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Zhang L, Pu T, Xu X, Raynald, Zheng S, Fu J, Yong Q, Zhang W, He W. Diagnostic feasibility of middle cerebral artery stenosis or occlusion evaluated by TCCS and CEUS: Repeatability, reproducibility, and diagnostic agreement with DSA. J Stroke Cerebrovasc Dis 2024; 33:107575. [PMID: 38232582 DOI: 10.1016/j.jstrokecerebrovasdis.2024.107575] [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: 08/04/2023] [Revised: 12/19/2023] [Accepted: 01/11/2024] [Indexed: 01/19/2024] Open
Abstract
AIM This study aimed to evaluate the feasibility of transcranial color-coded sonography (TCCS) and contrast-enhanced ultrasound (CEUS) in assessing middle cerebral artery (MCA) stem stenosis or occlusion compared to digital subtraction angiography (DSA). METHODS A total of 48 cases including 96 MCAs suspected stem stenosis or obstruction in the MCA were assessed by TCCS, CE-TCCS, and DSA. The diameters of the most severe stenosis (Ds), proximal normal artery (Dn), and diameter stenosis rate of MCA were measured using both the color doppler flow imaging (CDFI) modality of TCCS or CEUS and the CEUS imaging modality. The intraclass correlation coefficients (ICCs) and 95 % confidence intervals (CI) were evaluated, and a weighted Kappa value was used to evaluate the intra-observer agreement, inter-observer agreement, agreement between CDFI modality and DSA stenosis or occlusion, and agreement between CEUS imaging modality and DSA stenosis or occlusion. RESULTS The ICC results indicated excellent repeatability and reproducibility (all ICCs > 0.75; weighted Kappa values >0.81). Compared with DSA, the weighted Kappa values and 95 % CIs of stenosis (the first measurement was taken by two observers) of CDFI modality and CEUS imaging modality were 0.175 (0.041, 0.308) and 0.779 (0.570, 0.988) for observers A and 0.181 (0.046, 0.316) and 0.779 (0.570, 0.988) for observers B respectively. CONCLUSION This study indicates that inter- and intra-observer agreements were good for the direct method of measuring percentages of MCA stenosis by TCCS and CEUS. CEUS imaging modality is a new and reliable imaging modality approach to evaluate the MCAs stenosis and occlusion.
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Affiliation(s)
- Lei Zhang
- Department of Ultrasound, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Tianning Pu
- Department of comprehensive ultrasound, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Xiaotong Xu
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University
| | - Raynald
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University
| | - Shuai Zheng
- Department of Ultrasound, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Jingjing Fu
- Department of comprehensive ultrasound, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Qiang Yong
- Ultrasonic Medical Diagnosis and treatment Center, Shunyi Women's & Children's Hospital of Beijing Children's Hospital, Capital Medical University
| | - Wei Zhang
- Department of Ultrasound, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Wen He
- Department of Ultrasound, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
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Tang W, Chen Y, Ma L, Chen Y, Yang B, Li R, Li Z, Wu Y, Wang X, Guo X, Zhang W, Chen X, Lv M, Zhao Y, Guo G. Current perspectives and trends in the treatment of brain arteriovenous malformations: a review and bibliometric analysis. Front Neurol 2024; 14:1327915. [PMID: 38274874 PMCID: PMC10808838 DOI: 10.3389/fneur.2023.1327915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 12/19/2023] [Indexed: 01/27/2024] Open
Abstract
Background Currently, there is a lack of intuitive analysis regarding the development trend, main authors, and research hotspots in the field of cerebral arteriovenous malformation treatment, as well as a detailed elaboration of possible research hotspots. Methods A bibliometric analysis was conducted on data retrieved from the Web of Science core collection database between 2000 and 2022. The analysis was performed using R, VOSviewer, CiteSpace software, and an online bibliometric platform. Results A total of 1,356 articles were collected, and the number of publications has increased over time. The United States and the University of Pittsburgh are the most prolific countries and institutions in the field. The top three cited authors are Kondziolka D, Sheehan JP, and Lunsford LD. The Journal of Neurosurgery and Neurosurgery are two of the most influential journals in the field of brain arteriovenous malformation treatment research, with higher H-index, total citations, and number of publications. Furthermore, the analysis of keywords indicates that "aruba trial," "randomised trial," "microsurgery," "onyx embolization," and "Spetzler-Martin grade" may become research focal points. Additionally, this paper discusses the current research status, existing issues, and potential future research directions for the treatment of brain arteriovenous malformations. Conclusion This bibliometric study comprehensively analyses the publication trend of cerebral arteriovenous malformation treatment in the past 20 years. It covers the trend of international cooperation, publications, and research hotspots. This information provides an important reference for scholars to further study cerebral arteriovenous malformation.
