Clinical Applications of Conebeam CTP Imaging in Cerebral Disease: A Systematic Review

BACKGROUND: Perfusion imaging with multidetector CT is integral to the evaluation of patients presenting with ischemic stroke due to large-vessel occlusion. Using conebeam CT perfusion in a direct-to-angio approach could reduce workflow times and improve functional outcome.

PURPOSE: Our aim was to provide an overview of conebeam CT techniques for quantifying cerebral perfusion, their clinical applications, and validation.

DATA SOURCES: A systematic search was performed for articles published between January 2000 and October 2022 in which a conebeam CT imaging technique for quantifying cerebral perfusion in human subjects was compared against a reference technique.

STUDY SELECTION: Eleven articles were retrieved describing 2 techniques: dual-phase (n = 6) and multiphase (n = 5) conebeam CTP.

DATA ANALYSIS: Descriptions of the conebeam CT techniques and the correlations between them and the reference techniques were retrieved.

DATA SYNTHESIS: Appraisal of the quality and risk of bias of the included studies revealed little concern about bias and applicability. Good correlations were reported for dual-phase conebeam CTP; however, the comprehensiveness of its parameter is unclear. Multiphase conebeam CTP demonstrated the potential for clinical implementation due to its ability to produce conventional stroke protocols. However, it did not consistently correlate with the reference techniques.

LIMITATIONS: The heterogeneity within the available literature made it impossible to apply meta-analysis to the data.

CONCLUSIONS: The reviewed techniques show promise for clinical use. Beyond evaluating their diagnostic accuracy, future studies should address the practical challenges associated with implementing these techniques and the potential benefits for different ischemic diseases.