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Shi Z, Hu B, Lu M, Zhang M, Yang H, He B, Ma J, Hu C, Lu L, Li S, Ren S, Zhang Y, Li J, Nijiati M, Dong J, Wang H, Zhou Z, Zhang F, Pan C, Yu Y, Chen Z, Zhou CS, Wei Y, Zhou J, Zhang LJ, China Aneurysm AI Project Group. Development and Validation of a Sham-AI Model for Intracranial Aneurysm Detection at CT Angiography. Radiol Artif Intell 2025; 7:e240140. [PMID: 40105449 DOI: 10.1148/ryai.240140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/20/2025]
Abstract
Purpose To evaluate a sham-artificial intelligence (AI) model acting as a placebo control for a standard-AI model for diagnosis of intracranial aneurysm. Materials and Methods This retrospective crossover, blinded, multireader, multicase study was conducted from November 2022 to March 2023. A sham-AI model with near-zero sensitivity and similar specificity to a standard AI model was developed using 16 422 CT angiography examinations. Digital subtraction angiography-verified CT angiographic examinations from four hospitals were collected, half of which were processed by standard AI and the others by sham AI to generate sequence A; sequence B was generated in the reverse order. Twenty-eight radiologists from seven hospitals were randomly assigned to either sequence and then assigned to the other sequence after a washout period. The diagnostic performances of radiologists alone, radiologists with standard-AI assistance, and radiologists with sham-AI assistance were compared using sensitivity and specificity, and radiologists' susceptibility to sham AI suggestions was assessed. Results The testing dataset included 300 patients (median age, 61.0 years [IQR, 52.0-67.0]; 199 male), 50 of whom had aneurysms. Standard AI and sham AI performed as expected (sensitivity, 96.0% vs 0.0%; specificity, 82.0% vs 76.0%). The differences in sensitivity and specificity between standard AI-assisted and sham AI-assisted readings were 20.7% (95% CI: 15.8, 25.5 [superiority]) and 0.0% (95% CI: -2.0, 2.0 [noninferiority]), respectively. The difference between sham AI-assisted readings and radiologists alone was -2.6% (95% CI: -3.8, -1.4 [noninferiority]) for both sensitivity and specificity. After sham-AI suggestions, 5.3% (44 of 823) of true-positive and 1.2% (seven of 577) of false-negative results of radiologists alone were changed. Conclusion Radiologists' diagnostic performance was not compromised when aided by the proposed sham-AI model compared with their unassisted performance. Keywords: CT Angiography, Vascular, Intracranial Aneurysm, Sham AI Supplemental material is available for this article. Published under a CC BY 4.0 license. See also commentary by Mayfield and Romero in this issue.
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Affiliation(s)
- Zhao Shi
- Department of Radiology, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing 210002, China
| | - Bin Hu
- Department of Radiology, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing 210002, China
| | - Mengjie Lu
- Health Science Center, Ningbo University, Zhejiang, China
| | - Manting Zhang
- Department of Biostatistics, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Haiting Yang
- Department of Radiology, University Second Hospital, Lanzhou, China
| | - Bo He
- Department of Medical Imaging, The First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Jiyao Ma
- Department of Medical Imaging, The First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Chunfeng Hu
- Department of Radiology, the Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Li Lu
- Department of Radiology, the Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Sheng Li
- Department of Radiology, the Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Shiyu Ren
- Department of Radiology, the Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Yonggao Zhang
- The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jun Li
- The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Mayidili Nijiati
- Image Center, The First People's Hospital of Kashi Prefecture, Kashi, China
| | - Jiake Dong
- Image Center, The First People's Hospital of Kashi Prefecture, Kashi, China
| | - Hao Wang
- Deepwise Artificial Intelligence (AI) Laboratory, Deepwise, Beijing, China
| | - Zhen Zhou
- Deepwise Artificial Intelligence (AI) Laboratory, Deepwise, Beijing, China
| | - Fandong Zhang
- Deepwise Artificial Intelligence (AI) Laboratory, Deepwise, Beijing, China
| | - Chengwei Pan
- Institute of Artificial Intelligence, Beihang University, Beijing, China
| | - Yizhou Yu
- Department of Computer Science, The University of Hong Kong, Hong Kong, China
| | - Zijian Chen
- Department of Radiology, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing 210002, China
| | - Chang Sheng Zhou
- Department of Radiology, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing 210002, China
| | - Yongyue Wei
- Center for Public Health and Epidemic Preparedness & Response, Peking University, Beijing, China
| | - Junlin Zhou
- Department of Radiology, University Second Hospital, Lanzhou, China
| | - Long Jiang Zhang
- Department of Radiology, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing 210002, China
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Hsu WC, Meuschke M, Frangi AF, Preim B, Lawonn K. A survey of intracranial aneurysm detection and segmentation. Med Image Anal 2025; 101:103493. [PMID: 39970529 DOI: 10.1016/j.media.2025.103493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 01/31/2025] [Accepted: 02/01/2025] [Indexed: 02/21/2025]
Abstract
Intracranial aneurysms (IAs) are a critical public health concern: they are asymptomatic and can lead to fatal subarachnoid hemorrhage in case of rupture. Neuroradiologists rely on advanced imaging techniques to identify aneurysms in a patient and consider the characteristics of IAs along with several other patient-related factors for rupture risk assessment and treatment decision-making. The process of diagnostic image reading is time-intensive and prone to inter- and intra-individual variations, so researchers have proposed many computer-aided diagnosis (CAD) systems for aneurysm detection and segmentation. This paper provides a comprehensive literature survey of semi-automated and automated approaches for IA detection and segmentation and proposes a taxonomy to classify the approaches. We also discuss the current issues and give some insight into the future direction of CAD systems for IA detection and segmentation.
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Affiliation(s)
- Wei-Chan Hsu
- Friedrich Schiller University Jena, Faculty of Mathematics and Computer Science, Ernst-Abbe-Platz 2, Jena, 07743, Thuringia, Germany.
| | - Monique Meuschke
- Otto von Guericke University Magdeburg, Department of Simulation and Graphics, Universitätsplatz 2, Magdeburg, 39106, Saxony-Anhalt, Germany
| | - Alejandro F Frangi
- University of Manchester, Christabel Pankhurst Institute, Schools of Engineering and Health Sciences, Oxford Rd, Manchester, M13 9PL, Greater Manchester, United Kingdom
| | - Bernhard Preim
- Otto von Guericke University Magdeburg, Department of Simulation and Graphics, Universitätsplatz 2, Magdeburg, 39106, Saxony-Anhalt, Germany
| | - Kai Lawonn
- Friedrich Schiller University Jena, Faculty of Mathematics and Computer Science, Ernst-Abbe-Platz 2, Jena, 07743, Thuringia, Germany
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3
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Müller SJ, Einspänner E, Klebingat S, Zubel S, Schwab R, Fuchs E, Diamandis E, Khadhraoui E, Behme D. Calculation of virtual 3D subtraction angiographies using conditional generative adversarial networks (cGANs). BMC Med Imaging 2024; 24:276. [PMID: 39407196 PMCID: PMC11481798 DOI: 10.1186/s12880-024-01454-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2024] [Accepted: 10/07/2024] [Indexed: 10/19/2024] Open
Abstract
OBJECTIVE Subtraction angiographies are calculated using a native and a contrast-enhanced 3D angiography images. This minimizes both bone and metal artifacts and results in a pure image of the vessels. However, carrying out the examination twice means double the radiation dose for the patient. With the help of generative AI, it could be possible to simulate subtraction angiographies from contrast-enhanced 3D angiographies and thus reduce the need for another dose of radiation without a cutback in quality. We implemented this concept by using conditional generative adversarial networks. METHODS We selected all 3D subtraction angiographies from our PACS system, which had performed between 01/01/2018 and 12/31/2022 and randomly divided them into training, validation, and test sets (66%:17%:17%). We adapted the pix2pix framework to work on 3D data and trained a conditional generative adversarial network with 621 data sets. Additionally, we used 158 data sets for validation and 164 for testing. We evaluated two test sets with (n = 72) and without artifacts (n = 92). Five (blinded) neuroradiologists compared these datasets with the original subtraction dataset. They assessed similarity, subjective image quality, and severity of artifacts. RESULTS Image quality and subjective diagnostic accuracy of the virtual subtraction angiographies revealed no significant differences compared to the original 3D angiographies. While bone and movement artifact level were reduced, artifact level caused by metal implants differed from case to case between both angiographies without one group being significant superior to the other. CONCLUSION Conditional generative adversarial networks can be used to simulate subtraction angiographies in clinical practice, however, new artifacts can also appear as a result of this technology.
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Affiliation(s)
- Sebastian Johannes Müller
- Clinic for Neuroradiology, Otto-Von-Guericke-University Magdeburg, Leipziger Str. 44, D-39120, Magdeburg, Germany.
| | - Eric Einspänner
- Clinic for Neuroradiology, Otto-Von-Guericke-University Magdeburg, Leipziger Str. 44, D-39120, Magdeburg, Germany
- German Center for Neurodegenerative Diseases (DZNE), Leipziger Str. 44, D-39120, Magdeburg, Germany
| | - Stefan Klebingat
- Clinic for Neuroradiology, Otto-Von-Guericke-University Magdeburg, Leipziger Str. 44, D-39120, Magdeburg, Germany
- Stimulate Research Campus Magdeburg, Otto-Hahn-Str. 2, D-39106, Magdeburg, Germany
| | - Seraphine Zubel
- Clinic for Neuroradiology, Otto-Von-Guericke-University Magdeburg, Leipziger Str. 44, D-39120, Magdeburg, Germany
| | - Roland Schwab
- Clinic for Neuroradiology, Otto-Von-Guericke-University Magdeburg, Leipziger Str. 44, D-39120, Magdeburg, Germany
| | - Erelle Fuchs
- Clinic for Neuroradiology, Otto-Von-Guericke-University Magdeburg, Leipziger Str. 44, D-39120, Magdeburg, Germany
| | - Elie Diamandis
- Clinic for Neuroradiology, Otto-Von-Guericke-University Magdeburg, Leipziger Str. 44, D-39120, Magdeburg, Germany
| | - Eya Khadhraoui
- Clinic for Neuroradiology, Otto-Von-Guericke-University Magdeburg, Leipziger Str. 44, D-39120, Magdeburg, Germany
| | - Daniel Behme
- Clinic for Neuroradiology, Otto-Von-Guericke-University Magdeburg, Leipziger Str. 44, D-39120, Magdeburg, Germany
- Stimulate Research Campus Magdeburg, Otto-Hahn-Str. 2, D-39106, Magdeburg, Germany
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Saemann A, de Wilde D, Rychen J, Roethlisberger M, Żelechowski M, Faludi B, Cattin PC, Psychogios MN, Soleman J, Guzman R. Assessment of Interrater Reliability and Accuracy of Cerebral Aneurysm Morphometry Using 3D Virtual Reality, 2D Digital Subtraction Angiography, and 3D Reconstruction: A Randomized Comparative Study. Brain Sci 2024; 14:968. [PMID: 39451982 PMCID: PMC11506597 DOI: 10.3390/brainsci14100968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2024] [Revised: 09/18/2024] [Accepted: 09/24/2024] [Indexed: 10/26/2024] Open
Abstract
BACKGROUND/OBJECTIVES Detailed morphometric analysis of an aneurysm and the related vascular bifurcation are critical factors when determining rupture risk and planning treatment for unruptured intracranial aneurysms (UIAs). The standard visualization of digital subtraction angiography (DSA) and its 3D reconstruction on a 2D monitor provide precise measurements but are subject to variability based on the rater. Visualization using virtual (VR) and augmented reality platforms can overcome those limitations. It is, however, unclear whether accurate measurements of the aneurysm and adjacent arterial branches can be obtained on VR models. This study aimed to assess interrater reliability and compare measurements between 3D VR, standard 2D DSA, and 3D DSA reconstructions, evaluating the reliability and accuracy of 3D VR as a measurement tool. METHODS A pool of five neurosurgeons performed three individual analyses on each of the ten UIA cases, measuring them in completely immersed 3D VR and the standard on-screen format (2D DSA and 3D reconstruction). This resulted in three independent measurements per modality for each case. Interrater reliability of measurements and morphology characterization, comparative differences, measurement duration, and VR user experience were assessed. RESULTS Interrater reliability for 3D VR measurements was significantly higher than for 3D DSA measurements (3D VR mean intraclass correlation coefficient [ICC]: 0.69 ± 0.22 vs. 3D DSA mean ICC: 0.36 ± 0.37, p = 0.042). No significant difference was observed between 3D VR and 2D DSA (3D VR mean ICC: 0.69 ± 0.22 vs. 2D DSA mean ICC: 0.43 ± 0.31, p = 0.12). A linear mixed-effects model showed no effect of 3D VR and 3D DSA (95% CI = -0.26-0.28, p = 0.96) or 3D VR and 2D DSA (95% CI = -0.02-0.53, p = 0.066) on absolute measurements of the aneurysm in the anteroposterior, mediolateral, and craniocaudal dimensions. CONCLUSIONS 3D VR technology allows for reproducible, accurate, and reliable measurements comparable to measurements performed on a 2D screen. It may also potentially improve precision for measurements of non-planar aneurysm dimensions.
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Affiliation(s)
- Attill Saemann
- Department of Neurosurgery, University Hospital of Basel, 4031 Basel, Switzerland
| | - Daniel de Wilde
- Department of Neurosurgery, University Hospital of Basel, 4031 Basel, Switzerland
| | - Jonathan Rychen
- Department of Neurosurgery, University Hospital of Basel, 4031 Basel, Switzerland
| | - Michel Roethlisberger
- Department of Neurosurgery, University Hospital of Basel, 4031 Basel, Switzerland
- Faculty of Medicine, University of Basel, 4056 Basel, Switzerland
| | - Marek Żelechowski
- Department of Biomedical Engineering, University of Basel, 4123 Allschwil, Switzerland
| | - Balázs Faludi
- Department of Biomedical Engineering, University of Basel, 4123 Allschwil, Switzerland
| | | | - Marios-Nikos Psychogios
- Faculty of Medicine, University of Basel, 4056 Basel, Switzerland
- Department of Neuroradiology, University Hospital Basel, 4031 Basel, Switzerland
| | - Jehuda Soleman
- Department of Neurosurgery, University Hospital of Basel, 4031 Basel, Switzerland
- Faculty of Medicine, University of Basel, 4056 Basel, Switzerland
| | - Raphael Guzman
- Department of Neurosurgery, University Hospital of Basel, 4031 Basel, Switzerland
- Faculty of Medicine, University of Basel, 4056 Basel, Switzerland
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5
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Planinc A, Špegel N, Podobnik Z, Šinigoj U, Skubic P, Choi JH, Park W, Robič T, Tabor N, Jarabek L, Špiclin Ž, Bizjak Ž. Assessing accuracy and consistency in intracranial aneurysm sizing: human expertise vs. artificial intelligence. Sci Rep 2024; 14:16080. [PMID: 38992041 PMCID: PMC11239926 DOI: 10.1038/s41598-024-65825-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 06/24/2024] [Indexed: 07/13/2024] Open
Abstract
Intracranial aneurysms (IAs) are a common vascular pathology and are associated with a risk of rupture, which is often fatal. Aneurysm growth of more than 1 mm is considered a surrogate of rupture risk, therefore, this study presents a comprehensive analysis of intracranial aneurysm measurements utilizing a dataset comprising 358 IA from 248 computed tomography angiography (CTA) scans measured by four junior raters and one senior rater. The study explores the variability in sizing assessments by employing both human raters and an Artificial Intelligence (AI) system. Our findings reveal substantial inter- and intra-rater variability among junior raters, contrasting with the lower intra-rater variability observed in the senior rater. Standard deviations of all raters were above the threshold for IA growth (1 mm). Additionally, the study identifies a systemic bias, indicating a tendency for human experts to measure aneurysms smaller than the AI system. Our findings emphasize the challenges in human assessment while also showcasing the capacity of AI technology to improve the precision and reliability of intracranial aneurysm assessments, especially beneficial for junior raters. The potential of AI was particularly evident in the task of monitoring IA at various intervals, where the AI-based approach surpassed junior raters and achieved performance comparable to senior raters.
