterial input function. The CC map provided quantitative information about perfusion territory of a feeding artery (i.e., internal carotid artery), which helped neurologists on diagnosis and therapy of ischemic stroke.

Funding Information: This work was supported by Shanghai Rising-Star Program (21QA1405800) and Clinical Special Funds of Shanghai Health Committee (20204Y0131).

Conflict of Interests: The authors declare that they have no competing interests.

Ethical Approval: The study was approved by the ethical committee of Ruijin Hospital, Shanghai Jiao Tong University School of Medicine. Written informed consent was obtained from all participants.

Keywords: Digital Subtraction Angiography, Perfusion territory, Cross correlation