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Yu J, Hu M, Zhang J, Chen J. Analyzing characteristics of collateral flow to parasylvian cortical arteries by three-dimensional digital subtraction angiography-magnetic resonance angiography fusion imaging in adult moyamoya disease. Front Neurol 2023; 14:1251844. [PMID: 37808502 PMCID: PMC10551150 DOI: 10.3389/fneur.2023.1251844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Accepted: 08/24/2023] [Indexed: 10/10/2023] Open
Abstract
Objective The hemodynamic sources of recipient parasylvian cortical arteries (PSCAs) were significantly related to postoperative cerebral hyperperfusion (CHP) after bypass surgery in patients with moyamoya disease (MMD). The present study aimed to introduce a new method to investigate the characteristics of PSCAs hemodynamic sources and their relationships with clinical presentations in adult MMD and to provide preoperative evaluation for recipient vessel selection in MMD bypass surgery. Methods The hemodynamic sources of the PSCAs in 171 symptomatic MMD hemispheres were analyzed by three-dimensional digital subtraction angiography (3D-DSA) combined with magnetic resonance angiography (MRA) fusion imaging. The spatial and temporal characteristics of the hemodynamic sources of the PSCAs and their associations with the patient's demographics, Suzuki stage, and initial onset type were investigated. Results Six major types of hemodynamic sources in the PSCAs were observed. There was a significant difference between the hemodynamic sources of the PSCAs above and below the SF (P < 0.001). With advancing Suzuki stages, collateral flow to the PSCAs above the SF from the internal carotid arteries (ICAs) significantly decreased, while the non-ICAs increased (P < 0.001). Multivariate analysis revealed that hemodynamic sources of the PSCAs above the SF were significantly associated with patients' initial onset type (P = 0.026). Conclusion In MMD hemispheres, the hemodynamic sources of the PSCAs above the SF are more varied than those below the SF and present a typical conversion trend from ICAs to non-ICAs with advancing Suzuki stages. Analyzing the hemodynamic sources of the PSCAs can help in understanding the conversion pattern of compensatory vascular systems, predicting episodes in MMD, and preoperatively evaluating suitable recipient vessel selection for bypass surgery to avoid postoperative CHP.
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Affiliation(s)
| | | | - Jianjian Zhang
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Jincao Chen
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan, China
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2
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Ognard J, Magro E, Caroff J, Bodani V, Mosimann PJ, Gentric JC. Endovascular Management of Brain Arteriovenous Malformations. Semin Neurol 2023; 43:323-336. [PMID: 37276887 DOI: 10.1055/a-2105-6614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Due to the risk of cerebral hemorrhage, and its related morbidity-mortality, brain arteriovenous malformations (bAVMs) are a rare and potentially life-threatening disease. Despite this, there is only one randomized controlled trial on bAVM management, A Randomized trial of Unruptured Brain Arteriovenous malformations (ARUBA). The results of the ARUBA trial favor a noninterventional approach in the case of an unruptured bAVM; however, implementation of these findings is challenging in daily practice. Instead, management of bAVM relies on multidisciplinary discussions that lead to patient-specific strategies based on patient preferences, local expertise, and experience in referral centers. Considering the diverse patterns of presentation and numerous treatment modalities, implementing standardized guidelines in this context proves challenging, notwithstanding the recommendations or expert opinions offered. Endovascular treatment (EVT) of bAVM can be curative, or can serve as an adjunct treatment prior to surgery or radiosurgery ("pre-EVT"). EVT practice is in constant evolution (i.e., venous approach, combination with surgery during the same anesthesia, etc.). Liquid embolic agents such as ethylene vinyl alcohol (EVOH) copolymer and cyanoacrylates (CYA), and their method of injection to increase bAVM occlusion have also benefited from technical evolutions such as the use of adjunctive flow arrest techniques (mini balloons, pressure cooker technique, and multiple catheters). Further research is necessary to evaluate the advantages and disadvantages of EVT for bAVM.
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Affiliation(s)
- Julien Ognard
- Department of Interventional Neuroradiology, Brest University Hospital, Brest, France
- Inserm, UMR 1101 (Laboratoire de Traitement de l'Information Médicale-LaTIM), Université de Bretagne Occidentale, Brest, France
| | - Elsa Magro
- Inserm, UMR 1101 (Laboratoire de Traitement de l'Information Médicale-LaTIM), Université de Bretagne Occidentale, Brest, France
- Department of Neurosurgery, Brest University Hospital, Brest, France
| | - Jildaz Caroff
- Department of Interventional Neuroradiology, NEURI Brain Vascular Center, Bicêtre Hospital, APHP, Paris Saclay University, Le Kremlin-Bicêtre, France
| | - Vivek Bodani
- Division of Neuroradiology, Joint Department of Medical Imaging, Toronto Western Hospital and University of Toronto, Toronto, Ontario, Canada
| | - Pascal John Mosimann
- Division of Neuroradiology, Joint Department of Medical Imaging, Toronto Western Hospital and University of Toronto, Toronto, Ontario, Canada
| | - Jean-Christophe Gentric
- Department of Interventional Neuroradiology, Brest University Hospital, Brest, France
- Inserm, UMR 1304 (GETBO), Western Brittany Thrombosis Study Group, Université de Bretagne Occidentale, Brest, France
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Dimancea A, Trebern H, Sourour N, Lenck S, Clarençon F, Shotar E. Superselective 3D digital subtraction angiography and magnetic resonance fusion imaging for the management of micro-arteriovenous malformations. J Neuroradiol 2023; 50:366-367. [PMID: 36841511 DOI: 10.1016/j.neurad.2023.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Accepted: 02/21/2023] [Indexed: 02/27/2023]
Abstract
Cerebral micro-arteriovenous malformations (AVM) are defined by an infracentimetric nidus or a nidus solely visible on superselective digital subtraction angiography (DSA).12 While representing a minority of brain AVMs, intracerebral hemorrhage is a frequent manifestation in this subset of AMVs.2 Micro-AVMs are often occult lesions, with superselective DSA being instrumental for increasing diagnostic yield.13 While superselective three-dimensional DSA (3D-DSA)/MR fusion imaging has been employed to better delineate anatomical proximity in cerebral AVMs with a visible nidus on MRI,4 this fusion algorithm has not yet been used for describing the relationship of micro-AVMs nidus and afferent arteries with neighboring structures, in order to guide endovascular and microsurgical procedures. In this technical video (Video 1), we present 3 cases regarding micro-AVM embolization, in which superselective 3D-DSA/MR fusion imaging aided therapeutic decision, by defining the local anatomy and allowing a safer procedure.
