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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.

Supplemental digital content is available in the text.

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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