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Affiliation(s)
- Andrej Planinc
- Medilab Diagnostic Imaging, Vodovodna 100, 1000, Ljubljana, Slovenia.
| | - Nina Špegel
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Zala Podobnik
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Uroš Šinigoj
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Petra Skubic
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - June Ho Choi
- Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Wonhyoung Park
- Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Tina Robič
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Nika Tabor
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Leon Jarabek
- Laboratory of Imaging Technologies, Faculty of Electrical Engineering, University of Ljubljana, Ljubljana, Slovenia
| | - Žiga Špiclin
- Laboratory of Imaging Technologies, Faculty of Electrical Engineering, University of Ljubljana, Ljubljana, Slovenia
| | - Žiga Bizjak
- Laboratory of Imaging Technologies, Faculty of Electrical Engineering, University of Ljubljana, Ljubljana, Slovenia
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6
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Xu Y, Cheng Y, Guo Y, Chen G, Han X, Sheng Y, Wang W, Wu X. Preliminary application of three-dimensional venography and fusion navigation technique in May-Thurner syndrome. J Vasc Surg Venous Lymphat Disord 2024; 12:101660. [PMID: 37572776 PMCID: PMC11523461 DOI: 10.1016/j.jvsv.2023.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 07/22/2023] [Accepted: 08/02/2023] [Indexed: 08/14/2023]
Abstract
OBJECTIVE The purpose of this study was to report a technique for intraprocedural guidance of endovascular iliac vein stenting procedures using three-dimensional (3D) venography images as an overlay on live biplanar fluoroscopy. METHODS Using 3D venography and a fusion navigation technique, percutaneous transluminal angioplasty and stent placement were performed to evaluate the feasibility of using 3D venography images and the fusion navigation technique to treat MTS compared with traditional digital subtraction angiography. The general epidemiologic data (ie, age, gender), clinical manifestations (ie, major symptoms, affected extremity, CEAP [clinical, etiology, anatomy, pathophysiology] classification, comorbidity, stenosis rate), intraoperative findings (ie, stent type, stent count, stent to inferior vena cava distance, procedure time, radiation dose, contrast agent dosage), and postoperative recovery were obtained and analyzed. RESULTS A total of 30 consecutive patients with symptomatic MTS from our institution were enrolled in the present study. Of the 30 patients, 12 (group A) were treated using 3D venography images and fusion navigation and 18 (group B) were treated with two-dimensional venography images during endovascular management. Significant differences were observed between the two groups with respect to the procedure time (64.42 ± 4.35 minutes vs 76.61 ± 3.47 minutes; P = .04), radiation dose (2152 ± 124.7 mGy vs 2561 ± 105.6 mGy; P = .02), and contrast agent dosage (71.42 ± 4.87 mL vs 86.17 ± 4.14 mL; P = .03). CONCLUSIONS 3D venography and its fusion navigation technique can improve prediction of the coverage area of the stent. Its use can also shorten the procedure time and reduce the contrast agent dose and radiation exposure, making it a valuable tool for both the diagnosis and the treatment of symptomatic MTS.
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Affiliation(s)
- Yingjiang Xu
- Binzhou Medical University Hospital, Binzhou, People's Republic of China
| | - Yongjia Cheng
- Binzhou Medical University Hospital, Binzhou, People's Republic of China
| | - Yifan Guo
- Cheeloo College of Medicine, Shandong University, Jinan, People's Republic of China
| | - Gang Chen
- Binzhou Medical University Hospital, Binzhou, People's Republic of China
| | - Xinqiang Han
- Binzhou Medical University Hospital, Binzhou, People's Republic of China
| | - Yuguo Sheng
- Binzhou Medical University Hospital, Binzhou, People's Republic of China
| | - Wenming Wang
- Binzhou Medical University Hospital, Binzhou, People's Republic of China
| | - Xuejun Wu
- Department of Vascular Surgery, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, People's Republic of China.
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7
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Yang R, Ren Y, Kok HK, Smith PD, Kebria PM, Khosravi A, Maingard J, Yeo M, Hall J, Foo M, Zhou K, Jhamb A, Russell J, Brooks M, Asadi H. Verification of a simplified aneurysm dimensionless flow parameter to predict intracranial aneurysm rupture status. Br J Radiol 2024; 97:1357-1364. [PMID: 38796680 PMCID: PMC11186560 DOI: 10.1093/bjr/tqae106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Revised: 04/07/2023] [Accepted: 05/16/2024] [Indexed: 05/28/2024] Open
Abstract
OBJECTIVES Aneurysm number (An) is a novel prediction tool utilizing parameters of pulsatility index (PI) and aneurysm geometry. An has been shown to have the potential to differentiate intracranial aneurysm (IA) rupture status. The objective of this study is to investigate the feasibility and accuracy of An for IA rupture status prediction using Australian based clinical data. METHODS A retrospective study was conducted across three tertiary referral hospitals between November 2017 and November 2020 and all saccular IAs with known rupture status were included. Two sets of An values were calculated based on two sets of PI values previously reported in the literature. RESULTS Five hundred and four IA cases were included in this study. The results demonstrated no significant difference between ruptured and unruptured status when using An ≥1 as the discriminator. Further analysis showed no strong correlation between An and IA subtypes. The area under the curve (AUC) indicated poor performance in predicting rupture status (AUC1 = 0.55 and AUC2 = 0.56). CONCLUSIONS This study does not support An ≥1 as a reliable parameter to predict the rupture status of IAs based on a retrospective cohort. Although the concept of An is supported by hemodynamic aneurysm theory, further research is needed before it can be applied in the clinical setting. ADVANCES IN KNOWLEDGE This study demonstrates that the novel prediction tool, An, proposed in 2020 is not reliable and that further research of this hemodynamic model is needed before it can be incorporated into the prediction of IA rupture status.
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Affiliation(s)
- Runlin Yang
- Department of Radiology, Austin Hospital, Melbourne, 3084, Australia
| | - Yifan Ren
- Interventional Radiology Service—Department of Radiology, Austin Hospital, Melbourne, 3084, Australia
| | - Hong Kuan Kok
- Interventional Radiology Service, Northern Health Radiology, Melbourne, 3076, Australia
| | - Paul D Smith
- Melbourne Medical School, The University of Melbourne, Parkville, 3052, Australia
- Department of Neurosurgery, St Vincent’s Hospital, Melbourne, 3065, Australia
| | - Parham Mohsenzadeh Kebria
- Institute for Intelligent Systems Research and Innovation, Deakin University, Waurn Ponds, 3216, Australia
| | - Abbas Khosravi
- Institute for Intelligent Systems Research and Innovation, Deakin University, Waurn Ponds, 3216, Australia
| | - Julian Maingard
- Interventional Radiology Service—Department of Radiology, Austin Hospital, Melbourne, 3084, Australia
- Interventional Neuroradiology Service—Department of Radiology, Austin Hospital, Melbourne, 3084, Australia
- School of Medicine—Faculty of Health, Deakin University, Waurn Ponds, 3216, Australia
| | - Melissa Yeo
- Department of Radiology, Western Health, Melbourne, 3011, Australia
| | - Jonathan Hall
- Department of Radiology, St Vincent’s Hospital Melbourne, Melbourne, 3065, Australia
| | - Michelle Foo
- Interventional Radiology Service—Department of Radiology, Austin Hospital, Melbourne, 3084, Australia
| | - Kevin Zhou
- Department of Radiology, Monash Health, Monash University, Melbourne, 3168, Australia
| | - Ashu Jhamb
- Interventional Radiology Service—Department of Radiology, St Vincent’s Hospital Melbourne, Melbourne, 3065, Australia
| | - Jeremy Russell
- Department of Neurosurgery, Austin Hospital, Melbourne, 3084, Australia
| | - Mark Brooks
- Interventional Radiology Service—Department of Radiology, Austin Hospital, Melbourne, 3084, Australia
- The Florey Institute of Neuroscience and Mental Health, Melbourne, 3052, Australia
| | - Hamed Asadi
- Interventional Neuroradiology Service—Department of Radiology, Austin Hospital, Melbourne, 3084, Australia
- School of Medicine—Faculty of Health, Deakin University, Waurn Ponds, 3216, Australia
- The Florey Institute of Neuroscience and Mental Health, Melbourne, 3052, Australia
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Ishikawa K, Izumi T, Nishihori M, Imaizumi T, Goto S, Suzuki K, Yokoyama K, Kanamori F, Uda K, Araki Y, Saito R. Clinical Efficiency of an Artificial Intelligence-Based 3D-Angiography for Visualization of Cerebral Aneurysm: Comparison with the Conventional Method. Clin Neuroradiol 2023; 33:1143-1150. [PMID: 37400735 DOI: 10.1007/s00062-023-01325-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 05/31/2023] [Indexed: 07/05/2023]
Abstract
PURPOSE Artificial intelligence (AI)-based three-dimensional angiography (3D-A) was reported to demonstrate visualization of cerebral vasculature equivalent to that of three-dimensional digital subtraction angiography (3D-DSA). However, the applicability and efficacy of the AI-based 3D‑A algorithm have not yet been investigated for 3D-DSA micro imaging. In this study, we evaluated the usefulness of the AI-based 3D‑A in 3D-DSA micro imaging. MATERIALS AND METHODS The 3D-DSA micro datasets of 20 consecutive patients with cerebral aneurysm (CA) were reconstructed with 3D-DSA and 3D‑A. Three reviewers compared 3D-DSA and 3D‑A in terms of qualitative parameters (degrees of visualization of CA and the anterior choroidal artery [AChA]) and quantitative parameters (aneurysm diameter, neck diameter, parent vessel diameter, and visible length of AChA). RESULTS Qualitative evaluation of diagnostic potential revealed that visualization of CA and the proximal to middle parts of the AChA with 3D‑A was equal to that with conventional 3D-DSA; in contrast, visualization of the distal part of the AChA was lower with 3D‑A than with 3D-DSA. Further, regarding quantitative evaluation, the aneurysm diameter, neck diameter, and parent vessel diameter were comparable between 3D‑A and 3D-DSA; in contrast, the visible length of the AChA was lower with 3D‑A than with 3D-DSA. CONCLUSIONS The AI-based 3D‑A technique is feasible and evaluable visualization of cerebral vasculature with respect to quantitative and qualitative parameters in 3D-DSA micro imaging. However, the 3D‑A technique offers lower visualization of such as the distal portion of the AChA than 3D-DSA.
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Affiliation(s)
- Kojiro Ishikawa
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya University, 65 Tsurumaicho, Syowa-ku, Nagoya, Japan
| | - Takashi Izumi
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya University, 65 Tsurumaicho, Syowa-ku, Nagoya, Japan.
| | - Masahiro Nishihori
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya University, 65 Tsurumaicho, Syowa-ku, Nagoya, Japan
| | - Takahiro Imaizumi
- Department of Advanced Medicine, Nagoya University Hospital, Nagoya, Japan
| | - Shunsaku Goto
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya University, 65 Tsurumaicho, Syowa-ku, Nagoya, Japan
| | - Keita Suzuki
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya University, 65 Tsurumaicho, Syowa-ku, Nagoya, Japan
| | - Kinya Yokoyama
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya University, 65 Tsurumaicho, Syowa-ku, Nagoya, Japan
| | - Fumiaki Kanamori
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya University, 65 Tsurumaicho, Syowa-ku, Nagoya, Japan
| | - Kenji Uda
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya University, 65 Tsurumaicho, Syowa-ku, Nagoya, Japan
| | - Yoshio Araki
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya University, 65 Tsurumaicho, Syowa-ku, Nagoya, Japan
| | - Ryuta Saito
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya University, 65 Tsurumaicho, Syowa-ku, Nagoya, Japan
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Yamamoto K, Yamamoto K, Nakai G, Fujitani T, Omura S, Azuma H, Osuga K. Detection of the Vesical Arteries Using Three-dimensional Digital Subtraction Angiography Relevant to Intra-arterial Infusion Chemotherapy for Bladder Cancer Using Double-balloon Catheters. INTERVENTIONAL RADIOLOGY (HIGASHIMATSUYAMA-SHI (JAPAN) 2023; 8:64-69. [PMID: 37485483 PMCID: PMC10359176 DOI: 10.22575/interventionalradiology.2022-0030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 10/31/2022] [Indexed: 07/25/2023]
Abstract
Purpose This study aims to assess and measure the origin of the superior vesical artery and its distance from the anterior trunk of the internal iliac artery, to which the anticancer drug is infused via double-balloon-occluded arterial infusion bladder-preserving therapy for locally invasive bladder cancer. Material and Methods The 160 pelvic sides of 80 patients were analyzed. Double-balloon catheters were bilaterally introduced into the contralateral superior gluteal artery via the internal iliac arteries using a bilateral transfemoral approach. The proximal balloon is placed at the internal iliac artery, proximally from superior gluteal artery bifurcation, whereas the distal balloon at the origin of the superior gluteal artery to isolate the anterior trunk of the internal iliac artery discharging to the targeted vesical arteries between the balloons. The side hole between the distal and proximal balloons was adjusted at the origin of the anterior trunk of the internal iliac artery to allow clear visualization of the angiographic flow into the bladder. After the distal and proximal balloons were inflated, three-dimensional rotational digital subtraction angiography was performed by simultaneous contrast injection from one extension tube connected to bilateral catheters. The distance (X) between the origins of anterior trunk of the internal iliac artery and superior vesical artery was measured on three-dimensional digital subtraction angiography images, and the origin of the inferior vesical artery was investigated. Results All superior vesical artery originated from anterior trunk of the internal iliac artery. The mean x was 7.2 mm (range 1.0-22.0 mm). All inferior vesical arterys branched from anterior trunk of the internal iliac artery or its branches. Conclusions Superior vesical artery commonly originates from the proximal portion of anterior trunk of the internal iliac artery close to superior gluteal artery bifurcation.
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Affiliation(s)
- Kiyohito Yamamoto
- Department of Diagnostic Radiology, Osaka Medical and Pharmaceutical University, Japan
| | - Kazuhiro Yamamoto
- Department of Diagnostic Radiology, Osaka Medical and Pharmaceutical University, Japan
| | - Go Nakai
- Department of Diagnostic Radiology, Osaka Medical and Pharmaceutical University, Japan
| | - Tomohiro Fujitani
- Department of Diagnostic Radiology, Osaka Medical and Pharmaceutical University, Japan
| | - Shoko Omura
- Department of Diagnostic Radiology, Osaka Medical and Pharmaceutical University, Japan
| | - Haruhito Azuma
- Department of Urology, Osaka Medical and Pharmaceutical University, Japan
| | - Keigo Osuga
- Department of Diagnostic Radiology, Osaka Medical and Pharmaceutical University, Japan
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10
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Vignesh S, Prasad SN, Singh V, Neyaz Z, Phadke RV, Mehrotra A, Mishra P. Angiographic analysis on posterior fossa hemorrhages and vascular malformations beyond aneurysms by CT angiography and digital subtraction angiography. EGYPTIAN JOURNAL OF NEUROSURGERY 2022. [DOI: 10.1186/s41984-022-00152-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Posterior fossa malformations are less common than supratentorial malformations, but hemorrhages in posterior fossa are more serious due to presence of vital structures within this region. Most common cause of bleed in posterior fossa apart from hypertension is aneurysms but other vascular malformations are also there which cause hemorrhage. Here we discuss other causes of posterior fossa bleed beyond aneurysms.
Results
A total of 80 patients were evaluated: 47 (58.8%) had aneurysms, 29 (36.3%) had arteriovenous malformations, one each had developmental venous anomaly and brainstem cavernoma. Thirty vascular malformations were detected, of which 18 (62.1%) were pial arteriovenous malformations (AVMs), 11 (37.9%) were dural arteriovenous fistulas (dAVF), and one had developmental venous anomaly (DVA). Six patients of AVM underwent both DSA and CTA, and CTA could correctly diagnose only 2 of 4 pial AVMs detected by DSA. Among two dAVFs detected by DSA, CTA could demonstrate dAVF only in one patient.
Conclusion
CTA could be used as alternative to DSA in diagnosis and characterizing aneurysms in posterior fossa but for AVMs, 3D-CTA cannot replace DSA; however potential of time-resolved CTA (TR-CTA) appears promising.
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11
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Halter M, Wanderer S, Grüter B, Anon J, Diepers M, Gruber P, Andereggen L, Remonda L, Marbacher S. Interrater and intrarater agreement superior for three-dimensional digital subtraction angiography (3D-DSA) over 2D-DSA classification for detecting remnants after intracranial aneurysm clipping, a GRRAS Reliability and Agreement Study. Acta Neurochir (Wien) 2022; 164:2173-2179. [PMID: 35239014 DOI: 10.1007/s00701-022-05156-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 02/07/2022] [Indexed: 11/01/2022]
Abstract
BACKGROUND Growing evidence suggests that three-dimensional digital subtraction angiography (3D-DSA) is superior to 2D-DSA in detection of intracranial aneurysm (IA) remnants after clipping. With a simple, practical quantitative scale proposed to measure maximal remnant dimension on 3D-DSA, this study provides a rigorous interrater and intrarater reliability and agreement study comparing this newly established scale with a commonly used (Sindou) 2D-DSA scale. METHOD Records of 43 patients with clipped IAs harboring various sized remnants who underwent 2D- and 3D-DSA between 2012 and 2018 were evaluated. Using the 2D and 3D scales, six raters scored these remnants and repeated the scoring task 8 weeks later. Interrater and intrarater agreement for both grading schemes were calculated using kappa (κ) statistics. RESULTS Interrater agreement was highly significant, yielding κ-values at 95% CI (p = 0.000) of 0.225 for the first [0.185; 0.265] and 0.368 s [0.328; 0.408] time points for 2D-DSA and values of 0.700 for the first [0.654; 0.745] and 0.776 s [0.729; 0.822] time points for 3D-DSA. Intrarater agreement demonstrated κ-values between 0.139 and 0.512 for 2D-DSA and between 0.487 and 0.813 for 3D-DSA scores. CONCLUSION Interrater and intrarater agreement was minimal or weak for 2D-DSA scores, but strong for 3D-DSA scores. We propose that baseline 3D-DSA characterization may prove more reliable when categorizing clipped IA remnants for purposes of risk stratification and lifelong follow-up.
