Clinical Applications of Quantitative Perfusion Imaging with a C-Arm Flat-Panel Detector: A Systematic Review

Abdallah H.A. Zaid Al-Kaylani, Richte C.L. Schuurmann, Wouter D. Maathuis, Riemer H.J.A. Slart, Jean Paul P.M. de Vries, Reinoud P.H. Bokkers*

*Corresponding author for this work

Research output: Contribution to journalReview articleAcademicpeer-review

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C-arm systems with digital flat-panel detectors are used in interventional radiology and hybrid operating rooms for visualizing and performing interventions on three-dimensional structures. Advances in C-arm technology have enabled intraoperative quantitative perfusion imaging with these scanners. This systematic review provides an overview of flat-panel detector C-arm techniques for quantifying perfusion, their clinical applications, and their validation. A systematic search was performed for articles published between January 2000 and October 2022 in which a flat-panel detector C-arm technique for quantifying perfusion was compared with a reference technique. Nine articles were retrieved describing two techniques: two-dimensional perfusion angiography (n = 5) and dual-phase cone beam computed tomography perfusion (n = 4). A quality assessment revealed no concerns about the applicability of the studies. The risk of bias was relatively high for the index and reference tests. Both techniques demonstrated potential for clinical application; however, weak-to-moderate correlations were reported between them and the reference techniques. In conclusion, both techniques could add new possibilities to treatment planning and follow-up; however, the available literature is relatively scarce and heterogeneous. Larger-scale randomized prospective studies focusing on clinical outcomes and standardization are required for the full understanding and clinical implementation of these techniques.

Original languageEnglish
Article number128
Issue number1
Publication statusPublished - 30 Dec 2022


  • C-arm
  • Cone-beam computed tomography
  • Dual-phase perfusion
  • Flat-panel detector
  • Perfusion angiography
  • Perfusion imaging


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