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Affiliation(s)
- Alexandru Dimancea
- Department of Interventional Neuroradiology, Pitié-Salpêtrière Hospital, Paris, France.
| | - Hugo Trebern
- Department of Interventional Neuroradiology, Pitié-Salpêtrière Hospital, Paris, France
| | - Nader Sourour
- Department of Interventional Neuroradiology, Pitié-Salpêtrière Hospital, Paris, France
| | - Stéphanie Lenck
- Department of Interventional Neuroradiology, Pitié-Salpêtrière Hospital, Paris, France; Sorbonne Université, Paris, France; Inserm UMR 1127, Paris Brain Institute, Paris, France
| | - Frédéric Clarençon
- Department of Interventional Neuroradiology, Pitié-Salpêtrière Hospital, Paris, France; Sorbonne Université, Paris, France
| | - Eimad Shotar
- Department of Interventional Neuroradiology, Pitié-Salpêtrière Hospital, Paris, France
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Shimada K, Miyake K, Yamaguchi I, Sogabe S, Korai M, Kanematsu Y, Takagi Y. Efficacy of Utilizing Both 3-Dimensional Multimodal Fusion Image and Intra-Arterial Indocyanine Green Videoangiography in Cerebral Arteriovenous Malformation Surgery. World Neurosurg 2023; 169:e260-e269. [PMID: 36332776 DOI: 10.1016/j.wneu.2022.10.121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 10/30/2022] [Indexed: 11/17/2022]
Abstract
OBJECTIVE An understanding of the complex morphology of an arteriovenous malformation (AVM) is important for successful resection. We have previously reported the utility of intra-arterial indocyanine green (ICG) videoangiography for this purpose, but that method cannot detect the angioarchitecture covered by brain tissue. 3-dimensional (3D) multimodal fusion imaging is reportedly useful for this same purpose, but cannot always visualize the exact angioarchitecture due to poor source images and processing techniques. This study examined the results of utilizing both techniques in patients with AVMs. METHODS Both techniques were applied in 12 patients with AVMs. Both images were compared with surgical views and evaluated by surgeons. RESULTS Although evaluations for identifying superficial feeders by ICG videoangiography were high in all cases, the more complicated the AVM, the lower the evaluation by 3D multimodal fusion imaging. Conversely, evaluation of the estimated range of the nidus was high in all cases by 3D multimodal fusion imaging, but low in all but one case by ICG videoangiography. Nidus flow reduction was recognized by Flow 800 analysis obtained after ICG videoangiography. CONCLUSIONS These results showed that utilizing both techniques together was more useful than each modality alone in AVM surgery. This was particularly effective in identifying superficial feeders and estimating the range of the nidus. This technique is expected to offer an optimal tool for AVM surgery.
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Affiliation(s)
- Kenji Shimada
- Department of Neurosurgery, Tokushima University, Tokushima, Tokushima, Japan.
| | - Kazuhisa Miyake
- Department of Neurosurgery, Tokushima University, Tokushima, Tokushima, Japan
| | - Izumi Yamaguchi
- Department of Neurosurgery, Tokushima University, Tokushima, Tokushima, Japan
| | - Shu Sogabe
- Department of Neurosurgery, Tokushima University, Tokushima, Tokushima, Japan
| | - Masaaki Korai
- Department of Neurosurgery, Tokushima University, Tokushima, Tokushima, Japan
| | - Yasuhisa Kanematsu
- Department of Neurosurgery, Tokushima University, Tokushima, Tokushima, Japan
| | - Yasushi Takagi
- Department of Neurosurgery, Tokushima University, Tokushima, Tokushima, Japan
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Hamasaki T, Uchikawa H, Ohmori Y, Kaku Y, Ono T, Tochihara S, Hirai T, Kawano T, Mukasa A. Variations in the branching patterns of the anterior choroidal artery: an angiographic study with special reference to temporal lobe epilepsy surgery. Acta Neurochir (Wien) 2022; 164:2165-2172. [PMID: 35789290 DOI: 10.1007/s00701-022-05294-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 06/23/2022] [Indexed: 11/01/2022]
Abstract
BACKGROUND The preservation of the anterior choroidal artery (AChA) is essential for avoiding neurological sequelae after mesial temporal lobe epilepsy (mTLE) surgery. The purpose of this study is to reveal the anatomical variation in which the perforating branches arise from the plexal segment of the AChA by using a modern neuroimaging modality. METHODS This study analyzed 3D rotational angiography (3DRA) images from 56 subjects. The AChA and perforating branches were visualized using slab MIP. We analyzed branching patterns, courses of the perforating arteries arising from the plexal segment of the AChA, and the anastomosis of the AChA with other cerebral arteries. RESULTS The slab MIP applied to 3DRA visualized one or more perforating branches from the AChA in 92.9% of cases. The presence of perforating branches arising from the AChA plexal segment was 17.3%. Most of the branching points of plexal perforators were likely located in the operative field during hippocampal resection. The course of the AChA plexal perforators included the posterior limb of the internal capsule. Anastomosis with other cerebral arteries was visualized in 25% of the AChA with plexal perforators. CONCLUSIONS 3DRA slab MIP was useful for visualizing the perforating branches of the AChA. Our results showed the possibility that surgical manipulation of the choroid plexus may cause infarction in the AChA territory. We suggest that the existence of the AChA plexal perforators should be recognized to further enhance the safety of hippocampal resection for mTLE.