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12
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Maupu C, Lebas H, Boulaftali Y. Imaging Modalities for Intracranial Aneurysm: More Than Meets the Eye. Front Cardiovasc Med 2022; 9:793072. [PMID: 35242823 PMCID: PMC8885801 DOI: 10.3389/fcvm.2022.793072] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 01/17/2022] [Indexed: 11/21/2022] Open
Abstract
Intracranial aneurysms (IA) are often asymptomatic and have a prevalence of 3 to 5% in the adult population. The risk of IA rupture is low, however when it occurs half of the patients dies from subarachnoid hemorrhage (SAH). To avoid this fatal evolution, the main treatment is an invasive surgical procedure, which is considered to be at high risk of rupture. This risk score of IA rupture is evaluated mainly according to its size and location. Therefore, angiography and anatomic imaging of the intracranial aneurysm are crucial for its diagnosis. Moreover, it has become obvious in recent years that several other factors are implied in this complication, such as the blood flow complexity or inflammation. These recent findings lead to the development of new IA imaging tools such as vessel wall imaging, 4D-MRI, or molecular MRI to visualize inflammation at the site of IA in human and animal models. In this review, we will summarize IA imaging techniques used for the patients and those currently in development.
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Liu X, Feng J, Wu Z, Neo Z, Zhu C, Zhang P, Wang Y, Jiang Y, Mitsouras D, Li Y. Deep neural network-based detection and segmentation of intracranial aneurysms on 3D rotational DSA. Interv Neuroradiol 2021; 27:648-657. [PMID: 33715500 PMCID: PMC8493355 DOI: 10.1177/15910199211000956] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Revised: 12/27/2020] [Accepted: 02/12/2021] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE Accurate diagnosis and measurement of intracranial aneurysms are challenging. This study aimed to develop a 3D convolutional neural network (CNN) model to detect and segment intracranial aneurysms (IA) on 3D rotational DSA (3D-RA) images. METHODS 3D-RA images were collected and annotated by 5 neuroradiologists. The annotated images were then divided into three datasets: training, validation, and test. A 3D Dense-UNet-like CNN (3D-Dense-UNet) segmentation algorithm was constructed and trained using the training dataset. Diagnostic performance to detect aneurysms and segmentation accuracy was assessed for the final model on the test dataset using the free-response receiver operating characteristic (FROC). Finally, the CNN-inferred maximum diameter was compared against expert measurements by Pearson's correlation and Bland-Altman limits of agreement (LOA). RESULTS A total of 451 patients with 3D-RA images were split into n = 347/41/63 training/validation/test datasets, respectively. For aneurysm detection, observed FROC analysis showed that the model managed to attain a sensitivity of 0.710 at 0.159 false positives (FP)/case, and 0.986 at 1.49 FP/case. The proposed method had good agreement with reference manual aneurysmal maximum diameter measurements (8.3 ± 4.3 mm vs. 7.8 ± 4.8 mm), with a correlation coefficient r = 0.77, small bias of 0.24 mm, and LOA of -6.2 to 5.71 mm. 37.0% and 77% of diameter measurements were within ±1 mm and ±2.5 mm of expert measurements. CONCLUSIONS A 3D-Dense-UNet model can detect and segment aneurysms with relatively high accuracy using 3D-RA images. The automatically measured maximum diameter has potential clinical application value.
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Affiliation(s)
- Xinke Liu
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Junqiang Feng
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Zhenzhou Wu
- National Clinical Research Center (CNCRC)-Hanalytics Artificial Intelligence Research Center for Neurological Disorders and Biomind Technology, Beijing China
| | - Zhonghao Neo
- National Clinical Research Center (CNCRC)-Hanalytics Artificial Intelligence Research Center for Neurological Disorders and Biomind Technology, Beijing China
| | - Chengcheng Zhu
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA, USA
| | - Peifang Zhang
- National Clinical Research Center (CNCRC)-Hanalytics Artificial Intelligence Research Center for Neurological Disorders and Biomind Technology, Beijing China
| | - Yan Wang
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA, USA
| | - Yuhua Jiang
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Dimitrios Mitsouras
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA, USA
| | - Youxiang Li
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China
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Lang S, Hoelter P, Schmidt M, Strother C, Kaethner C, Kowarschik M, Doerfler A. Artificial Intelligence-Based 3D Angiography for Visualization of Complex Cerebrovascular Pathologies. AJNR Am J Neuroradiol 2021; 42:1762-1768. [PMID: 34503946 DOI: 10.3174/ajnr.a7252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 05/27/2021] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE By means of artificial intelligence, 3D angiography is a novel postprocessing method for 3D imaging of cerebral vessels. Because 3D angiography does not require a mask run like the current standard 3D-DSA, it potentially offers a considerable reduction of the patient radiation dose. Our aim was an assessment of the diagnostic value of 3D angiography for visualization of cerebrovascular pathologies. MATERIALS AND METHODS 3D-DSA data sets of cerebral aneurysms (n CA = 10), AVMs (n AVM = 10), and dural arteriovenous fistulas (dAVFs) (n dAVF = 10) were reconstructed using both conventional and prototype software. Corresponding reconstructions have been analyzed by 2 neuroradiologists in a consensus reading in terms of image quality, injection vessel diameters (vessel diameter [VD] 1/2), vessel geometry index (VGI = VD1/VD2), and specific qualitative/quantitative parameters of AVMs (eg, location, nidus size, feeder, associated aneurysms, drainage, Spetzler-Martin score), dAVFs (eg, fistulous point, main feeder, diameter of the main feeder, drainage), and cerebral aneurysms (location, neck, size). RESULTS In total, 60 volumes have been successfully reconstructed with equivalent image quality. The specific qualitative/quantitative assessment of 3D angiography revealed nearly complete accordance with 3D-DSA in AVMs (eg, mean nidus size3D angiography/3D-DSA= 19.9 [SD, 10.9]/20.2 [SD, 11.2] mm; r = 0.9, P = .001), dAVFs (eg, mean diameter of the main feeder3D angiography/3D-DSA= 2.04 [SD, 0.65]/2.05 [SD, 0.63] mm; r = 0.9, P = .001), and cerebral aneurysms (eg, mean size3D angiography/3D-DSA= 5.17 [SD, 3.4]/5.12 [SD, 3.3] mm; r = 0.9, P = .001). Assessment of the geometry of the injection vessel in 3D angiography data sets did not differ significantly from that of 3D-DSA (vessel geometry indexAVM: r = 0.84, P = .003; vessel geometry indexdAVF: r = 0.82, P = .003; vessel geometry indexCA: r = 0.84, P <.001). CONCLUSIONS In this study, the artificial intelligence-based 3D angiography was a reliable method for visualization of complex cerebrovascular pathologies and showed results comparable with those of 3D-DSA. Thus, 3D angiography is a promising postprocessing method that provides a significant reduction of the patient radiation dose.
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Affiliation(s)
- S Lang
- From the Department of Neuroradiology (S.L., P.H., M.S., A.D.), University of Erlangen-Nuremberg, Erlangen, Germany
| | - P Hoelter
- From the Department of Neuroradiology (S.L., P.H., M.S., A.D.), University of Erlangen-Nuremberg, Erlangen, Germany
| | - M Schmidt
- From the Department of Neuroradiology (S.L., P.H., M.S., A.D.), University of Erlangen-Nuremberg, Erlangen, Germany
| | - C Strother
- Department of Radiology (C.S.), University of Wisconsin School of Medicine and Public Health, E3/366 Clinical Sciences Center, Madison, Wisconsin
| | - C Kaethner
- Advanced Therapies (C.K., M.K.), Siemens Healthcare GmbH, Forchheim, Germany
| | - M Kowarschik
- Advanced Therapies (C.K., M.K.), Siemens Healthcare GmbH, Forchheim, Germany
| | - A Doerfler
- From the Department of Neuroradiology (S.L., P.H., M.S., A.D.), University of Erlangen-Nuremberg, Erlangen, Germany
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Definition and extraction of 2D shape indices of intracranial aneurysm necks for rupture risk assessment. Int J Comput Assist Radiol Surg 2021; 16:1977-1984. [PMID: 34406578 PMCID: PMC8589826 DOI: 10.1007/s11548-021-02469-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 07/27/2021] [Indexed: 11/23/2022]
Abstract
Purpose Intracranial aneurysms are local dilations of brain vessels. Their rupture, as well as their treatment, is associated with high risk of morbidity and mortality. In this work, we propose shape indices for aneurysm ostia for the rupture risk assessment of intracranial aneurysms. Methods We analyzed 84 middle cerebral artery bifurcation aneurysms (27 ruptured and 57 unruptured) and their ostia, with respect to their size and shape. We extracted 3D models of the aneurysms and vascular trees. A semi-automatic approach was used to separate the aneurysm from its parent vessel and to reconstruct the ostium. We used known indices to quantitatively describe the aneurysms. For the ostium, we present new shape indices: the 2D Undulation Index (UI\documentclass[12pt]{minimal}
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\begin{document}$$_\mathrm{2D}$$\end{document}2D), the 2D Ellipticity Index (EI\documentclass[12pt]{minimal}
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\begin{document}$$_\mathrm{2D}$$\end{document}2D) and the 2D Noncircularity Index (NCI\documentclass[12pt]{minimal}
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\begin{document}$$_\mathrm{2D}$$\end{document}2D). Results were analyzed using the Student t test, the Mann–Whitney U test and a correlation analysis between indices of the aneurysms and their ostia. Results Of the indices, none was significantly associated with rupture status. Most aneurysms have an NCI\documentclass[12pt]{minimal}
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\begin{document}$$_\mathrm{2D}$$\end{document}2D below 0.2. Of the aneurysms that have an NCI\documentclass[12pt]{minimal}
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\begin{document}$$_\mathrm{2D}$$\end{document}2D above 0.5, only one is ruptured, which indicates that ruptured aneurysms often have a circular-shaped ostium. Furthermore, the ostia of ruptured aneurysms tend to have a smaller area, which is also correlated with the aneurysm’s size. While also other variables were significantly correlated, strong linear correlations can only be seen between the area of the ostium with the aneurysm’s volume and surface. Conclusion The proposed shape indices open up new possibilities to quantitatively describe and compare ostia, which can be beneficial for rupture risk assessment and subsequent treatment decision. Additionally, this work shows that the ostium area and the size of the aneurysm are correlated. Further longitudinal studies are necessary to analyze whether stable and unstable aneurysms can be distinguished by their ostia.
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Marbacher S, Halter M, Vogt DR, Kienzler JC, Magyar CTJ, Wanderer S, Anon J, Diepers M, Remonda L, Fandino J. Value of 3-Dimensional Digital Subtraction Angiography for Detection and Classification of Intracranial Aneurysm Remnants After Clipping. Oper Neurosurg (Hagerstown) 2021; 21:63-72. [PMID: 33861324 PMCID: PMC8279834 DOI: 10.1093/ons/opab087] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 01/24/2021] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND The current gold standard for evaluation of the surgical result after intracranial aneurysm (IA) clipping is two-dimensional (2D) digital subtraction angiography (DSA). While there is growing evidence that postoperative 3D-DSA is superior to 2D-DSA, there is a lack of data on intraoperative comparison. OBJECTIVE To compare the diagnostic yield of detection of IA remnants in intra- and postoperative 3D-DSA, categorize the remnants based on 3D-DSA findings, and examine associations between missed 2D-DSA remnants and IA characteristics. METHODS We evaluated 232 clipped IAs that were examined with intraoperative or postoperative 3D-DSA. Variables analyzed included patient demographics, IA and remnant distinguishing characteristics, and 2D- and 3D-DSA findings. Maximal IA remnant size detected by 3D-DSA was measured using a 3-point scale of 2-mm increments. RESULTS Although 3D-DSA detected all clipped IA remnants, 2D-DSA missed 30.4% (7 of 23) and 38.9% (14 of 36) clipped IA remnants in intraoperative and postoperative imaging, respectively (95% CI: 30 [ 12, 49] %; P-value .023 and 39 [23, 55] %; P-value = <.001), and more often missed grade 1 (< 2 mm) clipped remnants (odds ratio [95% CI]: 4.3 [1.6, 12.7], P-value .005). CONCLUSION Compared with 2D-DSA, 3D-DSA achieves a better diagnostic yield in the evaluation of clipped IA. Our proposed method to grade 3D-DSA remnants proved to be simple and practical. Especially small IA remnants have a high risk to be missed in 2D-DSA. We advocate routine use of either intraoperative or postoperative 3D-DSA as a baseline for lifelong follow-up of clipped IA.
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Affiliation(s)
- Serge Marbacher
- Department of Neurosurgery, Kantonsspital Aarau, Aarau, Switzerland
| | - Matthias Halter
- Department of Neurosurgery, Kantonsspital Aarau, Aarau, Switzerland
| | - Deborah R Vogt
- Department of Clinical Research, Clinical Trial Unit, University of Basel and University Hospital Basel, Basel, Switzerland
| | - Jenny C Kienzler
- Department of Neurosurgery, Kantonsspital Aarau, Aarau, Switzerland
| | | | - Stefan Wanderer
- Department of Neurosurgery, Kantonsspital Aarau, Aarau, Switzerland
| | - Javier Anon
- Division of Neuroradiology, Department of Radiology, Kantonsspital Aarau, Aarau, Switzerland
| | - Michael Diepers
- Division of Neuroradiology, Department of Radiology, Kantonsspital Aarau, Aarau, Switzerland
| | - Luca Remonda
- Division of Neuroradiology, Department of Radiology, Kantonsspital Aarau, Aarau, Switzerland
| | - Javier Fandino
- Department of Neurosurgery, Kantonsspital Aarau, Aarau, Switzerland
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Tawk RG, Hasan TF, D'Souza CE, Peel JB, Freeman WD. Diagnosis and Treatment of Unruptured Intracranial Aneurysms and Aneurysmal Subarachnoid Hemorrhage. Mayo Clin Proc 2021; 96:1970-2000. [PMID: 33992453 DOI: 10.1016/j.mayocp.2021.01.005] [Citation(s) in RCA: 97] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 12/27/2020] [Accepted: 01/12/2021] [Indexed: 12/11/2022]
Abstract
Unruptured intracranial aneurysms (UIAs) are commonly acquired vascular lesions that form an outpouching of the arterial wall due to wall thinning. The prevalence of UIAs in the general population is 3.2%. In contrast, an intracranial aneurysm may be manifested after rupture with classic presentation of a thunderclap headache suggesting aneurysmal subarachnoid hemorrhage (SAH). Previous consensus suggests that although small intracranial aneurysms (<7 mm) are less susceptible to rupture, aneurysms larger than 7 mm should be treated on a case-by-case basis with consideration of additional risk factors of aneurysmal growth and rupture. However, this distinction is outdated. The PHASES score, which comprises data pooled from several prospective studies, provides precise estimates by considering not only the aneurysm size but also other variables, such as the aneurysm location. The International Study of Unruptured Intracranial Aneurysms is the largest observational study on the natural history of UIAs, providing the foundation to the current guidelines for the management of UIAs. Although SAH accounts for only 3% of all stroke subtypes, it is associated with considerable burden of morbidity and mortality. The initial management is focused on stabilizing the patient in the intensive care unit with close hemodynamic and serial neurologic monitoring with endovascular or open surgical aneurysm treatment to prevent rebleeding. Since the results of the International Subarachnoid Aneurysm Trial, treatment of aneurysmal SAH has shifted from surgical clipping to endovascular coiling, which demonstrated higher odds of survival free of disability at 1 year after SAH. Nonetheless, aneurysmal SAH remains a public health hazard and is associated with high rates of disability and death.
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Affiliation(s)
- Rabih G Tawk
- Department of Neurologic Surgery, Mayo Clinic, Jacksonville, FL.
| | - Tasneem F Hasan
- Department of Neurology, Ochsner Louisiana State University Health Sciences Center, Shreveport
| | | | | | - William D Freeman
- Department of Neurologic Surgery, Mayo Clinic, Jacksonville, FL; Department of Neurology, Mayo Clinic, Jacksonville, FL; Department of Critical Care, Mayo Clinic, Jacksonville, FL
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Yardımcıoğlu İ, Önal Y, Velioğlu M, Karakaş HM. Points to consider when evaluating three-dimensional digital subtraction angiography of intracranial aneurysms and their effects on treatment. Turk J Med Sci 2021; 51:1428-1438. [PMID: 33726484 PMCID: PMC8283457 DOI: 10.3906/sag-2008-134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 03/14/2021] [Indexed: 11/03/2022] Open
Abstract
Background/aim In this study, we aimed to investigate what should be regarded as potential determinants of treatment strategies when evaluating 3D digital subtraction angiography (DSA) images. Material and methods Our inclusion criteria were as follows: (1) presence of at least one intracranial aneurysm demonstrated by conventional angiography, (2) having both 2D and 3D images, and (3) being over 18 years old. First, two-dimensional (2D) and then 3D angiography images of 226 aneurysms of 150 patients were scanned. Morphological characteristics such as size, configurations, relationship with parent artery, baby counts, and other incidental findings were determined. Results Of the 226 aneurysms, 11 (4.9%) were only detected on 3D images. Four of these 11 additional aneurysms were believed to be babies of other aneurysms seen in 2D images. Middle cerebral artery (MCA) M1 segment was the most common localization in terms of missed aneurysms. Of the 28 aneurysms located in the communicating segment of the internal carotid artery, the absolute locations of 7 (25%) could not be detected in 2D images or detected in the wrong location. Of the 24 aneurysms located in the ophthalmic segment, the origin of 8 (33%) could not be clearly identified in 2D images. Truncus relationships of MCAs bifurcation/trifurcation aneurysms were seen in 41 of 63 aneurysms (65%) on 2D images, whereas all were confirmed on 3D images. Fenestrations not seen in 2D images were identified in 3D images of 4 patients (3%). Conclusion The superiority of 3D images compared to 2D images in determining the morphologic characteristics of intracranial aneurysms has been known for a long time. The contribution of 3D images to the treatment can be summarized as evaluating the parent artery relationship, revealing the number and shapes of aneurysm babies more clearly, detecting fenestrations, and shortening procedure time by finding the correct working angle.