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Affiliation(s)
- Weixia Tang
- School of Public Health, Shanxi Medical University, Taiyuan, Shanxi, China
- Department of Neurosurgery, First Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
| | - Yang Chen
- Department of Neurosurgery, First Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
- Shanxi Provincial Clinical Research Center for Interventional Medicine, Taiyuan, Shanxi, China
| | - Li Ma
- Department of Neurological Surgery, University of Pittsburgh Medical Center, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - Yu Chen
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Biao Yang
- Department of Neurosurgery, First Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
- Shanxi Provincial Clinical Research Center for Interventional Medicine, Taiyuan, Shanxi, China
| | - Ren Li
- School of Public Health, Shanxi Medical University, Taiyuan, Shanxi, China
- Department of Neurosurgery, First Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
| | - Ziao Li
- Department of Neurosurgery, First Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
- Shanxi Provincial Clinical Research Center for Interventional Medicine, Taiyuan, Shanxi, China
| | - Yongqiang Wu
- Shanxi Provincial Clinical Research Center for Interventional Medicine, Taiyuan, Shanxi, China
- Department of Emergency, First Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
| | - Xiaogang Wang
- Department of Neurosurgery, First Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
- Shanxi Provincial Clinical Research Center for Interventional Medicine, Taiyuan, Shanxi, China
| | - Xiaolong Guo
- Department of Neurosurgery, First Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
- Shanxi Provincial Clinical Research Center for Interventional Medicine, Taiyuan, Shanxi, China
| | - Wenju Zhang
- Department of Neurosurgery, First Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
- Shanxi Provincial Clinical Research Center for Interventional Medicine, Taiyuan, Shanxi, China
| | - Xiaolin Chen
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Ming Lv
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Yuanli Zhao
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
- Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Geng Guo
- Shanxi Provincial Clinical Research Center for Interventional Medicine, Taiyuan, Shanxi, China
- Department of Emergency, First Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
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Patel A, Patel D, Al-Bahou R, Thakkar R, Kioutchoukova I, Foreman M, Foster D, Lucke-Wold B. Updates on Neuronavigation: Emerging tools for tumor resection. GENERAL SURGERY (SINGAPORE) 2023; 7:10.18282/gs.v7i1.3352. [PMID: 38274640 PMCID: PMC10810325 DOI: 10.18282/gs.v7i1.3352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/27/2024]
Abstract
Multiple studies have been conducted to properly elucidate the various tools available to help enhance the resection of tumor tissue, aneurysms, and arteriovenous malformations (AVM). Diffusion tensor imaging (DTI) tractography is useful in providing a map of the tumor borders, allowing the optimal preservation of function and structure of specific regions of the brain. During neurosurgery, especially craniotomies, the possibility of the brain shifting due to swelling or gravity is high. Thus, tools for intraoperative imaging such as high-frequency linear array ultrasound transducers and doppler ultrasonography are utilized for high resolution images and detecting frequency shifts. 4D-digital subtraction angiography (DSA) is another technique used to create spatial resolutions and 3D maps for aneurysms. These similar techniques can also be utilized to assess the integrity of white matter in AVM. By implementing effective evaluation strategies, healthcare professionals can make informed decisions regarding treatment options, preventive measures, and long-term care plans tailored to individual patients.