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Affiliation(s)
- Tadashi Hamasaki
- Department of Neurosurgery, Kumamoto University Hospital, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan.
| | - Hiroki Uchikawa
- Department of Neurosurgery, Kumamoto University Hospital, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Yuki Ohmori
- Department of Neurosurgery, Kumamoto University Hospital, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Yasuyuki Kaku
- Department of Neurosurgery, Kumamoto University Hospital, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Tomonori Ono
- Department of Neurosurgery, Epilepsy Center, National Hospital Organization Nagasaki Medical Center, 2-1001-1, Kuhara, Omura, Nagasaki, 856-8562, Japan
| | - Shuichi Tochihara
- Department of Central Radiology, Kumamoto University Hospital, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Toshinori Hirai
- Department of Diagnostic Radiology, Kumamoto University Hospital, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Tatsuya Kawano
- Department of Neurosurgery, Kumamoto University Hospital, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Akitake Mukasa
- Department of Neurosurgery, Kumamoto University Hospital, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
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Frisken S, Haouchine N, Du R, Golby AJ. Using temporal and structural data to reconstruct 3D cerebral vasculature from a pair of 2D digital subtraction angiography sequences. Comput Med Imaging Graph 2022; 99:102076. [PMID: 35636377 PMCID: PMC10801782 DOI: 10.1016/j.compmedimag.2022.102076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 02/28/2022] [Accepted: 05/05/2022] [Indexed: 11/24/2022]
Abstract
PURPOSE The purpose of this work is to present a new method for reconstructing patient-specific three-dimensional (3D) vasculature of the brain from a pair of digital subtraction angiography (DSA) image sequences from different viewpoints, e.g., from bi-plane angiography. Our long-term goal is to provide high resolution visualization of 3D vasculature with dynamic flow of contrast agent from limited data that is readily available during surgical procedures. The proposed method is the second of a three-stage process composed of 1) augmenting vessel segmentation with vessel radii and timing of the arrival of a bolus of contrast agent, 2) reconstructing a volumetric representation of the augmented vessel data from the augmented 2D segmentations, and 3) generating a 3D model of vessels and flow of contrast agent from the volumetric reconstruction. Unlike previous methods, which are either limited to relatively simple vessel structures or rely on multiple views and/or prior models of the vasculature, our method requires only a single pair of 2D DSA sequences taken from different view directions. METHODS We developed a new mathematical algorithm that augments vessel centerlines with vessel radii and bolus arrival times derived directly from the 2D DSA sequences to constrain the 3D reconstruction. We validated this method on digital phantoms derived from clinical data and from fractal models of branching tree structures. RESULTS In standard reconstruction methods, reconstruction by projection of two views into 3D space results in 'ghosting' artifacts, i.e., false 3D structure that occurs where vessels or vessel segments overlap in the 2D images. For the complex vascular of the brain, this ghosting is severe and is a major hurdle for methods that attempt to generate 3D structure from 2D images. We show that our approach reduces ghosting by up to 99% in digital phantoms derived from clinical data. CONCLUSION Our dramatic reduction in ghosting artifacts in 3D reconstructions from a pair of 2D image sequences is an important step towards generating high resolution 3D vasculature with dynamic flow information from a single DSA sequence acquired using bi-plane angiography.
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Affiliation(s)
- Sarah Frisken
- Department of Radiology, Brigham and Women's Hospital, United States; Harvard Medical School, United States.
| | - Nazim Haouchine
- Department of Radiology, Brigham and Women's Hospital, United States; Harvard Medical School, United States
| | - Rose Du
- Department of Radiology, Brigham and Women's Hospital, United States; Department of Neurosurgery, Brigham and Women's Hospital, United States; Harvard Medical School, United States
| | - Alexandra J Golby
- Department of Radiology, Brigham and Women's Hospital, United States; Department of Neurosurgery, Brigham and Women's Hospital, United States; Harvard Medical School, United States
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7
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De Leacy R, Ansari SA, Schirmer CM, Cooke DL, Prestigiacomo CJ, Bulsara KR, Hetts SW. Endovascular treatment in the multimodality management of brain arteriovenous malformations: report of the Society of NeuroInterventional Surgery Standards and Guidelines Committee. J Neurointerv Surg 2022; 14:1118-1124. [PMID: 35414599 DOI: 10.1136/neurintsurg-2021-018632] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 03/07/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND The purpose of this review is to summarize the data available for the role of angiography and embolization in the comprehensive multidisciplinary management of brain arteriovenous malformations (AVMs METHODS: We performed a structured literature review for studies examining the indications, efficacy, and outcomes for patients undergoing endovascular therapy in the context of brain AVM management. We graded the quality of the evidence. Recommendations were arrived at through a consensus conference of the authors, then with additional input from the full Society of NeuroInterventional Surgery (SNIS) Standards and Guidelines Committee and the SNIS Board of Directors. RESULTS The multidisciplinary evaluation and treatment of brain AVMs continues to evolve. Recommendations include: (1) Digital subtraction catheter cerebral angiography (DSA)-including 2D, 3D, and reformatted cross-sectional views when appropriate-is recommended in the pre-treatment assessment of cerebral AVMs. (I, B-NR) . (2) It is recommended that endovascular embolization of cerebral arteriovenous malformations be performed in the context of a complete multidisciplinary treatment plan aiming for obliteration of the AVM and cure. (I, B-NR) . (3) Embolization of brain AVMs before surgical resection can be useful to reduce intraoperative blood loss, morbidity, and surgical complexity. (IIa, B-NR) . (4) The role of primary curative embolization of cerebral arteriovenous malformations is uncertain, particularly as compared with microsurgery and radiosurgery with or without adjunctive embolization. Further research is needed, particularly with regard to risk for AVM recurrence. (III equivocal, C-LD) . (5) Targeted embolization of high-risk features of ruptured brain AVMs may be considered to reduce the risk for recurrent hemorrhage. (IIb, C-LD) . (6) Palliative embolization may be useful to treat symptomatic AVMs in which curative therapy is otherwise not possible. (IIb, B-NR) . (7) The role of AVM embolization as an adjunct to radiosurgery is not well-established. Further research is needed. (III equivocal, C-LD) . (8) Imaging follow-up after apparent cure of brain AVMs is recommended to assess for recurrence. Although non-invasive imaging may be used for longitudinal follow-up, DSA remains the gold standard for residual or recurrent AVM detection in patients with concerning imaging and/or clinical findings. (I, C-LD) . (9) Improved national and international reporting of patients of all ages with brain AVMs, their treatments, side effects from treatment, and their long-term outcomes would enhance the ability to perform clinical trials and improve the rigor of research into this rare condition. (I, C-EO) . CONCLUSIONS Although the quality of evidence is lower than for more common conditions subjected to multiple randomized controlled trials, endovascular therapy has an important role in the management of brain AVMs. Prospective studies are needed to strengthen the data supporting these recommendations.