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Affiliation(s)
| | - Yılmaz Önal
- Department of Radiology, Fatih Sultan Mehmet Training and Research Hospital, İstanbul, Turkey
| | - Murat Velioğlu
- Department of Radiology, Fatih Sultan Mehmet Training and Research Hospital, İstanbul, Turkey
| | - Hakkı Muammer Karakaş
- Department of Radiology, Fatih Sultan Mehmet Training and Research Hospital, İstanbul, Turkey
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Berg P, Behrendt B, Voß S, Beuing O, Neyazi B, Sandalcioglu IE, Preim B, Saalfeld S. VICTORIA: VIrtual neck Curve and True Ostium Reconstruction of Intracranial Aneurysms. Cardiovasc Eng Technol 2021; 12:454-465. [PMID: 34100225 PMCID: PMC8354974 DOI: 10.1007/s13239-021-00535-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 03/17/2021] [Indexed: 11/24/2022]
Abstract
Purpose For the status evaluation of intracranial aneurysms (IAs), morphological and hemodynamic parameters can provide valuable information. For their extraction, a separation of the aneurysm sac from its parent vessel is required that yields the neck curve and the ostium. However, manual and subjective neck curve and ostium definitions might lead to inaccurate IA assessments. Methods The research project VICTORIA was initiated, allowing users to interactively define the neck curve of five segmented IA models using a web application. The submitted results were qualitatively and quantitatively compared to identify the minimum, median and maximum aneurysm surface area. Finally, image-based blood flow simulations were carried out to assess the effect of variable neck curve definitions on relevant flow- and shear-related parameters. Results In total, 55 participants (20 physicians) from 18 countries participated in VICTORIA. For relatively simple aneurysms, a good agreement with respect to the neck curve definition was found. However, differences among the participants increased with increasing complexity of the aneurysm. Furthermore, it was observed that the majority of participants excluded any small arteries occurring in the vicinity of an aneurysm. This can lead to non-negligible deviations among the flow- and shear-related parameters, which need to be carefully evaluated, if quantitative analysis is desired. Finally, no differences between participants with medical and non-medical background could be observed. Conclusions VICTORIAs findings reveal the complexity of aneurysm neck curve definition, especially for bifurcation aneurysms. Standardization appears to be mandatory for future sac-vessel-separations. For hemodynamic simulations a careful neck curve definition is crucial to avoid inaccuracies during the quantitative flow analysis. Supplementary Information The online version contains supplementary material available at 10.1007/s13239-021-00535-w.
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Affiliation(s)
- Philipp Berg
- Department of Fluid Dynamics and Technical Flows, University of Magdeburg, Magdeburg, Germany
| | - Benjamin Behrendt
- Department of Simulation and Graphics, University of Magdeburg, Magdeburg, Germany
| | - Samuel Voß
- Department of Fluid Dynamics and Technical Flows, University of Magdeburg, Magdeburg, Germany
| | - Oliver Beuing
- Department of Radiology, AMEOS Hospital, Bernburg, Germany
| | - Belal Neyazi
- Department of Neurosurgery, University Hospital of Magdeburg, Magdeburg, Germany
| | | | - Bernhard Preim
- Department of Simulation and Graphics, University of Magdeburg, Magdeburg, Germany
| | - Sylvia Saalfeld
- Department of Simulation and Graphics, University of Magdeburg, Magdeburg, Germany.
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The Natural History and Reperfusion Therapy Outcomes of Acute Ischemic Stroke due to Isolated M2 Occlusions. BIOMED RESEARCH INTERNATIONAL 2021; 2021:6626604. [PMID: 33997031 PMCID: PMC8096556 DOI: 10.1155/2021/6626604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Revised: 04/01/2021] [Accepted: 04/16/2021] [Indexed: 11/17/2022]
Abstract
Objective Currently, the standard treatment modality for patients with acute ischemic stroke (AIS) presenting with isolated M2 occlusions is not specific. We therefore assessed the difference in treatment outcomes for patients with isolated M2 occlusions. Methods We retrospectively analyzed consecutive patients with AIS presenting with isolated M2 occlusions from October 1, 2018, to June 30, 2020. Patients were divided into 3 groups based on the treatments they received: no reperfusion therapy (NRT), intravenous thrombolysis treatment (IVT), and endovascular intervention (EVT), which comprised IVT in conjunction with EVT or EVT alone. The primary outcomes were improvements in modified Rankin Scale (mRS) scores at 90 days and National Institutes of Health Stroke Scale (NIHSS) scores at 24 hours after treatment compared with the baseline. The secondary efficacy outcome comprised a good outcome rate defined as a 90 − day mRS score ≤ 2, final infarct volume (FIV), 90-day mortality rate, and successful recanalization rate, which was defined as a modified thrombolysis in cerebral infarction score ≥ 2b. Safety outcomes included symptomatic intracerebral hemorrhage and procedure-related complications. Results Seventy patients were enrolled and divided into 3 groups: the NRT group (n = 25), IVT group (n = 27), and EVT group (n = 18). Twenty-four-hour posttreatment NIHSS scores were substantially decreased by EVT compared with NRT (adjusted β -4.01, 95% confidence interval [CI] -6.60 to -1.43; P = 0.003) or IVT (adjusted β, -3.61 [95% CI, -6.45 to -0.77]; P = 0.013). Compared with the outcomes observed after NRT, patients who received EVT were more likely to achieve lower 90-day mRS scores (adjusted β, -1.42 [95% CI, -2.66 to -0.63]; P = 0.007), higher good outcome rates (adjusted odds ratio, 8.73 [95% CI, 1.43-53.24]; P = 0.019), and smaller FIVs (adjusted β, -29.66 [95% CI, -59.73 to 0.42]; P = 0.048). The recanalization rate of EVT was high (88.89%), and procedure-related complications were rare (5.56%). Conclusions For acute, isolated M2 occlusions, EVT could dramatically and rapidly improve neurological deficits with high safety and effectiveness. These changes were observed at 24 hours after treatment and were maintained over the long term.
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21
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Marbacher S, Kienzler JC, Mendelowitsch I, D'Alonzo D, Andereggen L, Diepers M, Remonda L, Fandino J. Comparison of Intra- and Postoperative 3-Dimensional Digital Subtraction Angiography in Evaluation of the Surgical Result After Intracranial Aneurysm Treatment. Neurosurgery 2021; 87:689-696. [PMID: 31748795 DOI: 10.1093/neuros/nyz487] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Accepted: 08/20/2019] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Postoperative three-dimensional digital subtraction angiography (3D-DSA) is the gold standard in evaluating intracranial aneurysm (IA) remnants after clipping. Should intraoperative 3D-DSA image quality be equally good as postoperative 3D-DSA, it could supplant the latter as standard of care for follow-up of clipped IA. OBJECTIVE To directly compare the quality of assessment of clipped IA by intraoperative and postoperative 3D-DSA. METHODS From a prospective cohort of 221 consecutive patients who underwent craniotomy for IA treatment in a hybrid operating room, we retrospectively studied 26 patients who had both intraoperative and postoperative 3D-DSA imaging of their clipped aneurysm. Comparison of intraoperative and postoperative 3D-DSA images (blinded for review) included parameters that affected image quality and differences between the 2 periods. RESULTS In the 26 patients with 32 clipped IAs, the mean interval was 11 ± 7 mo between intraoperative and postoperative imaging 3D-DSA examinations. Reconstruction with multiple clips was used in 14 (44%) cases. Of 15 remnants, 9 (60%) were small (<2 mm). In comparing intraoperative and postoperative 3D-DSA, no discordance or discrepancy in assessment of the surgical result was noted for any clipped IA, and overall imaging quality was excellent for both modalities. Factors affecting minor differences in image quality were not identified. CONCLUSION Compared with postoperative 3D-DSA, intraoperative 3D-DSA images achieved equally high quality and effective, immediate interpretation of the surgical clipping result. With comparable imaging quality and no discordant findings, intraoperative 3D-DSA could replace postoperative 3D-DSA to become the standard of care in IA surgery.
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Affiliation(s)
- Serge Marbacher
- Department of Neurosurgery, Kantonsspital Aarau, Aarau, Switzerland
| | - Jenny C Kienzler
- Department of Neurosurgery, Kantonsspital Aarau, Aarau, Switzerland
| | | | - Donato D'Alonzo
- Department of Neurosurgery, Kantonsspital Aarau, Aarau, Switzerland
| | - Lukas Andereggen
- Department of Neurosurgery, Kantonsspital Aarau, Aarau, Switzerland
| | - Michael Diepers
- Division of Neuroradiology, Department of Radiology, Kantonsspital Aarau, Aarau, Switzerland
| | - Luca Remonda
- Division of Neuroradiology, Department of Radiology, Kantonsspital Aarau, Aarau, Switzerland
| | - Javier Fandino
- Department of Neurosurgery, Kantonsspital Aarau, Aarau, Switzerland
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22
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Ohba H, Ikawa F, Hidaka T, Yoshiyama M, Matsuda S, Akiyama Y, Ohkuma H, Yamaguchi S, Inagawa T, Kurisu K. Aging Changes of Aneurysmal Subarachnoid Hemorrhage: A 35-year, Hospital-Based Study. J Stroke Cerebrovasc Dis 2020; 29:105247. [PMID: 33066898 DOI: 10.1016/j.jstrokecerebrovasdis.2020.105247] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 07/24/2020] [Accepted: 08/07/2020] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND The etiology and background factors which cause decreases in the size of ruptured intracranial aneurysms remain unclear. OBJECTIVE To clarify the age- and sex-related differences in aneurysmal subarachnoid hemorrhage (SAH) based on a 35-year-old hospital database and demographic data. METHODS A database of patients admitted to our hospital with aneurysmal SAH from 1983 to 2017 was split into 5-year intervals and analyzed. Demographic data of the general population were also analyzed for reference. RESULTS Altogether, 1,523 aneurysmal SAH events were enrolled in the analysis. Age (p<0.001), proportion of elderly patients ≥ 65 years old (p<0.001), female sex (p=0.005), very small aneurysms less than 5 mm (p<0.001), and the yearly-averaged number of fatal events showed increasing trends. The proportion of aneurysm size of 10 mm or more (p = 0.011) and the yearly-averaged population of Shimane prefecture (p < 0.001) showed declining trends. In the subgroup analyses, the proportion of very small aneurysms was found to increase significantly in the non-elderly male and elderly female subgroups. The proportion of large aneurysms (10 mm or more) decreased in the non-elderly subgroup (p<0.05). As for the elderly subgroups, the yearly-averaged number of events did not show a significant tendency, although the yearly-averaged population of Shimane prefecture showed an increasing trend. CONCLUSION We found an increasing trend in the prevalence of very small aneurysms in elderly females. Recent aging may contribute to this trend. The number of aneurysmal SAH events was confirmed to not increase, despite the increased aging population of Shimane prefecture.
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Affiliation(s)
- Hideo Ohba
- Department of Neurosurgery, Shimane Prefectural Central Hospital, Izumo, Japan
| | - Fusao Ikawa
- Department of Neurosurgery, Shimane Prefectural Central Hospital, Izumo, Japan.
| | - Toshikazu Hidaka
- Department of Neurosurgery, Shimane Prefectural Central Hospital, Izumo, Japan.
| | | | - Shingo Matsuda
- Department of Neurosurgery, Shimane Prefectural Central Hospital, Izumo, Japan
| | - Yasuhiko Akiyama
- Department of Neurosurgery, Shimane University Faculty of Medicine, Izumo, Japan.
| | - Hiroki Ohkuma
- Department of Neurosurgery, Hirosaki University School of Medicine, Hirosaki, Japan.
| | - Shuhei Yamaguchi
- Hospital Bureau of Shimane Prefecture, Izumo, Japan; Faculty of Medicine, Shimane University, Izumo, Shimane, Japan.
| | - Tetsuji Inagawa
- Department of Neurosurgery, Araki Neurosurgical Hospital, Hiroshima, Japan.
| | - Kaoru Kurisu
- Hiroshima University Graduate School of Biomedical Sciences, Department of Neurosurgery, Hiroshima, Japan.
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23
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Munarriz PM, Bárcena E, Alén JF, Castaño-Leon AM, Paredes I, Moreno-Gómez LM, García-Pérez D, Jiménez-Roldán L, Gómez PA, Lagares A. Reliability and accuracy assessment of morphometric measurements obtained with software for three-dimensional reconstruction of brain aneurysms relative to cerebral angiography measures. Interv Neuroradiol 2020; 27:191-199. [PMID: 32996346 DOI: 10.1177/1591019920961588] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To analyze the reliability and accuracy of morphological measurements of software employed to three-dimensionally reconstruct aneurysms and vessels (VMTKlab, version 1.6.1,) with computed tomography angiography (CTA) as the source of images. Agreement with measurements from three-dimensional digital subtraction angiography (3 D-DSA) was evaluated. METHODS We evaluated 40 patients presenting with aneurysmal subarachnoid hemorrhage (aSAH). We analyzed four main variables of the aneurysm morphology: absolute height (size), neck (maximum neck width), perpendicular height, and maximum width. The CTA images were uploaded to the software and then segmented to reconstruct the aneurysm. This new method was compared to the current gold standard-3D reconstruction of pretreatment cerebral angiography. We used intraclass correlation coefficient (ICC) and Bland-Altman plot analyses to evaluate the agreement between these methods. RESULTS The ICCs obtained for absolute height, neck, perpendicular height, and maximum width were 0.85, 0.57, 0.85, and 0.89, respectively. This implied good agreement except for the neck of the aneurysm (moderate agreement). Bland-Altman plots are presented for the four indexes. The average of the differences was not significant in terms of absolute height, perpendicular height, and maximum width indicating good agreement. However, it was significant for the neck of the aneurysm. CONCLUSIONS We report good agreement between the values generated using VMTKlab and cerebral angiography for three of the four main variables. Discrepancies in neck diameter are not surprising and its underestimation with a traditional delineation from cerebral angiography has been reported before.
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Affiliation(s)
- Pablo M Munarriz
- Department of Neurosurgery, Hospital Universitario 12 de Octubre, Instituto de Investigación i±12, Madrid, Spain.,Department of Surgery, Universidad Complutense de Madrid, Madrid, Spain
| | - Eduardo Bárcena
- Department of Radiology, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Jose F Alén
- Department of Radiology, Hospital Universitario 12 de Octubre, Madrid, Spain.,Department of Neurosurgery, Hospital Universitario La Princesa, Madrid, Spain
| | - Ana M Castaño-Leon
- Department of Neurosurgery, Hospital Universitario 12 de Octubre, Instituto de Investigación i±12, Madrid, Spain.,Department of Surgery, Universidad Complutense de Madrid, Madrid, Spain
| | - Igor Paredes
- Department of Neurosurgery, Hospital Universitario 12 de Octubre, Instituto de Investigación i±12, Madrid, Spain.,Department of Surgery, Universidad Complutense de Madrid, Madrid, Spain
| | - Luis Miguel Moreno-Gómez
- Department of Neurosurgery, Hospital Universitario 12 de Octubre, Instituto de Investigación i±12, Madrid, Spain
| | - Daniel García-Pérez
- Department of Neurosurgery, Hospital Universitario 12 de Octubre, Instituto de Investigación i±12, Madrid, Spain
| | - Luis Jiménez-Roldán
- Department of Neurosurgery, Hospital Universitario 12 de Octubre, Instituto de Investigación i±12, Madrid, Spain.,Department of Surgery, Universidad Complutense de Madrid, Madrid, Spain
| | - Pedro A Gómez
- Department of Neurosurgery, Hospital Universitario 12 de Octubre, Instituto de Investigación i±12, Madrid, Spain.,Department of Surgery, Universidad Complutense de Madrid, Madrid, Spain
| | - Alfonso Lagares
- Department of Neurosurgery, Hospital Universitario 12 de Octubre, Instituto de Investigación i±12, Madrid, Spain.,Department of Surgery, Universidad Complutense de Madrid, Madrid, Spain
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24
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Smithee W, Chakravarthi S, Epping A, Kassam M, Monroy-Sosa A, Thota A, Kura B, Rovin RA, Fukui MB, Kassam AB. Initial Experience with Exoscopic-Based Intraoperative Indocyanine Green Fluorescence Video Angiography in Cerebrovascular Surgery: A Preliminary Case Series Showing Feasibility, Safety, and Next-Generation Handheld Form-Factor. World Neurosurg 2020; 138:e82-e94. [DOI: 10.1016/j.wneu.2020.01.244] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 01/30/2020] [Accepted: 01/31/2020] [Indexed: 12/14/2022]
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25
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Zhu W, Li W, Tian Z, Zhang Y, Wang K, Zhang Y, Liu J, Yang X. Stability Assessment of Intracranial Aneurysms Using Machine Learning Based on Clinical and Morphological Features. Transl Stroke Res 2020; 11:1287-1295. [PMID: 32430796 DOI: 10.1007/s12975-020-00811-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 03/19/2020] [Accepted: 03/19/2020] [Indexed: 02/07/2023]
Abstract
Machine learning (ML) as a novel approach could help clinicians address the challenge of accurate stability assessment of unruptured intracranial aneurysms (IAs). We developed multiple ML models for IA stability assessment and compare their performances. We enrolled 1897 consecutive patients with unstable (n = 528) and stable (n = 1539) IAs. Thirteen patient-specific clinical features and eighteen aneurysm morphological features were extracted to generate support vector machine (SVM), random forest (RF), and feed-forward artificial neural network (ANN) models. The discriminatory performances of the models were compared with statistical logistic regression (LR) model and the PHASES score in IA stability assessment. Based on the receiver operating characteristic (ROC) curve and area under the curve (AUC) values for each model in the test set, the AUC values for RF, SVM, and ANN were 0.850 (95% CI 0.806-0.893), 0.858 (95 %CI 0.816-0.900), and 0.867 (95% CI 0.828-0.906), demonstrating good discriminatory ability. All ML models exhibited superior performance compared with the statistical LR and the PHASES score (the AUC values were 0.830 and 0.589, respectively; RF versus PHASES, P < 0.001; RF versus LR, P = 0.038). Important features contributing to the stability discrimination included three clinical features (location, sidewall/bifurcation type, and presence of symptoms) and three morphological features (undulation index, height-width ratio, and irregularity). These findings demonstrate the potential of ML to augment the clinical decision-making process for IA stability assessment, which may enable more optimal management for patients with IAs in the future.
