Real-time planar angiographic cerebral perfusion imaging

Purpose Digital Subtraction Angiography (DSA) is an X-ray-based imaging modality intimately related to minimally invasive procedures in interventional radiology, cardiology, vascular and neurologic surgery. Emulating tomographic methods like 3D vessel reconstruction and flat-panel detector CT perfusion imaging increases its diagnostic utility. This study demonstrates a hardware and software setup expanding DSA capability to functional perfusion imaging by assessing planar cerebral perfusion at runtime. Methods The setup uses an HDMI video splitter and frame-grabber for duplicating the video output of the intervention suite to an arbitrary machine at the time of image acquisition. A selection of methods, including numerical approximation and neural network inference of fitted curve features, is applied to create perfusion parameter maps and compare their respective completion times over a set of angiographic runs. Results We identified two distinct perfusion estimation methods able to yield results within 1–2 s, signal deconvolution using single-value decomposition (SVD) and numerical curve feature estimation, as well as a variation on conventional curve fitting that massively shortened calculation times from five minutes to clinically feasible 30 s. Conclusion Directly accessing image data outside of the angiography suite enables real-time angiographic cerebral perfusion evaluation in the clinical workflow. This way, on-the-fly analysis of angiograms in clinical settings, e.g., angiographic perfusion, is made possible, facilitating future clinical studies.