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Affiliation(s)
- Reade De Leacy
- Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Sameer A Ansari
- Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | | | - Daniel L Cooke
- Radiology and Biomedical Imaging, University California San Francisco, San Francisco, California, USA
| | | | - Ketan R Bulsara
- Division of Neurosurgery, University of Connecticut, Farmington, Connecticut, USA
| | - Steven W Hetts
- Radiology and Biomedical Imaging, University California San Francisco, San Francisco, California, USA
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Ryu B, Sato S, Takase M, Mochizuki T, Shima S, Inoue T, Okada Y, Niimi Y. Diagnostic accuracy of three-dimensional-rotational angiography and heavily T2-weighted volumetric magnetic resonance fusion imaging for the diagnosis of spinal arteriovenous shunts. J Neurointerv Surg 2021; 14:neurintsurg-2020-017252. [PMID: 33674393 PMCID: PMC8785054 DOI: 10.1136/neurintsurg-2020-017252] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 02/10/2021] [Accepted: 02/11/2021] [Indexed: 11/03/2022]
Abstract
BACKGROUND Spinal arteriovenous shunts (SAVSs) are rare entities occurring in various areas, from the craniocervical junction to the sacral level. Recently, better understanding of SAVS angioarchitecture and elucidation of its pathogenesis have become possible with the advancement of imaging techniques. However, the utility of fusing different image modalities for SAVS diagnostics has not been determined. This study aimed to investigate whether three-dimensional-rotational angiography (3D-RA) and 3D-heavily T2-weighted volumetric MR (3D-MR) fusion imaging would improve the diagnostic accuracy for SAVSs. METHODS We retrospectively reviewed 12 SAVSs in 12 patients. Assessment of 3D-RA and 3D-RA/3D-MR fusion images for SAVS was performed by seven blinded reviewers. The final diagnosis was performed by two interventional neuroradiologists with extensive experience, and the interobserver agreement between the reviewers and the final diagnosis was calculated using κ statistics. The comparison of the interobserver agreement between 3D-RA and 3D-RA/3D-MR fusion images was performed for the diagnosis of SAVS subtypes. We also statistically compared the image-quality gradings (on a 4-grade scale) to delineate the 3D relationship between vascular malformations and the surrounding anatomical landmarks. RESULTS The interobserver agreement for the 3D-RA/3D-MR fusion images was substantial (κ=0.7071) and higher than that for the 3D-RA images (κ=0.3534). Significantly better image quality grades were assigned to 3D-RA/3D-MR fusion images than to 3D-RA images (p<0.0001) for the evaluation of the examined 3D relationships. CONCLUSION The 3D-RA/3D-MR fusion images provided better interobserver agreement of SAVS subtype diagnosis, allowing for detailed evaluation of the SAVS anatomical structures surrounding the shunt.