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Affiliation(s)
- Wei Zhu
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, No.119 South Fourth Ring West Road, Fengtai District, Beijing, 100050, China
| | - Wenqiang Li
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, No.119 South Fourth Ring West Road, Fengtai District, Beijing, 100050, China
| | - Zhongbin Tian
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, No.119 South Fourth Ring West Road, Fengtai District, Beijing, 100050, China
| | - Yisen Zhang
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, No.119 South Fourth Ring West Road, Fengtai District, Beijing, 100050, China
| | - Kun Wang
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, No.119 South Fourth Ring West Road, Fengtai District, Beijing, 100050, China
| | - Ying Zhang
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, No.119 South Fourth Ring West Road, Fengtai District, Beijing, 100050, China
| | - Jian Liu
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, No.119 South Fourth Ring West Road, Fengtai District, Beijing, 100050, China.
| | - Xinjian Yang
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, No.119 South Fourth Ring West Road, Fengtai District, Beijing, 100050, China.
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26
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Wu TC, Tsui YK, Chen TY, Ko CC, Lin CJ, Chen JH, Lin CP. Discrepancy between two-dimensional and three-dimensional digital subtraction angiography for the planning of endovascular coiling of small cerebral aneurysms <5 mm. Interv Neuroradiol 2020; 26:733-740. [PMID: 32423318 DOI: 10.1177/1591019920925706] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND To investigate the discrepancy between two-dimensional digital subtraction angiography and three-dimensional rotational angiography for small (<5 mm) cerebral aneurysms and the impact on decision making among neuro-interventional experts as evaluated by online questionnaire. MATERIALS AND METHODS Eight small (<5 mm) ruptured aneurysms were visually identified in 16 image sets in either two-dimensional or three-dimensional format for placement in a questionnaire for 11 invited neuro-interventionalists. For each set, two questions were posed: Question 1: "Which of the following is the preferred treatment choice: simple coiling, balloon remodeling or stent assisted coiling?"; Question 2: "Is it achievable to secure the aneurysm with pure simple coiling?" The discrepancies of angio-architecture parameters and treatment choices between two-dimensional-digital subtraction angiography and three-dimensional rotational angiography were evaluated. RESULTS In all eight cases, the neck images via three-dimensional rotational angiography were larger than two-dimensional-digital subtraction angiography with a mean difference of 0.95 mm. All eight cases analyzed with three-dimensional rotational angiography, but only one case with two-dimensional-digital subtraction angiography were classified as wide-neck aneurysms with dome-to-neck ratio < 1.5. The treatment choices based on the two-dimensional or three-dimensional information were different in 56 of 88 (63.6%) paired answers. Simple coiling was the preferred choice in 66 (75%) and 26 (29.6%) answers based on two-dimensional and three-dimensional information, respectively. Three types of angio-architecture with a narrow gap between the aneurysm sidewall and parent artery were proposed as an explanation for neck overestimation with three-dimensional rotational angiography. CONCLUSIONS Aneurysm neck overestimation with three-dimensional rotational angiography predisposed neuro-interventionalists to more complex treatment techniques. Additional two-dimensional information is crucial for endovascular treatment planning for small cerebral aneurysms.
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Affiliation(s)
- Te-Chang Wu
- Department of Medical Imaging, Chi-Mei Medical Center, Tainan.,Department of Biomedical Imaging and Radiological Sciences, National Yang-Ming University, Taipei.,Department of Medical Sciences Industry, Chang Jung Christian University, Tainan
| | - Yu-Kun Tsui
- Department of Medical Imaging, Chi-Mei Medical Center, Tainan
| | - Tai-Yuan Chen
- Department of Medical Imaging, Chi-Mei Medical Center, Tainan.,Graduate Institute of Medical Sciences, Chang Jung Christian University, Tainan
| | - Ching-Chung Ko
- Department of Medical Imaging, Chi-Mei Medical Center, Tainan.,The Center of Humanities and Society, Chia-Nan University of Pharmacy and Science, Tainan
| | - Chien-Jen Lin
- Department of Medical Imaging, Chi-Mei Medical Center, Tainan
| | - Jeon-Hor Chen
- Department of Radiology, E-DA Hospital, E-DA Cancer Hospital, I-Shou University, Kaohsiung.,Center for Functional Onco-Imaging of Radiological Sciences, School of Medicine, University of California, Irvine, CA, USA
| | - Ching-Po Lin
- Department of Biomedical Imaging and Radiological Sciences, National Yang-Ming University, Taipei.,Institute of Neuroscience, School of Life Science, National Yang-Ming University, Taipei
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27
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Zeng Y, Liu X, Xiao N, Li Y, Jiang Y, Feng J, Guo S. Automatic Diagnosis Based on Spatial Information Fusion Feature for Intracranial Aneurysm. IEEE TRANSACTIONS ON MEDICAL IMAGING 2020; 39:1448-1458. [PMID: 31689186 DOI: 10.1109/tmi.2019.2951439] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Timely and accurate auxiliary diagnosis of intracranial aneurysm can help radiologist make treatment plans quickly, saving lives and cutting costs at the same time. At present, Digital Subtraction Angiography (DSA) is the gold standard for the diagnosis of intracranial aneurysm, but as radiologists interpret those imaging sequences frame by frame, misdiagnosis might occur. The utilization of computer-aided diagnosis (CAD) can ease the burdens of radiologists and improve the detection accuracy of aneurysms. In this article, a deep learning method is applied to detect the intracranial aneurysm in 3D Rotational Angiography (3D-RA) based on a spatial information fusion (SIF) method, and instead of a 3D vascular model, 2D image sequences are used. Given the intracranial aneurysm and vascular overlap having similar feature in the most time, rather than focusing on distinguishing them in one frame, the morphological differences between frames are considered as major feature. In the training data, consecutive frames of every imaging time series are extracted and concatenated in a specific way, so that the spatial contextual information could be embedded into a single two-dimensional image. This method enables the time series with obvious correlation between frames be directly trained on 2D convolutional neural network (CNN), instead of 3D-CNN with huge computational cost. Finally, we got an accuracy of 98.89%, with sensitivity and specificity of 99.38% and 98.19%, respectively, which proves the feasibility and availability of the SIF feature.
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28
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Su T, Reymond P, Brina O, Bouillot P, Machi P, Delattre BMA, Jin L, Lövblad KO, Vargas MI. Large Neck and Strong Ostium Inflow as the Potential Causes for Delayed Occlusion of Unruptured Sidewall Intracranial Aneurysms Treated by Flow Diverter. AJNR Am J Neuroradiol 2020; 41:488-494. [PMID: 32054620 DOI: 10.3174/ajnr.a6413] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Accepted: 12/23/2019] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Flow diverter-induced hemodynamic change plays an important role in the mechanism of intracranial aneurysm occlusion. Our aim was to explore the relationship between aneurysm features and flow-diverter treatment of unruptured sidewall intracranial aneurysms. MATERIALS AND METHODS MR imaging, 4D phase-contrast, was prospectively performed before flow diverter implantation in each patient with unruptured intracranial aneurysm. Two postprocedure follow-ups were scheduled at 6 and 12 months. Responses were grouped according to whether the aneurysms were occluded or remnant. Preprocedural aneurysm geometries and ostium hemodynamics in 38 patients were compared between the 2 groups at 6 and 12 months. Receiver operating characteristic curve analyses were performed for significant geometric and hemodynamic continuous parameters. RESULTS After the 6-month assessment, 21 of 41 intracranial aneurysms were occluded, and 9 additional aneurysms were occluded at 12 months. Geometrically, the ostium maximum diameter was significantly larger in the remnant group at 6 and 12 months (both P < .001). Hemodynamically, the proximal inflow zone was more frequently observed in the remnant group at 6 months. Several preprocedural ostium hemodynamic parameters were significantly higher in the remnant group. As a prediction for occlusion, the areas under the curve of the ostium maximum diameter (for 6 and 12 months), systolic inflow rate ratio (for 6 months), and systolic inflow area (for 12 months) reached 0.843, 0.883, 0.855, and 0.860, respectively. CONCLUSIONS Intracranial aneurysms with a large ostium and strong ostium inflow may need a longer time for occlusion. Preprocedural 4D flow MR imaging can well illustrate ostium hemodynamics and characterize aneurysm treatment responses.
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Affiliation(s)
- T Su
- From the Department of Interventional Radiology (T.S., L.J.), Beijing Friendship Hospital, Capital Medical University, Beijing, People's Republic of China
| | - P Reymond
- Division of Neuroradiology and Neuro-Interventional Radiology (P.R., O.B., P.M., K.O.L., M.I.V.)
| | - O Brina
- Division of Neuroradiology and Neuro-Interventional Radiology (P.R., O.B., P.M., K.O.L., M.I.V.)
| | - P Bouillot
- and Division of Radiology (B.M.A.D.), University Hospitals of Geneva, Geneva, Switzerland
| | - P Machi
- Division of Neuroradiology and Neuro-Interventional Radiology (P.R., O.B., P.M., K.O.L., M.I.V.)
| | - B M A Delattre
- Department of Quantum Matter Physics (P.B.), University of Geneva, Geneva, Switzerland
| | - L Jin
- From the Department of Interventional Radiology (T.S., L.J.), Beijing Friendship Hospital, Capital Medical University, Beijing, People's Republic of China
| | - K O Lövblad
- Division of Neuroradiology and Neuro-Interventional Radiology (P.R., O.B., P.M., K.O.L., M.I.V.)
| | - M I Vargas
- Division of Neuroradiology and Neuro-Interventional Radiology (P.R., O.B., P.M., K.O.L., M.I.V.)
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Burkhardt JK, Chua MH, Winkler EA, Rutledge WC, Lawton MT. Incidence, classification, and treatment of angiographically occult intracranial aneurysms found during microsurgical aneurysm clipping of known aneurysms. J Neurosurg 2020; 132:434-441. [PMID: 30797191 DOI: 10.3171/2018.11.jns182416] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Accepted: 11/21/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVE During the microsurgical clipping of known aneurysms, angiographically occult (AO) aneurysms are sometimes found and treated simultaneously to prevent their growth and protect the patient from future rupture or reoperation. The authors analyzed the incidence, treatment, and outcomes associated with AO aneurysms to determine whether limited surgical exploration around the known aneurysm was safe and justified given the known limitations of diagnostic angiography. METHODS An AO aneurysm was defined as a saccular aneurysm detected using the operative microscope during dissection of a known aneurysm, and not detected on preoperative catheter angiography. A prospective database was retrospectively reviewed to identify patients with AO aneurysms treated microsurgically over a 20-year period. RESULTS One hundred fifteen AO aneurysms (4.0%) were identified during 2867 distinct craniotomies for aneurysm clipping. The most common locations for AO aneurysms were the middle cerebral artery (60 aneurysms, 54.1%) and the anterior cerebral artery (20 aneurysms, 18.0%). Fifty-six AO aneurysms (50.5%) were located on the same artery as the known saccular aneurysm. Most AO aneurysms (95.5%) were clipped and there was no attributed morbidity. The most common causes of failed angiographic detection were superimposition of a large aneurysm (type 1, 30.6%), a small aneurysm (type 2, 18.9%), or an adjacent normal artery (type 3, 36.9%). Multivariate analysis identified multiple known aneurysms (odds ratio [OR] 3.45, 95% confidence interval [CI] 2.16-5.49, p < 0.0001) and young age (OR 0.981, 95% CI 0.965-0.997, p = 0.0226) as independent predictors of AO aneurysms. CONCLUSIONS Meticulous inspection of common aneurysm sites within the surgical field will identify AO aneurysms during microsurgical dissection of another known aneurysm. Simultaneous identification and treatment of these additional undiagnosed aneurysms can spare patients later rupture or reoperation, particularly in those with multiple known aneurysms and a history of subarachnoid hemorrhage. Limited microsurgical exploration around a known aneurysm can be performed safely without additional morbidity.
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Affiliation(s)
- Jan-Karl Burkhardt
- Department of Neurological Surgery, Barrow Neurological Institute, Phoenix, Arizona; and
| | - Michelle H Chua
- Department of Neurological Surgery, Barrow Neurological Institute, Phoenix, Arizona
| | - Ethan A Winkler
- Department of Neurological Surgery, Barrow Neurological Institute, Phoenix, Arizona; and
| | - W Caleb Rutledge
- Department of Neurological Surgery, Barrow Neurological Institute, Phoenix, Arizona; and
| | - Michael T Lawton
- Department of Neurological Surgery, Barrow Neurological Institute, Phoenix, Arizona
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Lang S, Hoelter P, Schmidt M, Eisenhut F, Kaethner C, Kowarschik M, Lücking H, Doerfler A. Evaluation of an Artificial Intelligence-Based 3D-Angiography for Visualization of Cerebral Vasculature. Clin Neuroradiol 2019; 30:705-712. [PMID: 31598760 DOI: 10.1007/s00062-019-00836-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Accepted: 08/28/2019] [Indexed: 11/30/2022]
Abstract
PURPOSE The three-dimensional digital subtraction angiography (3D DSA) technique is the current standard and is based on both mask and fill runs to enable the subtraction technique. Artificial intelligence (AI)-based 3D angiography (3DA) was developed to reduce radiation dosage because only one contrast-enhanced run of the C‑arm system is required for reconstruction of DSA-like 3D volumes. The aim was the evaluation of this algorithm regarding its diagnostic information. METHODS 3D DSA datasets without pathologic findings were reconstructed both with subtraction technique and with the AI-based algorithm. Corresponding reconstructions were evaluated by 2 neuroradiologists with respect to image quality (IQ), visualization of major segments of the circle of Willis (ICA = C4-C7; OphA; ACA = A1-A2, MCA = M1-M2; VA = V4; BA; AICA; SUCA; PCA = P1-P2), identifiability of perforators (lenticulostriate/thalamoperforating arteries) and vessel diameters (ICA = C4; MCA = M1; BA; PCA = P1). RESULTS In total 15 datasets were successfully reconstructed as 3D DSA and 3DA with diagnostic image quality. All major segments of the circle of Willis and perforators were comparably visualized with 3DA. Quantitative analysis of vessel diameters in 3D DSA and 3DA datasets was equivalent and did not show relevant differences (rICA = 0.901, p = 0.001; rM1 = 0.951, p = 0.001; rBA = 0.906, p = 0.001; rP1 = 0.991, p = 0.001). CONCLUSIONS The use of 3DA demonstrated reliable visualization of cerebral vasculature with respect to quantitative and qualitative parameters. Therefore, 3DA is a promising method that might help to reduce patient radiation.
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Affiliation(s)
- Stefan Lang
- Department of Neuroradiology, University of Erlangen-Nuremberg, Schwabachanlage 6, 91054, Erlangen, Germany.
| | - Philip Hoelter
- Department of Neuroradiology, University of Erlangen-Nuremberg, Schwabachanlage 6, 91054, Erlangen, Germany
| | - Manuel Schmidt
- Department of Neuroradiology, University of Erlangen-Nuremberg, Schwabachanlage 6, 91054, Erlangen, Germany
| | - Felix Eisenhut
- Department of Neuroradiology, University of Erlangen-Nuremberg, Schwabachanlage 6, 91054, Erlangen, Germany
| | - Christian Kaethner
- Angiography & Interventional X‑Ray Systems, Siemens Healthcare GmbH, Siemensstraße 1, 91301, Forchheim, Germany
| | - Markus Kowarschik
- Angiography & Interventional X‑Ray Systems, Siemens Healthcare GmbH, Siemensstraße 1, 91301, Forchheim, Germany
| | - Hannes Lücking
- Department of Neuroradiology, University of Erlangen-Nuremberg, Schwabachanlage 6, 91054, Erlangen, Germany
| | - Arnd Doerfler
- Department of Neuroradiology, University of Erlangen-Nuremberg, Schwabachanlage 6, 91054, Erlangen, Germany
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Abe Y, Yuki I, Otani K, Shoji T, Ishibashi T, Murayama Y. Agreement of intracranial vessel diameters measured on 2D and 3D digital subtraction angiography using an automatic windowing algorithm. J Neuroradiol 2019; 48:311-315. [PMID: 31563590 DOI: 10.1016/j.neurad.2019.08.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 08/16/2019] [Accepted: 08/19/2019] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND PURPOSE Precise vessel measurement plays a major role in size selection of stents used for the treatment of intracranial aneurysms and became even more critical after the introduction of flow diverter stents. We assessed agreement between intracranial vessel diameters of aneurysm patients measured on 2D digital subtraction (2D DSA) and 3D volume rendering digital subtraction angiography (3D DSA) images using an automatic windowing algorithm. MATERIALS AND METHODS Ten patients with intracranial aneurysms were enrolled and 120 measurement points were selected on both 2D and 3D DSA images acquired by a biplane angiographic system. Automatic windowing was applied to the 3D DSA images. Inter-method agreement of vessel measurements on 2D and 3D DSA images was assessed by Bland Altman plots and intraclass correlation coefficients (ICC). Inter- and intra-rater agreement of measurements on 3D DSA images were assessed by ICCs. RESULTS The mean differences between measurements on 2D and 3D DSA images were 0.14mm for the ICA, and 0.18mm for the ACA and MCA, which is about the size of one 3D DSA image voxel. For ICA measurements, inter-method, inter-rater and intra-rater agreements were good or excellent (consistency and absolute ICC≥0.95). For ACA and MCA measurements, the inter-method, inter-rater and intra-rater agreements were also good or excellent (consistency ICC=0.94, 0.89 and 0.93, absolute ICC=0.83, 0.84 and 0.85 respectively). CONCLUSIONS Vessel diameters may be measured on 3D DSA images with sufficient reliability for clinical use when applying an automatic windowing algorithm.
