Perfusion estimation in the peripheral vasculature using C-arm X-ray systems

In this paper we introduce a framework for the quantitative assessment of perfusion in peripheral body parts on state of the art flat detector C-arm systems, which enable direct and quantitative outcome control of the success of complex procedures. The method is based on a two-scan acquisition protocol. First a rotational soft tissue scan is made to extract the 3D anatomy of the perfused area (vascular territory and tissue) by means of a segmentation algorithm. Then a dynamic X-ray perfusion sequence is acquired from a fixed angular position that is suggested by the anatomy. For quantitative analysis, each projected ray is normalized by the effective length of contrast material along each X-ray. The method is evaluated in a simulation study using phantom data and a CT perfusion dataset of a patient affected by arterial occlusions. Results show that quantitative perfusion assessment and detection of hypo-perfused areas with this method are possible.