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Affiliation(s)
- Bikei Ryu
- Neuroendovascular Therapy, St. Luke's International Hospital, Chuo-ku, Tokyo, Japan .,Neurosurgery, Tokyo Women's Medical University, Shinjuku-ku, Tokyo, Japan.,Neurosurgery, St. Luke's International Hospital, Chuo-ku, Tokyo, Japan
| | - Shinsuke Sato
- Neuroendovascular Therapy, St. Luke's International Hospital, Chuo-ku, Tokyo, Japan.,Neurosurgery, Tokyo Women's Medical University, Shinjuku-ku, Tokyo, Japan.,Neurosurgery, St. Luke's International Hospital, Chuo-ku, Tokyo, Japan
| | - Masayuki Takase
- Radiology, St. Luke's International Hospital, Chuo-ku, Tokyo, Japan
| | - Tatsuki Mochizuki
- Neurosurgery, St. Luke's International Hospital, Chuo-ku, Tokyo, Japan
| | - Shogo Shima
- Neurosurgery, St. Luke's International Hospital, Chuo-ku, Tokyo, Japan
| | - Tatsuya Inoue
- Neurosurgery, St. Luke's International Hospital, Chuo-ku, Tokyo, Japan
| | - Yoshikazu Okada
- Neurosurgery, St. Luke's International Hospital, Chuo-ku, Tokyo, Japan
| | - Yasunari Niimi
- Neuroendovascular Therapy, St. Luke's International Hospital, Chuo-ku, Tokyo, Japan
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9
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Feddal A, Escalard S, Delvoye F, Fahed R, Desilles JP, Zuber K, Redjem H, Savatovsky JS, Ciccio G, Smajda S, Ben Maacha M, Mazighi M, Piotin M, Blanc R. Fusion Image Guidance for Supra-Aortic Vessel Catheterization in Neurointerventions: A Feasibility Study. AJNR Am J Neuroradiol 2020; 41:1663-1669. [PMID: 32819903 DOI: 10.3174/ajnr.a6707] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Accepted: 06/03/2020] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Endovascular navigation through tortuous vessels can be complex. Tools that can optimise this access phase need to be developed. Our aim was to evaluate the feasibility of supra-aortic vessel catheterization guidance by means of live fluoroscopy fusion with MR angiography or CT angiography. MATERIALS AND METHODS Twenty-five patients underwent preinterventional diagnostic MRA, and 8 patients underwent CTA. Fusion guidance was evaluated in 35 sessions of catheterization, targeting a total of 151 supra-aortic vessels. The time for MRA/CTA segmentation and fluoroscopy with MRA/CTA coregistration was recorded. The feasibility of fusion guidance was evaluated by recording the catheterizations executed by interventional neuroradiologists according to a standard technique under fluoroscopy and conventional road-mapping independent of the fusion guidance. Precision of the fusion roadmap was evaluated by measuring (on a semiquantitative 3-point scale) the maximum offset between the position of the guidewires/catheters and the vasculature on the virtual CTA/MRA images. The targeted vessels were divided in 2 groups according to their position from the level of the aortic arch. RESULTS The average time needed for segmentation and image coregistration was 7 ± 2 minutes. The MRA/CTA virtual roadmap overlaid on live fluoroscopy was considered accurate in 84.8% (128/151) of the assessed landmarks, with a higher accuracy for the group of vessels closer to the aortic arch (92.4%; OR, 4.88; 95% CI, 1.83-11.66; P = .003). CONCLUSIONS Fluoroscopy with MRA/CTA fusion guidance for supra-aortic vessel interventions is feasible. Further improvements of the technique to increase accuracy at the cervical level and further studies are needed for assessing the procedural time savings and decreasing the x-ray radiation exposure.
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Affiliation(s)
- A Feddal
- From the Interventional Neuroradiology Unit (A.F., S.E., F.D., R.F., J.P.D., K.Z., H.R., G.C., S.S., M.B.M., M.M., M.P., R.B.), Fondation Ophtalmologique Adolphe de Rothschild, Paris, France
| | - S Escalard
- From the Interventional Neuroradiology Unit (A.F., S.E., F.D., R.F., J.P.D., K.Z., H.R., G.C., S.S., M.B.M., M.M., M.P., R.B.), Fondation Ophtalmologique Adolphe de Rothschild, Paris, France
| | - F Delvoye
- From the Interventional Neuroradiology Unit (A.F., S.E., F.D., R.F., J.P.D., K.Z., H.R., G.C., S.S., M.B.M., M.M., M.P., R.B.), Fondation Ophtalmologique Adolphe de Rothschild, Paris, France
| | - R Fahed
- From the Interventional Neuroradiology Unit (A.F., S.E., F.D., R.F., J.P.D., K.Z., H.R., G.C., S.S., M.B.M., M.M., M.P., R.B.), Fondation Ophtalmologique Adolphe de Rothschild, Paris, France
| | - J P Desilles
- From the Interventional Neuroradiology Unit (A.F., S.E., F.D., R.F., J.P.D., K.Z., H.R., G.C., S.S., M.B.M., M.M., M.P., R.B.), Fondation Ophtalmologique Adolphe de Rothschild, Paris, France
- Université Paris Denis Diderot (J.P.D., M.M., M.P., R.B.), Sorbonne Paris Cite, Paris, France
- Laboratory of Vascular Translational Science (J.P.D., M.M., M.P., R.B.), U1148 Institut National de la Santé et de la Recherche Médicale, Paris, France
| | - K Zuber
- From the Interventional Neuroradiology Unit (A.F., S.E., F.D., R.F., J.P.D., K.Z., H.R., G.C., S.S., M.B.M., M.M., M.P., R.B.), Fondation Ophtalmologique Adolphe de Rothschild, Paris, France
| | - H Redjem
- From the Interventional Neuroradiology Unit (A.F., S.E., F.D., R.F., J.P.D., K.Z., H.R., G.C., S.S., M.B.M., M.M., M.P., R.B.), Fondation Ophtalmologique Adolphe de Rothschild, Paris, France
| | - J S Savatovsky
- Diagnostic Neuroradiology Unit (J.S.S.), Fondation Ophtalmologique Adolphe de Rothschild, Paris, France