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Affiliation(s)
- Y Abe
- Department of Radiology, The Jikei University Hospital, Tokyo, Japan.
| | - I Yuki
- Department of Neurosurgery, The Jikei University School of Medicine, Tokyo, Japan
| | - K Otani
- Siemens Healthcare, Tokyo, Japan
| | - T Shoji
- Department of Radiology, The Jikei University Hospital, Tokyo, Japan
| | - T Ishibashi
- Department of Neurosurgery, The Jikei University School of Medicine, Tokyo, Japan
| | - Y Murayama
- Department of Neurosurgery, The Jikei University School of Medicine, Tokyo, Japan
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Lang S, Hoelter P, Birkhold AI, Schmidt M, Endres J, Strother C, Doerfler A, Luecking H. Quantitative and Qualitative Comparison of 4D-DSA with 3D-DSA Using Computational Fluid Dynamics Simulations in Cerebral Aneurysms. AJNR Am J Neuroradiol 2019; 40:1505-1510. [PMID: 31467234 DOI: 10.3174/ajnr.a6172] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Accepted: 07/01/2019] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE 4D-DSA allows time-resolved 3D imaging of the cerebral vasculature. The aim of our study was to evaluate this method in comparison with the current criterion standard 3D-DSA by qualitative and quantitative means using computational fluid dynamics. MATERIALS AND METHODS 3D- and 4D-DSA datasets were acquired in patients with cerebral aneurysms. Computational fluid dynamics analysis was performed for all datasets. Using computational fluid dynamics, we compared 4D-DSA with 3D-DSA in terms of both aneurysmal geometry (quantitative: maximum diameter, ostium size [OZ1/2], volume) and hemodynamic parameters (qualitative: flow stability, flow complexity, inflow concentration; quantitative: average/maximum wall shear stress, impingement zone, low-stress zone, intra-aneurysmal pressure, and flow velocity). Qualitative parameters were descriptively analyzed. Correlation coefficients (r, P value) were calculated for quantitative parameters. RESULTS 3D- and 4D-DSA datasets of 10 cerebral aneurysms in 10 patients were postprocessed. Evaluation of aneurysmal geometry with 4D-DSA (r maximum diameter = 0.98, P maximum diameter <.001; r OZ1/OZ2 = 0.98/0.86, P OZ1/OZ2 < .001/.002; r volume = 0.98, P volume <.001) correlated highly with 3D-DSA. Evaluation of qualitative hemodynamic parameters (flow stability, flow complexity, inflow concentration) did show complete accordance, and evaluation of quantitative hemodynamic parameters (r average/maximum wall shear stress diastole = 0.92/0.88, P average/maximum wall shear stress diastole < .001/.001; r average/maximum wall shear stress systole = 0.94/0.93, P average/maximum wall shear stress systole < .001/.001; r impingement zone = 0.96, P impingement zone < .001; r low-stress zone = 1.00, P low-stress zone = .01; r pressure diastole = 0.84, P pressure diastole = .002; r pressure systole = 0.9, P pressure systole < .001; r flow velocity diastole = 0.95, P flow velocity diastole < .001; r flow velocity systole = 0.93, P flow velocity systole < .001) did show nearly complete accordance between 4D- and 3D-DSA. CONCLUSIONS Despite a different injection protocol, 4D-DSA is a reliable basis for computational fluid dynamics analysis of the intracranial vasculature and provides equivalent visualization of aneurysm geometry compared with 3D-DSA.
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Affiliation(s)
- S Lang
- From the Department of Neuroradiology (S.L., P.H., M.S., J.E., A.D., H.L.), University of Erlangen-Nuremberg, Erlangen, Germany
| | - P Hoelter
- From the Department of Neuroradiology (S.L., P.H., M.S., J.E., A.D., H.L.), University of Erlangen-Nuremberg, Erlangen, Germany
| | - A I Birkhold
- Siemens Healthcare GmbH (A.I.B.), Erlangen, Germany
| | - M Schmidt
- From the Department of Neuroradiology (S.L., P.H., M.S., J.E., A.D., H.L.), University of Erlangen-Nuremberg, Erlangen, Germany
| | - J Endres
- From the Department of Neuroradiology (S.L., P.H., M.S., J.E., A.D., H.L.), University of Erlangen-Nuremberg, Erlangen, Germany
| | - C Strother
- Department of Radiology (C.S.), Clinical Sciences Center, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - A Doerfler
- From the Department of Neuroradiology (S.L., P.H., M.S., J.E., A.D., H.L.), University of Erlangen-Nuremberg, Erlangen, Germany
| | - H Luecking
- From the Department of Neuroradiology (S.L., P.H., M.S., J.E., A.D., H.L.), University of Erlangen-Nuremberg, Erlangen, Germany
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Marbacher S, Mendelowitsch I, Grüter BE, Diepers M, Remonda L, Fandino J. Comparison of 3D intraoperative digital subtraction angiography and intraoperative indocyanine green video angiography during intracranial aneurysm surgery. J Neurosurg 2019; 131:64-71. [PMID: 30004279 DOI: 10.3171/2018.1.jns172253] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2017] [Accepted: 01/16/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVE During the last decade, improvements in real-time, high-resolution imaging of surgically exposed cerebral vasculature have been realized with the successful introduction of intraoperative indocyanine green video angiography (ICGVA) and technical advances in intraoperative digital subtraction angiography (DSA). With the availability of 3D intraoperative DSA (3D-iDSA) in hybrid operating rooms, the present study offers a contemporary comparison for rates of accuracy and discordance. METHODS In this retrospective study of prospectively collected data, 140 consecutive patients underwent microsurgical treatment of intracranial aneurysms (IAs) in a hybrid operating room. Variables analyzed included patient demographics, aneurysm-specific characteristics, intraoperative ICGVA and 3D-iDSA findings, and the need for intraoperative clip readjustment. The authors defined the discordance rate of the two modalities as a false-negative finding that necessitated clip repositioning after 3D-iDSA. RESULTS In 120 patients, ICGVA and 3D-iDSA were used to evaluate 134 IA obliterations. Of 215 clips used, 29 (14%) were repositioned intraoperatively, improving the surgical result in all 29 patients (24%). Repositioning was prompted by visual inspection and microvascular Doppler ultrasonography in 8 (28%), ICGVA in 13 (45%), and 3D-iDSA in 7 (24%) patients. Clip repositioning was needed in 7 patients (6%) based on 3D-iDSA, yielding an ICGVA accuracy rate of 94%. Five (71%) of the ICGVA-3D-iDSA discordances that prompted clip repositioning occurred at the anterior communicating artery complex. CONCLUSIONS A combination of vascular monitoring techniques most often achieved correct intraoperative interpretation of complete IA occlusion and parent artery integrity. Compared with 3D-iDSA imaging, ICGVA demonstrated high accuracy. Despite the relatively low discordance rate, iDSA was confirmed to be the gold standard. Improved imaging quality, including 3D-iDSA, supports its routine use in IA surgery, obviating the need for postoperative DSA.
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Affiliation(s)
| | | | | | - Michael Diepers
- 2Division of Neuroradiology, Department of Radiology, Kantonsspital Aarau, Switzerland
| | - Luca Remonda
- 2Division of Neuroradiology, Department of Radiology, Kantonsspital Aarau, Switzerland
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Tsuei YS, Luo CB, Fay LY, Yang HC, Guo WY, Wu HM, Chung WY, Teng MMH. Morphologic Change of Flow-Related Aneurysms in Brain Arteriovenous Malformations after Stereotactic Radiosurgery. AJNR Am J Neuroradiol 2019; 40:675-680. [PMID: 30948381 DOI: 10.3174/ajnr.a6018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2018] [Accepted: 01/25/2019] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE The natural history of flow-related aneurysms after obliteration of brain arteriovenous malformations is poorly understood. The purpose of this study was to evaluate the angioarchitecture and morphologic change in flow-related aneurysms after gamma knife surgery of brain arteriovenous malformations. MATERIALS AND METHODS During a 12-year period, 823 patients with brain arteriovenous malformations underwent gamma knife surgery at our institution with complete peritherapeutic angiographic evaluation. From this population, a series of 72 patients (8.8%) with 111 flow-related aneurysms were enrolled (1.5 aneurysms per patient). There were 43 men and 29 women; ages ranged from 18 to 72 years (mean, 43 years). The morphologic change of flow-related aneurysms was longitudinally evaluated before and after obliteration of brain arteriovenous malformations. After gamma knife surgery, angiographic follow-up varied from 26 to 130 months (mean, 58 months). RESULTS All flow-related aneurysms were small (mean, 4.1 mm; range, 2-9 mm). There were 72 proximal flow-related aneurysms (mean size, 4.3 mm) and 39 distal flow-related aneurysms (mean size, 3.7 mm). Spontaneous thrombosis occurred more frequently in distal flow-related aneurysms than in proximal flow-related aneurysms (P < .001). Smaller flow-related aneurysms (<5 mm) tended to spontaneously occlude after obliteration of brain arteriovenous malformations (P = .036). Two patients had ruptures of proximal flow-related aneurysms at 27- and 54-month follow-ups, respectively. CONCLUSIONS Spontaneous thrombosis occurred more frequently in distal flow-related aneurysms due to occlusion or normalization of distal feeders. Smaller flow-related aneurysms also tended to spontaneously thrombose after obliteration of brain arteriovenous malformations. The rate of flow-related aneurysm rupture in our series was similar to that of natural intradural aneurysms.
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Affiliation(s)
- Y-S Tsuei
- From the Department of Neurosurgery (Y.-S.T.), Taichung Veterans General Hospital, Taichung, Taiwan.,Departments of Neurosugery (Y.-S.T.)
| | - C-B Luo
- Radiology (C.-B.L.), Tri-Service General Hospital, National Defenses Medical Center, Taipei, Taiwan .,Departments of Radiology (C.-B.L., W.-Y.G., H.-M.W., M.M.H.T.)
| | - L-Y Fay
- Neurosurgery (L.-Y.F., H.-C.Y., W.-Y.C.), Taipei Veterans General Hospital and National Yang-Ming University, School of Medicine, Taipei, Taiwan
| | - H-C Yang
- Neurosurgery (L.-Y.F., H.-C.Y., W.-Y.C.), Taipei Veterans General Hospital and National Yang-Ming University, School of Medicine, Taipei, Taiwan
| | - W-Y Guo
- Departments of Radiology (C.-B.L., W.-Y.G., H.-M.W., M.M.H.T.)
| | - H-M Wu
- Departments of Radiology (C.-B.L., W.-Y.G., H.-M.W., M.M.H.T.)
| | - W-Y Chung
- Neurosurgery (L.-Y.F., H.-C.Y., W.-Y.C.), Taipei Veterans General Hospital and National Yang-Ming University, School of Medicine, Taipei, Taiwan
| | - M M H Teng
- Departments of Radiology (C.-B.L., W.-Y.G., H.-M.W., M.M.H.T.).,Department of Radiology (M.M.H.T.), Cheng-Hsin General Hospital, Taipei, Taiwan
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Kan I, Kato N, Otani K, Abe Y, Ishibashi T, Murayama Y. Intravenous 3-Dimensional Digital Subtraction Angiography During Surgical Treatment of Intracranial Aneurysm. World Neurosurg 2019; 126:533-536. [PMID: 30862577 DOI: 10.1016/j.wneu.2019.02.160] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 02/19/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND Although intraarterial 3-dimensional digital subtraction angiography (ia-3DDSA) using an angiographic C-arm system is still the gold standard for postoperative confirmation of surgical clipping of intracranial aneurysms, ia-3DDSA requires catheterization and intraarterial injection of contrast medium, which adds risks to the surgical procedure and takes time. We propose a less invasive acquisition of 3D digital subtraction angiography with intravenous injection (iv-3DDSA) in the hybrid operating room to confirm the results of surgical clipping immediately after surgery. CASE DESCRIPTION A 56-year-old woman was diagnosed with an incidental wide-necked aneurysm located at the distal anterior cerebral artery. We performed surgical clipping. During the surgery, indocyanine green video angiography and Doppler ultrasonography were used for confirmation, and after the surgery iv-3DDSA and ia-3DDSA were performed with the angiography C-arm system in the hybrid operating room while the patient was still under anesthesia. We could confirm that there was no neck remnant left and that the parent vessels were patent on both iv-3DDSA and ia-3DDSA images. The image quality of iv-3DDSA was sufficient for all treatment evaluations and offered the additional benefits of visualizing the whole angioarchitecture including the contralateral side, being less invasive, and requiring only a few minutes until the availability of images. CONCLUSIONS Iv-3DDSA can be useful for postsurgical confirmation of clipping of aneurysms in the hybrid operating room.
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Affiliation(s)
- Issei Kan
- Department of Neurosurgery, The Jikei University Hospital, Tokyo, Japan.
| | - Naoki Kato
- Department of Neurosurgery, The Jikei University Hospital, Tokyo, Japan
| | - Katharina Otani
- Siemens Healthcare K.K., AT Innovation Department, Tokyo, Japan
| | - Yukiko Abe
- Department of Radiology, The Jikei University Hospital, Tokyo, Japan
| | | | - Yuichi Murayama
- Department of Neurosurgery, The Jikei University Hospital, Tokyo, Japan
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Behme D, Amelung N, Khakzad T, Psychogios MN. How to Size Intracranial Aneurysms: A Phantom Study of Invasive and Noninvasive Methods. AJNR Am J Neuroradiol 2018; 39:2291-2296. [PMID: 30409851 DOI: 10.3174/ajnr.a5866] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Accepted: 09/17/2018] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Endovascular treatment of intracranial aneurysms has relevantly changed over the past decades. Multiple new devices such as intrasaccular flow diverters have broadened the treatment spectrum but require very exact aneurysm sizing. In this study, we investigated multidetector and flat panel angiographic CT and digital subtraction imaging as well as different postprocessing methods (multiplanar reconstruction, volume-rendering technique, 3D DSA, and conventional 2D angiography) for their ability to exactly size 2 aneurysm models. MATERIALS AND METHODS Two aneurysm models with known aneurysm sizes were placed inside a human skull. After injection of iodine contrast media, imaging was performed using a 128-slice CT scanner or an Artis Q biplane angiosuite, respectively. Aneurysms were measured for width, neck, and height, and the mean difference from the known sizes was calculated for each technique. The technique with the most exact measurement was defined as the criterion standard. We performed Bland-Altman plots comparing all techniques against the criterion standard. RESULTS Angiograms adjusted according a previous 3D run with a short object-to-detector distance resulted in the most exact aneurysm measurement: -0.07 ± 0.61 mm for aneurysm 1 and 0.17 ± 0.39 mm for aneurysm 2. Measurements of conventional DSA images were similar, and CT-based images were significantly inferior to the criterion standard. CONCLUSIONS 2D DSA with a short objective-to-detector distance adjusted according to a previous 3D run resulted in the most exact aneurysm measurement and should therefore be performed before all endovascular aneurysm treatments.
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Affiliation(s)
- D Behme
- From the Department of Diagnostic and Interventional Neuroradiology, University Medical Center Göttingen, Göttingen, Germany
| | - N Amelung
- From the Department of Diagnostic and Interventional Neuroradiology, University Medical Center Göttingen, Göttingen, Germany
| | - T Khakzad
- From the Department of Diagnostic and Interventional Neuroradiology, University Medical Center Göttingen, Göttingen, Germany
| | - M-N Psychogios
- From the Department of Diagnostic and Interventional Neuroradiology, University Medical Center Göttingen, Göttingen, Germany.
