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Wavelet-Based Angiographic Reconstruction of Computed Tomography Perfusion Data: Diagnostic Value in Cerebral Venous Sinus Thrombosis

Kunz, Wolfgang G. MD; Schuler, Felix; Sommer, Wieland H. MD, MPH; Fabritius, Matthias P. MD; Havla, Lukas PhD; Meinel, Felix G. MD; Reiser, Maximilian F. MD; Ertl-Wagner, Birgit MD, MHBA; Thierfelder, Kolja M. MD, MSc

doi: 10.1097/RLI.0000000000000337
Technical Notes

Objective: The aim of this study was to test the diagnostic value of wavelet-based angiographic reconstruction of CT perfusion data (waveletCTA) to detect cerebral venous sinus thrombosis (CVST) in patients who underwent whole-brain CT perfusion imaging (WB-CTP).

Materials and Methods: Datasets were retrospectively selected from an initial cohort of 2863 consecutive patients who had undergone multiparametric CT including WB-CTP. WaveletCTA was reconstructed from WB-CTP: the angiographic signal was generated by voxel-based wavelet transform of time attenuation curves (TACs) from WB-CTP raw data. In a preliminary clinical evaluation, waveletCTA was analyzed by 2 readers with respect to presence and location of CVST. Venous CT and MR angiography (venCTA/venMRA) served as reference standard. Diagnostic confidence for CVST detection and the quality of depiction for venous sections were evaluated on 5-point Likert scales. Thrombus extent was assessed by length measurements. The mean CT attenuation and waveletCTA signal of the thrombus and of flowing blood were quantified.

Results: Sixteen patients were included: 10 patients with venCTA-/venMRA-confirmed CVST and 6 patients with arterial single-phase CT angiography (artCTA)–suspected but follow-up-excluded CVST. The reconstruction of waveletCTA was successful in all patients. Among the patients with confirmed CVST, waveletCTA correctly demonstrated presence, location, and extent of the thrombosis in 10/10 cases. In 6 patients with artCTA-suspected but follow-up–excluded CVST, waveletCTA correctly ruled out CVST in 5 patients. Reading waveletCTA in addition to artCTA significantly increased the diagnostic confidence concerning CVST compared with reading artCTA alone (4.4 vs 3.6, P = 0.044). The mean flowing blood-to-thrombus ratio was highest in waveletCTA, followed by venCTA and artCTA (146.2 vs 5.9 vs 2.6, each with P < 0.001). In waveletCTA, the venous sections were depicted better compared with artCTA (4.2 vs 2.6, P < 0.001), and equally well compared with venCTA/venMRA (4.2 vs 4.1, P = 0.374).

Conclusions: WaveletCTA was technically feasible in CVST patients and reliably identified CVST in a preliminary clinical evaluation. WaveletCTA might serve as an additional reconstruction to rule out or incidentally detect CVST in patients who undergo WB-CTP.

From the *Institute for Clinical Radiology, and †Josef Lissner Laboratory for Biomedical Imaging of the Institute for Clinical Radiology, Ludwig-Maximilian-University Hospital Munich, Germany.

Received for publication September 13, 2016; and accepted for publication, after revision, October 6, 2016.

Conflicts of interest and sources of funding: none declared.

Correspondence to: Wolfgang G. Kunz, MD, Institute for Clinical Radiology, Ludwig-Maximilian-University Hospital Munich, Marchioninistraße 15, 81377 Munich, Germany. E-mail:

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