| | - G Ciccio
- From the Interventional Neuroradiology Unit (A.F., S.E., F.D., R.F., J.P.D., K.Z., H.R., G.C., S.S., M.B.M., M.M., M.P., R.B.), Fondation Ophtalmologique Adolphe de Rothschild, Paris, France
| | - S Smajda
- From the Interventional Neuroradiology Unit (A.F., S.E., F.D., R.F., J.P.D., K.Z., H.R., G.C., S.S., M.B.M., M.M., M.P., R.B.), Fondation Ophtalmologique Adolphe de Rothschild, Paris, France
| | - M Ben Maacha
- From the Interventional Neuroradiology Unit (A.F., S.E., F.D., R.F., J.P.D., K.Z., H.R., G.C., S.S., M.B.M., M.M., M.P., R.B.), Fondation Ophtalmologique Adolphe de Rothschild, Paris, France
| | - M Mazighi
- From the Interventional Neuroradiology Unit (A.F., S.E., F.D., R.F., J.P.D., K.Z., H.R., G.C., S.S., M.B.M., M.M., M.P., R.B.), Fondation Ophtalmologique Adolphe de Rothschild, Paris, France
- Université Paris Denis Diderot (J.P.D., M.M., M.P., R.B.), Sorbonne Paris Cite, Paris, France
- Laboratory of Vascular Translational Science (J.P.D., M.M., M.P., R.B.), U1148 Institut National de la Santé et de la Recherche Médicale, Paris, France
| | - M Piotin
- From the Interventional Neuroradiology Unit (A.F., S.E., F.D., R.F., J.P.D., K.Z., H.R., G.C., S.S., M.B.M., M.M., M.P., R.B.), Fondation Ophtalmologique Adolphe de Rothschild, Paris, France
- Université Paris Denis Diderot (J.P.D., M.M., M.P., R.B.), Sorbonne Paris Cite, Paris, France
- Laboratory of Vascular Translational Science (J.P.D., M.M., M.P., R.B.), U1148 Institut National de la Santé et de la Recherche Médicale, Paris, France
| | - R Blanc
- From the Interventional Neuroradiology Unit (A.F., S.E., F.D., R.F., J.P.D., K.Z., H.R., G.C., S.S., M.B.M., M.M., M.P., R.B.), Fondation Ophtalmologique Adolphe de Rothschild, Paris, France
- Université Paris Denis Diderot (J.P.D., M.M., M.P., R.B.), Sorbonne Paris Cite, Paris, France
- Laboratory of Vascular Translational Science (J.P.D., M.M., M.P., R.B.), U1148 Institut National de la Santé et de la Recherche Médicale, Paris, France
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10
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Guan M, Lin J, Huang S, Leng X, Shi C, Qiao H, Wang X, Huang L. High-Degree Middle Cerebral Artery Stenosis : Can Advanced 3D DSA-MRI Fusion Imaging Better Illustrate Plaques and Perforators? Clin Neuroradiol 2020; 31:51-59. [PMID: 32617602 PMCID: PMC7943526 DOI: 10.1007/s00062-020-00927-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Accepted: 06/10/2020] [Indexed: 11/24/2022]
Abstract
Purpose Endovascular treatment in severe middle cerebral artery (MCA) stenosis is controversial owing to high rates of periprocedural complications, especially occlusion of the lenticulostriate arteries (LSA). The characteristics of LSAs and the spatial relationships between MCA plaques and LSAs using the fusion of three-dimensional (3D) digital subtraction angiography (DSA) and magnetic resonance imaging (3D DSA-MRI fusion) were investigated. Methods We retrospectively analyzed data from 32 ischemic stroke or transient ischemic attack patients with severe MCA stenosis, who underwent MRI and DSA within 2 weeks after symptom onset. The patients were divided into culprit and non-culprit MCA stenosis groups. The 3D DSA-MRI fusion was performed on dedicated workstations, which allowed automated overlays of the target vessels. The characteristics of LSAs, plaque distribution and lesion patterns, and their relationships were evaluated. Results The 3D DSA-MRI fusion image was able to illustrate the spatial relationships between MCA plaques and LSA orifices. Of 42 LSA stems in 32 patients, 10 had MCA plaque over the LSA orifice and were all found in the culprit MCA stenosis group. Over half (51.9%) of the LSA stems in patients with culprit MCA stenosis originated from the stenotic MCA segment. The MCA plaque-LSA orifice spatial relationships were classified into four types, which were significantly different between the two groups (p = 0.016). Conclusion The 3D DSA-MRI fusion technique enables visualization of the LSA orifice and MCA plaque and their spatial relationships. This classification of the type of spatial relationships can provide insights into the pathogenesis of MCA stroke and useful guides for treatment strategies.
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Affiliation(s)
- Min Guan
- Department of Neurology, The First Affiliated Hospital, Jinan University, NO.613 the West of Huangpu street, 510630, Guangzhou, China
| | - Jia'xing Lin
- Department of Neurology, The First Affiliated Hospital, Jinan University, NO.613 the West of Huangpu street, 510630, Guangzhou, China
| | - Sheng'ming Huang
- Department of Neurology, The First Affiliated Hospital, Jinan University, NO.613 the West of Huangpu street, 510630, Guangzhou, China
| | - Xin'yi Leng
- Department of Medicine & Therapeutics, The Chinese University of Hong Kong Shatin, Hong Kong, SAR, China
| | - Chang'zheng Shi
- Medical Imaging Center, The First Affiliated Hospital, Jinan University, Guangzhou, China
| | - Hong'yu Qiao
- Department of Neurology, The First Affiliated Hospital, Jinan University, NO.613 the West of Huangpu street, 510630, Guangzhou, China
| | - Xiang'yu Wang
- Department of Neurosurgery, The First Affiliated Hospital, Jinan University, Guangzhou, China
| | - Li'an Huang
- Department of Neurology, The First Affiliated Hospital, Jinan University, NO.613 the West of Huangpu street, 510630, Guangzhou, China.
