Reconstructing Quantitative Cerebral Perfusion Images Directly From Measured Sinogram Data Acquired Using C-arm Cone-Beam CT

To shorten the door-to-puncture time for better treating patients with acute ischemic stroke, it is highly desired to obtain quantitative cerebral perfusion images using C-arm cone-beam computed tomography (CBCT) equipped in the interventional suite. However, limited by the slow gantry rotation speed, the temporal resolution and temporal sampling density of typical C-arm CBCT are much poorer than those of multi-detector-row CT in the diagnostic imaging suite. The current quantitative perfusion imaging includes two cascaded steps: time-resolved image reconstruction and perfusion parametric estimation. For time-resolved image reconstruction, the technical challenge imposed by poor temporal resolution and poor sampling density causes inaccurate quantification of the temporal variation of cerebral artery and tissue attenuation values. For perfusion parametric estimation, it remains a technical challenge to appropriately design the handcrafted regularization for better solving the associated deconvolution problem. These two challenges together prevent obtaining quantitatively accurate perfusion images using C-arm CBCT. The purpose of this work is to simultaneously address these two challenges by combining the two cascaded steps into a single joint optimization problem and reconstructing quantitative perfusion images directly from the measured sinogram data. In the developed direct cerebral perfusion parametric image reconstruction technique, TRAINER in short, the quantitative perfusion images have been represented as a subject-specific conditional generative model trained under the constraint of the time-resolved CT forward model, perfusion convolutional model, and the subject's own measured sinogram data. Results shown in this paper demonstrated that using TRAINER, quantitative cerebral perfusion images can be accurately obtained using C-arm CBCT in the interventional suite.