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Semiautomatic neck curve reconstruction for intracranial aneurysm rupture risk assessment based on morphological parameters. Int J Comput Assist Radiol Surg 2018; 13:1781-1793. [PMID: 30159832 DOI: 10.1007/s11548-018-1848-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Accepted: 08/14/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE Morphological parameters of intracranial aneurysms (IAs) are well established for rupture risk assessment. However, a manual measurement is error-prone, not reproducible and cumbersome. For an automatic extraction of morphological parameters, a 3D neck curve reconstruction approach to delineate the aneurysm from the parent vessel is required. METHODS We present a 3D semiautomatic aneurysm neck curve reconstruction for the automatic extraction of morphological parameters which was developed and evaluated with an experienced neuroradiologist. We calculate common parameters from the literature and include two novel angle-based parameters: the characteristic dome point angle and the angle difference of base points. RESULTS We applied our method to 100 IAs acquired with rotational angiography in clinical routine. For validation, we compared our approach to manual segmentations yielding highly significant correlations. We analyzed 95 of these datasets regarding rupture state. Statistically significant differences were found in ruptured and unruptured groups for maximum diameter, maximum height, aspect ratio and the characteristic dome point angle. These parameters were also found to statistically significantly correlate with each other. CONCLUSIONS The new 3D neck curve reconstruction provides robust results for all datasets. The reproducibility depends on the vessel tree centerline and the user input for the initial dome point and parameters characterizing the aneurysm neck region. The characteristic dome point angle as a new metric regarding rupture risk assessment can be extracted. It requires less computational effort than the complete neck curve reconstruction.
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Rajabzadeh-Oghaz H, Varble N, Shallwani H, Tutino VM, Mowla A, Shakir HJ, Vakharia K, Atwal GS, Siddiqui AH, Davies JM, Meng H. Computer-Assisted Three-Dimensional Morphology Evaluation of Intracranial Aneurysms. World Neurosurg 2018; 119:e541-e550. [PMID: 30075262 DOI: 10.1016/j.wneu.2018.07.208] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Revised: 07/12/2018] [Accepted: 07/13/2018] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Precise morphologic evaluation is important for intracranial aneurysm (IA) management. At present, clinicians manually measure the IA size and neck diameter on 2-dimensional (2D) digital subtraction angiographic (DSA) images and categorize the IA shape as regular or irregular on 3-dimensional (3D)-DSA images, which could result in inconsistency and bias. We investigated whether a computer-assisted 3D analytical approach could improve IA morphology assessment. METHODS Five neurointerventionists evaluated the size, neck diameter, and shape of 39 IAs using current and computer-assisted 3D approaches. In the computer-assisted 3D approach, the size, neck diameter, and undulation index (UI, a shape irregularity metric) were extracted using semiautomated reconstruction of aneurysm geometry using 3D-DSA, followed by IA neck identification and computerized geometry assessment. RESULTS The size and neck diameter measured using the manual 2D approach were smaller than computer-assisted 3D measurements by 2.01 mm (P < 0.001) and 1.85 mm (P < 0.001), respectively. Applying the definitions of small IAs (<7 mm) and narrow-necked IAs (<4 mm) from the reported data, interrater variation in manual 2D measurements resulted in inconsistent classification of the size of 14 IAs and the necks of 19 IAs. Visual inspection resulted in an inconsistent shape classification for 23 IAs among the raters. Greater consistency was achieved using the computer-assisted 3D approach for size (intraclass correlation coefficient [ICC], 1.00), neck measurements (ICC, 0.96), and shape quantification (UI; ICC, 0.94). CONCLUSIONS Computer-assisted 3D morphology analysis can improve accuracy and consistency in measurements compared with manual 2D measurements. It can also more reliably quantify shape irregularity using the UI. Future application of computer-assisted analysis tools could help clinicians standardize morphology evaluations, leading to more consistent IA evaluations.
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Affiliation(s)
- Hamidreza Rajabzadeh-Oghaz
- Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, New York, USA; Department of Mechanical and Aerospace Engineering, University at Buffalo, Buffalo, New York, USA
| | - Nicole Varble
- Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, New York, USA; Department of Mechanical and Aerospace Engineering, University at Buffalo, Buffalo, New York, USA
| | - Hussain Shallwani
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA; Department of Neurosurgery, Gates Vascular Institute, Kaleida Health, Buffalo, New York, USA
| | - Vincent M Tutino
- Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, New York, USA; Department of Biomedical Engineering, University at Buffalo, Buffalo, New York, USA; Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA; Department of Neurosurgery, Gates Vascular Institute, Kaleida Health, Buffalo, New York, USA
| | - Ashkan Mowla
- Stroke Division, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
| | - Hakeem J Shakir
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA; Department of Neurosurgery, Gates Vascular Institute, Kaleida Health, Buffalo, New York, USA
| | - Kunal Vakharia
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA; Department of Neurosurgery, Gates Vascular Institute, Kaleida Health, Buffalo, New York, USA
| | - Gursant S Atwal
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA; Department of Neurosurgery, Gates Vascular Institute, Kaleida Health, Buffalo, New York, USA
| | - Adnan H Siddiqui
- Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, New York, USA; Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA; Department of Radiology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA; Department of Neurosurgery, Gates Vascular Institute, Kaleida Health, Buffalo, New York, USA; Jacobs Institute, Buffalo, New York, USA
| | - Jason M Davies
- Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, New York, USA; Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA; Department of Biomedical Informatics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA; Department of Neurosurgery, Gates Vascular Institute, Kaleida Health, Buffalo, New York, USA; Jacobs Institute, Buffalo, New York, USA
| | - Hui Meng
- Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, New York, USA; Department of Mechanical and Aerospace Engineering, University at Buffalo, Buffalo, New York, USA; Department of Biomedical Engineering, University at Buffalo, Buffalo, New York, USA; Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA.
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Yang X, Lu J, Wang J, Wang L, Qi P, Hu S, Chen K, Wang D. A clinical study and meta-analysis of carotid stenosis with coexistent intracranial aneurysms. J Clin Neurosci 2018; 52:41-49. [PMID: 29550249 DOI: 10.1016/j.jocn.2018.02.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2017] [Revised: 12/19/2017] [Accepted: 02/22/2018] [Indexed: 10/17/2022]
Abstract
Carotid stenosis (CS) and intracranial aneurysms (IAs) may concur in one person. We studied the prevalence of IAs in CS patients in our retrospectively collected database and systematically reviewed this issue. Five hundred and fifty-seven CS (≥50%) patients confirmed by DSA in our hospital from 2010-06 to 2015-06 were screened for coexistent IAs. After searching the related literatures from English and Chinese journal literature databases, a meta-analysis was performed to pool the prevalence of CS with coexistent IAs. Subgroup analyses were performed to explore the causes of heterogeneity among studies. IAs were detected in 98(17.0%) out of the 577 CS patients. 12 literatures and the present study including a total of 6965 CS patients and 446 cases with coexistent IAs. The pooled prevalence of CS with coexistent IAs was 6.3% (95%CI: 4.2-8.3%) in all the CS patients. The pooled RR for female to male CS patients to have coexistent IAs was 1.67 (95%CI: 1.34-2.08, P = 0.000). 3 studies and the present study were carried out in Asian countries with a pooled prevalence of 10.8% (95%CI: 5.3-16.3%); 6 studies in European countries with 3.0% (95%CI: 2.2-3.7%); and 3 studies in USA with 6.0% (95%CI: 2.2-9.7%). There was a statistically significant difference between the three subgroups (P < 0.001). The prevalence of IAs in CS patients seems higher in our clinical study and the meta-analysis than in the general population and previously reported. The eastern and the women CS patients have a higher risk for coexistent IAs.
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Affiliation(s)
- Ximeng Yang
- Department of Neurosurgery, Beijing Hospital, National Center of Gerontology, Beijing, China
| | - Jun Lu
- Department of Neurosurgery, Beijing Hospital, National Center of Gerontology, Beijing, China
| | - Junjie Wang
- Department of Neurosurgery, Beijing Hospital, National Center of Gerontology, Beijing, China
| | - Lijun Wang
- Department of Neurosurgery, Beijing Hospital, National Center of Gerontology, Beijing, China
| | - Peng Qi
- Department of Neurosurgery, Beijing Hospital, National Center of Gerontology, Beijing, China
| | - Shen Hu
- Department of Neurosurgery, Beijing Hospital, National Center of Gerontology, Beijing, China
| | - Kunpeng Chen
- Department of Neurosurgery, Beijing Hospital, National Center of Gerontology, Beijing, China
| | - Daming Wang
- Department of Neurosurgery, Beijing Hospital, National Center of Gerontology, Beijing, China.
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Ognard J, Magro E, Caroff J, Ben Salem D, Andouard S, Nonent M, Gentric JC. A new time-resolved 3D angiographic technique (4D DSA): Description, and assessment of its reliability in Spetzler-Martin grading of cerebral arteriovenous malformations. J Neuroradiol 2017; 45:177-185. [PMID: 29274362 DOI: 10.1016/j.neurad.2017.11.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Revised: 10/23/2017] [Accepted: 11/19/2017] [Indexed: 01/18/2023]
Abstract
BACKGROUND AND PURPOSE The Spetzler and Martin (SM) cerebral arteriovenous malformation (AVM) classification is a widely used 5-tier classification. This common language allows specialists to exchange about AVMs and must be reliably characterized by the imaging methods. We presented an agreement study on a new method of digital subtracted 3D rotational angiography resolved in time (four-dimensional DSA: 4D DSA) compared to the gold standard (two-dimensional DSA: 2D DSA) in AVM grading using the SM classification. METHODS Ten patients with AVMs were included during one year, they had an angiographic exploration with both 4D DSA and 2D DSA. Three readers assessed the SM classification. One reader conducted a second reading. The inter-, intra-observer and intermodality agreements were calculated by Kappas. Dose to patient was reported. RESULTS Considering the SM grade, the inter-observer agreement between 4D DSA and 2D DSA was equivalent (κ=0.45 and 0.46), and calculated as substantial κ=0.76 between the 2 methods. The agreement between 4D DSA and 2D DSA was calculated as moderate κ=0.46 assessing the size of the nidus, slight κ=0.18 analyzing the drainage and almost perfect κ=0.95 depicting the localization. 4D DSA performed during a standard initial angiographic assessment of AVM represented approximately 6% of the total dose. CONCLUSION The addition of this new technique 4D DSA could be performed regularly in addition to the 2D DSA if available, to assess SM grading, with an acceptable exposure to ionizing radiation.
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Affiliation(s)
- Julien Ognard
- Service d'imagerie médicale, CHU de la Cavale-Blanche, boulevard Tanguy-Prigent, 29609 Brest, France; Inserm UMR 1101, laboratoire de traitement de l'information médicale (LaTIM), 5, avenue Foch, 29200 Brest cedex, France.
| | - Elsa Magro
- Inserm UMR 1101, laboratoire de traitement de l'information médicale (LaTIM), 5, avenue Foch, 29200 Brest cedex, France; Service de neurochirurgie, CHU de la Cavale-Blanche, boulevard Tanguy-Prigent, 29609 Brest, France
| | - Jildaz Caroff
- Service de neuroradiologie interventionnelle, hôpital Bicêtre, AP-HP, 78, rue du Général-Leclerc, 94270 Le Kremlin-Bicêtre, France
| | - Douraied Ben Salem
- Service d'imagerie médicale, CHU de la Cavale-Blanche, boulevard Tanguy-Prigent, 29609 Brest, France; Inserm UMR 1101, laboratoire de traitement de l'information médicale (LaTIM), 5, avenue Foch, 29200 Brest cedex, France
| | - Sebastien Andouard
- SIEMENS S.A.S. Division Healthcare, service application, 40, avenue des Fruitiers, 93200 Saint-Denis, France
| | - Michel Nonent
- Service d'imagerie médicale, CHU de la Cavale-Blanche, boulevard Tanguy-Prigent, 29609 Brest, France; Groupe d'étude de la thrombose occidentale, CHU de la Cavale-Blanche, boulevard Tanguy-Prigent, 29609 Brest, France
| | - Jean-Christophe Gentric
- Service d'imagerie médicale, CHU de la Cavale-Blanche, boulevard Tanguy-Prigent, 29609 Brest, France; Groupe d'étude de la thrombose occidentale, CHU de la Cavale-Blanche, boulevard Tanguy-Prigent, 29609 Brest, France
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Sun J, Li Z, Lu C, Chen X, Chen M, Ba H, Lin Q. Application of 3D–DSA simulated surgical path in intracranial aneurysm clipping surgery. Chin Neurosurg J 2017. [DOI: 10.1186/s41016-017-0105-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Borota L, Patz A. Flexible lateral isocenter: A novel mechanical functionality contributing to dose reduction in neurointerventional procedures. Interv Neuroradiol 2017; 23:669-675. [PMID: 28944706 PMCID: PMC5814073 DOI: 10.1177/1591019917728260] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Aim of the study A new functionality that enables vertical mobility of the lateral arm of a
biplane angiographic machine is referred to as the flexible lateral
isocenter. The aim of this study was to analyze the impact of the flexible
lateral isocenter on the air-kerma rate under experimental conditions. Material and methods An anthropomorphic head-and-chest phantom with anteroposterior (AP) diameter
of the chest varying from 22 cm to 30 cm simulated human bodies of different
body constitutions. The angulation of the AP arm in the sagittal plane
varied from 35 degrees to 55 degrees for each AP diameter. The air-kerma
rate (mGy/min) values were read from the system dose display in two settings
for each angle: flexible lateral isocenter and fixed lateral isocenter. Results The air-kerma rate was significantly lower for all AP diameters of the chest
of the phantom when the flexible lateral isocenter was used: (a) For 22 cm,
the p value was 0.028; (b) For 25 cm, the
p value was 0.0169; (c) For 28 cm, the
p value was 0.01005 and (d) For 30 cm, the
p value was 0.01703. Conclusion Our results show that the flexible lateral isocenter contributes
significantly to the reduction of the air-kerma rate, and thus to a safer
environment in terms of dose lowering both for patients and staff.
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Affiliation(s)
- Ljubisa Borota
- 1 Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Andreas Patz
- 2 Toshiba Medical Systems Europe, Zoetermeer, the Netherlands
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Yang ZL, Ni QQ, Schoepf UJ, De Cecco CN, Lin H, Duguay TM, Zhou CS, Zhao YE, Lu GM, Zhang LJ. Small Intracranial Aneurysms: Diagnostic Accuracy of CT Angiography. Radiology 2017; 285:941-952. [PMID: 28654338 DOI: 10.1148/radiol.2017162290] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Purpose To assess the accuracy of computed tomographic (CT) angiography for diagnosis of cerebral aneurysms 5 mm or smaller, with digital subtraction angiography (DSA) as the reference standard, in a large patient cohort Materials and Methods This retrospective study was approved by the local institutional review board with a waiver of written informed consent. A total of 1366 patients who underwent cerebral CT angiography followed by DSA were included. The performance of CT angiography for depiction of aneurysms was evaluated by two readers on a per-patient and per-aneurysm basis and based on size of aneurysm, location, and status of rupture. The performance of CT angiography for diagnosis of aneurysms of different size, location, and rupture status was compared by using χ2 test. κ statistic was used to assess interreader agreement for diagnosis of aneurysms. Results Of 1366 patients, 579 patients had 711 small aneurysms at DSA. By using DSA as the reference standard, the respective sensitivity, specificity, and accuracy of CT angiography for readers 1 and 2 for detection of small aneurysms on a per-patient basis were 97.1% (562 of 579) and 97.4% (564 of 579), 98.5% (451 of 458) and 99.1% (454 of 458), and 97.7% (1013 of 1037) and 98.2% (1018 of 1037) and those on a per-aneurysm basis were 95.2% (677 of 711) and 95.4% (678 of 711), 96.6% (451 of 467) and 97.0% (454 of 468), and 95.8% (1128 of 1178) and 96.0% (1132 of 1179). The sensitivities of CT angiography were lower for detection of aneurysms smaller than 3 mm and unruptured compared with aneurysms that were 3-5 mm and ruptured (P < .001). No difference existed for the sensitivities of CT angiography for diagnosis of aneurysms in the anterior versus posterior circulation (P > .0167). Excellent or good interreader agreement was found for detection of intracranial aneurysms on a per-patient (κ = 0.982) and per-aneurysm (κ = 0.748) basis. Conclusion This large cohort study demonstrated that CT angiography had high accuracy for detection of small cerebral aneurysms, including those smaller than 3 mm. © RSNA, 2017 Online supplemental material is available for this article.
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Affiliation(s)
- Zhen Lu Yang
- From the Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu 210002, China (Z.L.Y., Q.Q.N., U.J.S., C.S.Z., Y.E.Z., G.M.L., L.J.Z.); and Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC (U.J.S., C.N.D.C., H.L., T.M.D.)
| | - Qian Qian Ni
- From the Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu 210002, China (Z.L.Y., Q.Q.N., U.J.S., C.S.Z., Y.E.Z., G.M.L., L.J.Z.); and Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC (U.J.S., C.N.D.C., H.L., T.M.D.)
| | - U Joseph Schoepf
- From the Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu 210002, China (Z.L.Y., Q.Q.N., U.J.S., C.S.Z., Y.E.Z., G.M.L., L.J.Z.); and Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC (U.J.S., C.N.D.C., H.L., T.M.D.)
| | - Carlo N De Cecco
- From the Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu 210002, China (Z.L.Y., Q.Q.N., U.J.S., C.S.Z., Y.E.Z., G.M.L., L.J.Z.); and Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC (U.J.S., C.N.D.C., H.L., T.M.D.)
| | - Han Lin
- From the Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu 210002, China (Z.L.Y., Q.Q.N., U.J.S., C.S.Z., Y.E.Z., G.M.L., L.J.Z.); and Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC (U.J.S., C.N.D.C., H.L., T.M.D.)
| | - Taylor M Duguay
- From the Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu 210002, China (Z.L.Y., Q.Q.N., U.J.S., C.S.Z., Y.E.Z., G.M.L., L.J.Z.); and Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC (U.J.S., C.N.D.C., H.L., T.M.D.)
| | - Chang Sheng Zhou
- From the Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu 210002, China (Z.L.Y., Q.Q.N., U.J.S., C.S.Z., Y.E.Z., G.M.L., L.J.Z.); and Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC (U.J.S., C.N.D.C., H.L., T.M.D.)
| | - Yan E Zhao
- From the Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu 210002, China (Z.L.Y., Q.Q.N., U.J.S., C.S.Z., Y.E.Z., G.M.L., L.J.Z.); and Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC (U.J.S., C.N.D.C., H.L., T.M.D.)
| | - Guang Ming Lu
- From the Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu 210002, China (Z.L.Y., Q.Q.N., U.J.S., C.S.Z., Y.E.Z., G.M.L., L.J.Z.); and Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC (U.J.S., C.N.D.C., H.L., T.M.D.)
| | - Long Jiang Zhang
- From the Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu 210002, China (Z.L.Y., Q.Q.N., U.J.S., C.S.Z., Y.E.Z., G.M.L., L.J.Z.); and Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC (U.J.S., C.N.D.C., H.L., T.M.D.)