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11
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Brunozzi D, Hussein AE, Shakur SF, Linninger A, Hsu CY, Charbel FT, Alaraj A. Contrast Time-Density Time on Digital Subtraction Angiography Correlates With Cerebral Arteriovenous Malformation Flow Measured by Quantitative Magnetic Resonance Angiography, Angioarchitecture, and Hemorrhage. Neurosurgery 2019; 83:210-216. [PMID: 29106647 DOI: 10.1093/neuros/nyx351] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Accepted: 05/24/2017] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Digital subtraction angiography (DSA) currently provides angioarchitectural features of cerebral arteriovenous malformations (AVMs) but its role in the hemodynamic evaluation of AVMs is poorly understood. OBJECTIVE To assess contrast time-density time (TT) on DSA relative to AVM flow measured using quantitative magnetic resonance angiography (QMRA). METHODS Patients seen at our institution between 2007 and 2014 with a supratentorial AVM and DSA and QMRA obtained prior to any treatment were retrospectively reviewed. Regions of interest were selected on the draining veins at the point closest to the nidus. TT on DSA was defined as time needed for contrast to change image intensity from 10% to 100%, 100% to 10%, and 25% to 25%. TT was correlated to AVM total flow, angioarchitectural features, and hemorrhage. RESULTS Twenty-eight patients (mean age 35.6 yr) were included. Six patients presented with hemorrhage. Mean AVM volume was 11.42 mL (range 0.3-57.7 mL). Higher total AVM flow significantly correlated with shorter TT100%-10% and TT25%-25% (P = .02, .02, respectively). Presence of venous stenosis correlated significantly with shorter TT100%-10% (P = .04) and TT25%-25% (P = .04). AVMs with a single draining vein exhibited longer TT25%-25% compared to those with multiple draining veins (P = .04). Ruptured AVMs had significantly shorter TT10%-100% compared to unruptured AVMs (P = .05). CONCLUSION TT on DSA correlates with cerebral AVM flow measured using QMRA and with AVM angioarchitecture and hemorrhagic presentation. Thus, TT may be used to indirectly estimate AVM flow during angiography in real-time and may also be an indicator of important AVM characteristics associated with outflow resistance and increased rupture risk, such as venous stenosis.
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Affiliation(s)
- Denise Brunozzi
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois
| | - Ahmed E Hussein
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois
| | - Sophia F Shakur
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois
| | - Andreas Linninger
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois.,Department of Bioengineering, Univers-ity of Illinois at Chicago, Chicago, Illinois
| | - Chih-Yang Hsu
- Department of Bioengineering, Univers-ity of Illinois at Chicago, Chicago, Illinois
| | - Fady T Charbel
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois
| | - Ali Alaraj
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois.,Department of Bioengineering, Univers-ity of Illinois at Chicago, Chicago, Illinois
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12
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Saito M, Kawano H, Amano T, Iwamoto T, Hirano T. [A case of definite diagnosis of branch atheromatous disease confirmed by digital subtraction angiography-3 tesla magnetic resonance fusion imaging]. Rinsho Shinkeigaku 2019; 59:525-529. [PMID: 31341128 DOI: 10.5692/clinicalneurol.cn-001297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We herein experienced one patient with typical branch atheromatous disease (BAD) type infarction. Digital subtraction angiography (DSA) and MRI fusion imaging revealed the relationship between atheromatous plaque and perforating branches. A 66-year-old male presented acute onset of dysarthria, the left side hemiparesis and sensory disturbance. Diffusion-weighted MR imaging (DWI) showed the right pontine acute infarction. We started to treat with dual antiplatelet therapy. However, the left-side hemiparesis was worsening on 4 days after admission. DWI showed infarct growth and plaque imaging revealed the atheromatous plaque in the basilar artery. We fused DSA and MRI T2 weighted imaging (DSA-MR fusion imaging) to illustrate the relationship between the atheromatous plaque and the perforating branches. DSA-MR fusion imaging showed that the paramedian artery and the short circumferential artery ran around and into the pontine infarct lesion. Additionally, one of the paramedian arteries was occluded. Those neuroradiological findings coincided with the pathological concept of BAD. DSA-MR fusion imaging can prove the pathological concept of BAD.
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Affiliation(s)
- Mikito Saito
- Department of Stroke and Cerebrovascular Medicine, Kyorin University Faculty of Medicine
| | - Hiroyuki Kawano
- Department of Stroke and Cerebrovascular Medicine, Kyorin University Faculty of Medicine
| | - Tatsuo Amano
- Department of Stroke and Cerebrovascular Medicine, Kyorin University Faculty of Medicine
| | | | - Teruyuki Hirano
- Department of Stroke and Cerebrovascular Medicine, Kyorin University Faculty of Medicine
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13
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Shigenaga Y, Sasaki M, Ishimoto T, Ama K. Simultaneous Visualization of Vessels and Brain Tumor with Contrast-enhanced Three-dimensional Phase-contrast MR Imaging. Magn Reson Med Sci 2018; 17:184-188. [PMID: 28539559 PMCID: PMC5891345 DOI: 10.2463/mrms.cr.2017-0002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
The sequence for concurrently depicting engulfed vessels and a well-enhanced tumor in once-off scanning has never been reported for preoperative magnetic resonance imaging for brain tumor resection. Multimodal fusion techniques have been recently developed, but the risks of misregistration still remain. Here a case is reported where contrast-enhanced three-dimensional phase contrast sequence concurrently depicted an engulfed vessel and metastatic brain tumor in once-off scanning and related technical aspects are discussed.
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Affiliation(s)
| | | | | | - Keiko Ama
- Department of Radiology, Hyogo Cancer Center
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14
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Derdeyn CP, Zipfel GJ, Albuquerque FC, Cooke DL, Feldmann E, Sheehan JP, Torner JC. Management of Brain Arteriovenous Malformations: A Scientific Statement for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke 2017. [DOI: 10.1161/str.0000000000000134] [Citation(s) in RCA: 143] [Impact Index Per Article: 20.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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15
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Zhang Q, Zhang Z, Yang J, Sun Q, Luo Y, Shan T, Zhang H, Han J, Liang C, Pan W, Gu C, Mao G, Xu R. CBCT-based 3D MRA and angiographic image fusion and MRA image navigation for neuro interventions. Medicine (Baltimore) 2016; 95:e4358. [PMID: 27512846 PMCID: PMC4985301 DOI: 10.1097/md.0000000000004358] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Digital subtracted angiography (DSA) remains the gold standard for diagnosis of cerebral vascular diseases and provides intraprocedural guidance. This practice involves extensive usage of x-ray and iodinated contrast medium, which can induce side effects. In this study, we examined the accuracy of 3-dimensional (3D) registration of magnetic resonance angiography (MRA) and DSA imaging for cerebral vessels, and tested the feasibility of using preprocedural MRA for real-time guidance during endovascular procedures.Twenty-three patients with suspected intracranial arterial lesions were enrolled. The contrast medium-enhanced 3D DSA of target vessels were acquired in 19 patients during endovascular procedures, and the images were registered with preprocedural MRA for fusion accuracy evaluation. Low-dose noncontrasted 3D angiography of the skull was performed in the other 4 patients, and registered with the MRA. The MRA was overlaid afterwards with 2D live fluoroscopy to guide endovascular procedures.The 3D registration of the MRA and angiography demonstrated a high accuracy for vessel lesion visualization in all 19 patients examined. Moreover, MRA of the intracranial vessels, registered to the noncontrasted 3D angiography in the 4 patients, provided real-time 3D roadmap to successfully guide the endovascular procedures. Radiation dose to patients and contrast medium usage were shown to be significantly reduced.Three-dimensional MRA and angiography fusion can accurately generate cerebral vasculature images to guide endovascular procedures. The use of the fusion technology could enhance clinical workflow while minimizing contrast medium usage and radiation dose, and hence lowering procedure risks and increasing treatment safety.
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Affiliation(s)
- Qiang Zhang
- Beijing PLA Military General Hospital Affiliated Bayi Brain Hospital, Beijing
| | - Zhiqiang Zhang
- Beijing PLA Military General Hospital Affiliated Bayi Brain Hospital, Beijing
| | | | - Qi Sun
- Siemens Ltd. China, Healthcare Sector
| | - Yongchun Luo
- Beijing PLA Military General Hospital Affiliated Bayi Brain Hospital, Beijing
| | - Tonghui Shan
- Beijing PLA Military General Hospital Affiliated Bayi Brain Hospital, Beijing
| | - Hao Zhang
- Beijing PLA Military General Hospital Affiliated Bayi Brain Hospital, Beijing
| | | | - Chunyang Liang
- Beijing PLA Military General Hospital Affiliated Bayi Brain Hospital, Beijing
| | - Wenlong Pan
- Beijing PLA Military General Hospital Affiliated Bayi Brain Hospital, Beijing
| | - Chuanqi Gu
- Beijing PLA Military General Hospital Affiliated Bayi Brain Hospital, Beijing
| | - Gengsheng Mao
- General Hospital of Chinese People's Armed Police Forces, Beijing, China
| | - Ruxiang Xu
- Beijing PLA Military General Hospital Affiliated Bayi Brain Hospital, Beijing
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16
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Wojak JC, Abruzzo TA, Bello JA, Blackham KA, Hirsch JA, Jayaraman MV, Dariushnia SR, Meyers PM, Midia M, Russell EJ, Walker TG, Nikolic B. Quality Improvement Guidelines for Adult Diagnostic Cervicocerebral Angiography: Update Cooperative Study between the Society of Interventional Radiology (SIR), American Society of Neuroradiology (ASNR), and Society of NeuroInterventional Surgery (SNIS). J Vasc Interv Radiol 2015; 26:1596-608. [DOI: 10.1016/j.jvir.2015.07.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2015] [Revised: 07/07/2015] [Accepted: 07/07/2015] [Indexed: 12/19/2022] Open
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17
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Takagi S, Tokumitsu H, Sanada S. Relationship between the contrast effects of raw data projection images from three-dimensional digital subtraction angiography and the optimal volume rendering parameters. J Digit Imaging 2015; 28:368-72. [PMID: 25447419 DOI: 10.1007/s10278-014-9745-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
Volume rendering (VR) is a technique commonly used for the reconstruction of three-dimensional (3D) digital subtraction angiography (DSA) images, and the rendering parameters greatly affect the characteristics of the 3D image. This study aimed to test whether the optimal VR parameters for 3D DSA could be estimated from the contrast effects in rotational two-dimensional (2D) DSA images acquired using 3D DSA. Simulated blood vessels filled with various concentrations of contrast medium were scanned, and the 3D DSA data sets were reconstructed. The syngo AX vessel analysis software that was able to analyze 3D DSA VR image was used for objective measures. Raw data projection images of the 3D DSA data sets in which the mean diameter was calculated as a true value by the software at nine different thresholds for vessel segmentation were selected. In each image set, five images of all 133 rotational 2D DSA images were selected, and the contrast-enhanced area was extracted using a region-growing algorithm. Mean values and standard deviations of each contrast-enhanced area were calculated, and as the thresholds for vessel segmentation of the software increased by 500 every time, significant differences were observed in the mean values (P < 0.01). This optimal threshold can be applied to the window settings of the VR technique. Therefore, the optimal VR parameters for 3D DSA may be determined by analyzing the contrast effects of the raw data projection images, and user-dependent over- and underestimations of 3D DSA VR images also may be prevented.
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Tanoue S, Kiyosue H, Mori H, Hongo N, Okahara M, Kubo T. Fusion imaging using subtracted and unsubtracted rotational angiography for pretherapeutic evaluation of dural arteriovenous fistulas. Jpn J Radiol 2014; 32:600-7. [DOI: 10.1007/s11604-014-0351-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2014] [Accepted: 08/06/2014] [Indexed: 10/24/2022]
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19
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Jiang Y, Lan Q, Wang Q, Lu H, Ge F, Wang Y. Correlation Between the Rupture Risk and 3D Geometric Parameters of Saccular Intracranial Aneurysms. Cell Biochem Biophys 2014; 70:1417-20. [DOI: 10.1007/s12013-014-0074-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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