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Maldaner N, Stienen MN, Bijlenga P, Croci D, Zumofen DW, Dalonzo D, Marbacher S, Maduri R, Daniel RT, Serra C, Esposito G, Neidert MC, Bozinov O, Regli L, Burkhardt JK. Interrater Agreement in the Radiologic Characterization of Ruptured Intracranial Aneurysms Based on Computed Tomography Angiography. World Neurosurg 2017; 103:876-882.e1. [PMID: 28461281 DOI: 10.1016/j.wneu.2017.04.131] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Revised: 04/18/2017] [Accepted: 04/20/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To determine interrater agreement in the initial radiologic characterization of ruptured intracranial aneurysms based on computed tomography angiography (CTA) with special emphasis on the rater's level of experience. METHODS One junior and one senior rater of 5 high-volume neurovascular tertiary centers evaluated anonymized CTA images of 30 consecutive patients with aneurysmal subarachnoid hemorrhage. Each rater described location, side, size, and morphology in a standardized manner. Interrater variability was analyzed using intraclass correlation and Fleiss' kappa analysis. RESULTS There was a high level of agreement for location (κ = 0.76, 95% confidence interval [CI] 0.74-0.79), side (κ = 0.95, CI 0.91-0.99), maximum diameter (intraclass correlation coefficient [ICC] 0.81, CI 0.70-0.90), and dome (ICC 0.78, CI 0.66-0.88) of intracranial aneurysms. In contrast, a lower level of agreement was observed for aneurysms' neck diameter (ICC 0.39, CI 0.28-0.58), the presence of multiple aneurysms (κ = 0.35, CI 0.30-0.40), and aneurysm morphology (blister κ = 0.11, CI -0.05 to 0.07; fusiform κ = 0.54, CI 0.48-0.60; multilobular, κ = 0.39 CI 0.33-0.45). The interrater agreement in the senior rater group was greater than in the junior rater group. CONCLUSIONS Interrater agreement confirms the benefit of CTA as initial diagnostic imaging in ruptured intracranial aneurysms but not for aneurysm morphology and presence of multiple aneurysms. A trend towards greater interrater agreement between more experienced raters was noticed.
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Affiliation(s)
- Nicolai Maldaner
- Department of Neurosurgery, University Hospital Zurich, Zurich, Switzerland.
| | - Martin N Stienen
- Department of Neurosurgery, University Hospital Zurich, Zurich, Switzerland; Department of Neurosurgery, University Clinic Geneva, Geneva, Switzerland
| | - Philippe Bijlenga
- Department of Neurosurgery, University Clinic Geneva, Geneva, Switzerland
| | - Davide Croci
- Department of Neurosurgery, Basel University Hospital, Basel, Switzerland
| | - Daniel W Zumofen
- Department of Neurosurgery, Basel University Hospital, Basel, Switzerland; Section for Diagnostic and Interventional Neuroradiology, Department of Radiology, Basel University Hospital, Basel, Switzerland
| | - Donato Dalonzo
- Department of Neurosurgery, Kantonsspital Aarau, Aarau, Switzerland
| | - Serge Marbacher
- Department of Neurosurgery, Kantonsspital Aarau, Aarau, Switzerland
| | - Rodolfo Maduri
- Department of Neurosurgery, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Roy Thomas Daniel
- Department of Neurosurgery, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Carlo Serra
- Department of Neurosurgery, University Hospital Zurich, Zurich, Switzerland
| | - Giuseppe Esposito
- Department of Neurosurgery, University Hospital Zurich, Zurich, Switzerland
| | | | - Oliver Bozinov
- Department of Neurosurgery, University Hospital Zurich, Zurich, Switzerland
| | - Luca Regli
- Department of Neurosurgery, University Hospital Zurich, Zurich, Switzerland
| | - Jan-Karl Burkhardt
- Department of Neurosurgery, University Hospital Zurich, Zurich, Switzerland
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Shang S, Ye J, Luo X, Qu J, Zhen Y, Wu J. Follow-up assessment of coiled intracranial aneurysms using zTE MRA as compared with TOF MRA: a preliminary image quality study. Eur Radiol 2017; 27:4271-4280. [PMID: 28382536 DOI: 10.1007/s00330-017-4794-z] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Revised: 02/15/2017] [Accepted: 03/07/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVES To prospectively assess coiled intracranial aneurysms using a novel non-contrast enhanced zero echo time (zTE) MR angiography (MRA) method, and compare its image quality with time-of-flight (TOF) MRA, using digital subtraction angiography (DSA) as reference. METHODS Twenty-five patients (10 males and 15 females; age 53.96 ± 12.46 years) were enrolled in this monocentric study. MRA sequences were performed 24 h before DSA. Susceptibility artefact intensity and flow signal within the parent artery were carried out using a 4-point scale. Occlusion status was assessed using the 3-grade Montreal scale. RESULTS Scores of zTE were higher than TOF for both susceptibility artefact intensity (3.42 ± 0.64, 2.92 ± 0.63, P = 0.01) and flow signal (3.66 ± 0.95, 3.24 ± 1.24, P = 0.01). DSA revealed 17 complete occlusions, five residual neck aneurysms and two residual aneurysms. Inter-observer agreement was excellent (weighted κ: 0.89) for zTE and good (weighted κ: 0.68) for TOF. Intermodality agreement was excellent for zTE (weighted κ: 0.95) and good for TOF (weighted κ: 0.80). Correlations of both MRA sequences with DSA were high (zTE, Spearman's ρ: 0.91; TOF, Spearman's ρ: 0.81). CONCLUSIONS zTE MRA showed promising results for follow-up assessment of coiled intracranial aneurysms and was superior to TOF MRA for visualizing the parent artery and evaluating occlusion status. KEY POINTS • Various MRA sequences were applied for follow-up assessment of coiled intracranial aneurysms. • zTE MRA was less sensitive to susceptibility artefacts and haemodynamics. • In this monocentric study, zTE MRA was equivalent to DSA. • zTE MRA maybe an alternative to TOF MRA for follow-up assessment.
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Affiliation(s)
- Song'an Shang
- Department of Radiology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, 410011, China
| | - Jing Ye
- Department of Radiology, Northern Jiangsu People's Hospital, Yangzhou, Jiangsu, 225001, China
| | - Xianfu Luo
- Department of Radiology, Northern Jiangsu People's Hospital, Yangzhou, Jiangsu, 225001, China
| | - Jianxun Qu
- MR Enhanced Application, GE Healthcare, Beijing, 100176, China
| | - Yong Zhen
- Department of Neurosurgery, Northern Jiangsu People's Hospital, Yangzhou, Jiangsu, 225001, China
| | - Jingtao Wu
- Department of Radiology, Northern Jiangsu People's Hospital, Yangzhou, Jiangsu, 225001, China.
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Sandoval-Garcia C, Yang P, Schubert T, Schafer S, Hetzel S, Ahmed A, Strother C. Comparison of the Diagnostic Utility of 4D-DSA with Conventional 2D- and 3D-DSA in the Diagnosis of Cerebrovascular Abnormalities. AJNR Am J Neuroradiol 2017; 38:729-734. [PMID: 28279986 DOI: 10.3174/ajnr.a5137] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Accepted: 11/15/2016] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE 4D-DSA is a time-resolved technique that allows viewing of a contrast bolus at any time and from any desired viewing angle. Our hypothesis was that the information content in a 4D-DSA reconstruction was essentially equivalent to that in a combination of 2D acquisitions and a 3D-DSA reconstruction. MATERIALS AND METHODS Twenty-six consecutive patients who had both 2D- and 3D-DSA acquisitions were included in the study. The angiography report was used to obtain diagnoses and characteristics of abnormalities. Diagnoses included AVM/AVFs, aneurysms, stenosis, and healthy individuals. 4D-DSA reconstructions were independently reviewed by 3 experienced observers who had no part in the clinical care. Using an electronic evaluation form, these observers recorded their assessments based only on the 4D reconstructions. The clinical evaluations were then compared with the 4D evaluations for diagnosis and lesion characteristics. RESULTS Results showed both interrater and interclass agreements (κ = 0.813 and 0.858). Comparing the 4D diagnosis with the clinical diagnosis for the 3 observers yielded κ values of 0.906, 0.912, and 0.906. The κ values for agreement among the 3 observers for the type of abnormality were 0.949, 0.845, and 0.895. There was complete agreement on the presence of an abnormality between the clinical and 4D-DSA in 23/26 cases. In 2 cases, there were conflicting opinions. CONCLUSIONS In this study, the information content of 4D-DSA reconstructions was largely equivalent to that of the combined 2D/3D studies. The availability of 4D-DSA should reduce the requirement for 2D-DSA acquisitions.
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Affiliation(s)
| | - P Yang
- Department of Neurosurgery (P.Y.), Changhai Hospital, Second Military Medical University, Shanghai, China
| | | | - S Schafer
- Siemens Healthineers, USA (S.S.), Hoffman Estates, Illinois
| | - S Hetzel
- Biostatistics and Medical Informatics (S.H.), University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - A Ahmed
- From the Departments of Neurological Surgery (C.S.-G., A.A.)
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Laviña B. Brain Vascular Imaging Techniques. Int J Mol Sci 2016; 18:ijms18010070. [PMID: 28042833 PMCID: PMC5297705 DOI: 10.3390/ijms18010070] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Revised: 12/13/2016] [Accepted: 12/26/2016] [Indexed: 12/13/2022] Open
Abstract
Recent major improvements in a number of imaging techniques now allow for the study of the brain in ways that could not be considered previously. Researchers today have well-developed tools to specifically examine the dynamic nature of the blood vessels in the brain during development and adulthood; as well as to observe the vascular responses in disease situations in vivo. This review offers a concise summary and brief historical reference of different imaging techniques and how these tools can be applied to study the brain vasculature and the blood-brain barrier integrity in both healthy and disease states. Moreover, it offers an overview on available transgenic animal models to study vascular biology and a description of useful online brain atlases.
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Affiliation(s)
- Bàrbara Laviña
- Department of Immunology, Genetics and Pathology, Rudbeck Laboratory, Uppsala University, 75185 Uppsala, Sweden.
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Potter CA, Fink KR, Ginn AL, Haynor DR. Perimesencephalic Hemorrhage: Yield of Single versus Multiple DSA Examinations-A Single-Center Study and Meta-Analysis. Radiology 2016; 281:858-864. [PMID: 27232640 DOI: 10.1148/radiol.2016152402] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Purpose To quantify the rate of detection of aneurysms at follow-up digital subtraction angiography (DSA) after initial DSA with results negative for aneurysms in subjects with perimesencephalic (PM) nonaneurysmal subarachnoid hemorrhage. Materials and Methods This single-center retrospective study and meta-analysis was approved by the institutional review board. At a single institution from 2000 to 2013, 252 consecutive patients with subarachnoid hemorrhage at computed tomography (CT) and two DSA examinations negative for aneurysm within 10 days were evaluated for inclusion in the study, and 131 met CT criteria for PM nonaneurysmal subarachnoid hemorrhage (53 women; mean age, 53 years [range, 33-88 years]). DS angiographic reports were reviewed for causative abnormalities. Three reviewers searched MEDLINE and electronic databases for studies that reported detection of aneurysm in subjects with PM hemorrhage who had undergone multiple DSA examinations. Main inclusion criteria were PM hemorrhage at CT per van Gijn classification, head CT performed within 72 hours of symptom onset, initial DS angiographic results negative for aneurysm, and two DSA examinations within 10 days. Studies with fewer than 25 subjects were excluded. Methodology was assessed by using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The summary rate of aneurysm detection for subsequent DSA was calculated by using a fixed-effects model. Results Six studies with 298 subjects and a single-institution study with 131 subjects were included. No aneurysms were seen at follow-up DSA in the single-center study (0.0%). Three aneurysms were detected at follow-up DSA in three of six studies from the literature (one of 29 [3.4%], one of 65 [1.5%], and one of 34 [2.9%] patients). Two occurred in cases that likely preceded the use of the current DSA technique. The summary aneurysm detection rate at subsequent DSA was 1.6% (95% confidence interval: 0.7%, 3.8%; range of individual study detection rate: 0.0%-3.4%). Conclusion In patients with PM nonaneurysmal subarachnoid hemorrhage and initial DSA negative for aneurysms, the yield of follow-up DSA for detection of causative aneurysms is very low. © RSNA, 2016 Online supplemental material is available for this article.
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Affiliation(s)
- Christopher A Potter
- From the Neuroradiology Section, Department of Radiology, University of Washington, Seattle, Wash
| | - Kathleen R Fink
- From the Neuroradiology Section, Department of Radiology, University of Washington, Seattle, Wash
| | - Amanda L Ginn
- From the Neuroradiology Section, Department of Radiology, University of Washington, Seattle, Wash
| | - David R Haynor
- From the Neuroradiology Section, Department of Radiology, University of Washington, Seattle, Wash
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Li Y, Niu K, Yang P, Aagaard-Kienitz B, Niemann DB, Ahmed AS, Strother C, Chen GH. Mask free Intravenous 3D Digital Subtraction Angiography (IV 3D-DSA) from a single C-arm acquisition. PROCEEDINGS OF SPIE--THE INTERNATIONAL SOCIETY FOR OPTICAL ENGINEERING 2016; 9783:97830V. [PMID: 29200594 PMCID: PMC5710838 DOI: 10.1117/12.2216869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Currently, clinical acquisition of IV 3D-DSA requires two separate scans: one mask scan without contrast medium and a filled scan with contrast injection. Having two separate scans adds radiation dose to the patient and increases the likelihood of suffering inadvertent patient motion induced mis-registration and the associated mis-registraion artifacts in IV 3D-DSA images. In this paper, a new technique, SMART-RECON is introduced to generate IV 3D-DSA images from a single Cone Beam CT (CBCT) acquisition to eliminate the mask scan. Potential benefits of eliminating mask scan would be: (1) both radiation dose and scan time can be reduced by a factor of 2; (2) intra-sweep motion can be eliminated; (3) inter-sweep motion can be mitigated. Numerical simulations were used to validate the algorithm in terms of contrast recoverability and the ability to mitigate limited view artifacts.
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Affiliation(s)
- Yinsheng Li
- Department of Medical Physics, University of Wisconsin-Madison, WI 53705
| | - Kai Niu
- Department of Medical Physics, University of Wisconsin-Madison, WI 53705
| | - Pengfei Yang
- Department of Radiology, University of Wisconsin-Madison, WI 53792
| | | | - David B Niemann
- Department of Neurological Surgery,University of Wisconsin-Madison, WI, 53792
| | - Azam S Ahmed
- Department of Neurological Surgery,University of Wisconsin-Madison, WI, 53792
| | - Charles Strother
- Department of Radiology, University of Wisconsin-Madison, WI 53792
| | - Guang-Hong Chen
- Department of Medical Physics, University of Wisconsin-Madison, WI 53705
- Department of Radiology, University of Wisconsin-Madison, WI 53792
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Thompson BG, Brown RD, Amin-Hanjani S, Broderick JP, Cockroft KM, Connolly ES, Duckwiler GR, Harris CC, Howard VJ, Johnston SCC, Meyers PM, Molyneux A, Ogilvy CS, Ringer AJ, Torner J. Guidelines for the Management of Patients With Unruptured Intracranial Aneurysms: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke 2015; 46:2368-400. [PMID: 26089327 DOI: 10.1161/str.0000000000000070] [Citation(s) in RCA: 696] [Impact Index Per Article: 69.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
PURPOSE The aim of this updated statement is to provide comprehensive and evidence-based recommendations for management of patients with unruptured intracranial aneurysms. METHODS Writing group members used systematic literature reviews from January 1977 up to June 2014. They also reviewed contemporary published evidence-based guidelines, personal files, and published expert opinion to summarize existing evidence, indicate gaps in current knowledge, and when appropriate, formulated recommendations using standard American Heart Association criteria. The guideline underwent extensive peer review, including review by the Stroke Council Leadership and Stroke Scientific Statement Oversight Committees, before consideration and approval by the American Heart Association Science Advisory and Coordinating Committee. RESULTS Evidence-based guidelines are presented for the care of patients presenting with unruptured intracranial aneurysms. The guidelines address presentation, natural history, epidemiology, risk factors, screening, diagnosis, imaging and outcomes from surgical and endovascular treatment.
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