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Affiliation(s)
- Anjali Patel
- College of Medicine, University of Florida, Gainesville, FL 32610, USA
| | - Drashti Patel
- College of Medicine, University of Florida, Gainesville, FL 32610, USA
| | - Raja Al-Bahou
- College of Medicine, University of Florida, Gainesville, FL 32610, USA
| | - Rajvi Thakkar
- College of Medicine, University of Florida, Gainesville, FL 32610, USA
| | | | - Marco Foreman
- College of Medicine, University of Florida, Gainesville, FL 32610, USA
| | - Devon Foster
- College of Medicine, Florida International University, Miami, FL 33199, USA
| | - Brandon Lucke-Wold
- Department of Neurosurgery, University of Florida, Gainesville, FL 32610, USA
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Pacini A, Shotar E, Granger B, Maizeroi-Eugène F, Delaitre M, Talbi A, Boch AL, Valéry CA, Premat K, Drir M, Lenck S, Mounayer C, Sourour NA, Clarençon F. Nidus Compacity Determined by Semi-Automated Segmentation is a Strong Quantitative Predictor of Brain Arterio-Venous Malformation Cure. Clin Neuroradiol 2023; 33:1095-1104. [PMID: 37378842 DOI: 10.1007/s00062-023-01313-y] [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: 11/30/2022] [Accepted: 05/22/2023] [Indexed: 06/29/2023]
Abstract
BACKGROUND AND OBJECTIVE A compact nidus is a well-known feature of good outcome after treatment in brain arteriovenous malformations (bAVM). This item, included in the "Supplementary AVM grading system" by Lawton, is subjectively evaluated on DSA. The present study aimed to assess whether quantitative nidus compacity along with other angio-architectural bAVM features were predictive of angiographic cure or the occurrence of procedure-related complications. MATERIALS AND METHODS Retrospective analysis of 83 patients prospectively collected data base between 2003 to 2018 having underwent digital subtraction 3D rotation angiography (3D-RA) for pre-therapeutic assessment of bAVM. Angio-architectural features were analyzed. Nidus compacity was measured with a dedicated segmentation tool. Univariate and multivariate analyses were performed to test the association between these factors and complete obliteration or complication. RESULTS Compacity was the only significant factor associated with complete obliteration in our predictive model using logistic multivariate regression; the area under the curve for compacity predicting complete obliteration was excellent (0.82; 95% CI 0.71-0.90; p < 0.0001). The threshold value maximizing the Youden index was a compacity > 23% (sensitivity 97%; specificity 52%; 95% CI 85.1-99.9; p = 0.055). No angio-architectural factor was associated with the occurrence of a complication. CONCLUSION Nidus high compacity quantitatively measured on 3D-RA, using a dedicated segmentation tool is predictive of bAVM cure. Further investigation and prospective studies are warranted to confirm these preliminary results.
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Affiliation(s)
- Aurélien Pacini
- Department of Interventional Neuroradiology, Pitié-Salpêtrière Hospital. APHP, Paris, France.
| | - Eimad Shotar
- Department of Interventional Neuroradiology, Pitié-Salpêtrière Hospital. APHP, Paris, France
| | - Benjamin Granger
- Department of Public Health, Pitié-Salpêtrière Hospital. APHP, Paris, France
- INSERM UMR 1136, Sorbonne University, Paris, France
| | | | | | - Atika Talbi
- Department of Interventional Neuroradiology, Pitié-Salpêtrière Hospital. APHP, Paris, France
| | - Anne-Laure Boch
- Department of Neurosurgery, Pitié-Salpêtrière Hospital. APHP, Paris, France
| | | | - Kévin Premat
- Department of Interventional Neuroradiology, Pitié-Salpêtrière Hospital. APHP, Paris, France
| | - Mehdi Drir
- Department of Neuro-intensive care, Pitié-Salpêtrière Hospital. APHP, Paris, France
| | - Stéphanie Lenck
- Department of Interventional Neuroradiology, Pitié-Salpêtrière Hospital. APHP, Paris, France
| | - Charbel Mounayer
- Department of Interventional Neuroradiology, Limoges University Hospital, Limoges, France
| | - Nader-Antoine Sourour
- Department of Interventional Neuroradiology, Pitié-Salpêtrière Hospital. APHP, Paris, France
| | - Frédéric Clarençon
- Department of Interventional Neuroradiology, Pitié-Salpêtrière Hospital. APHP, Paris, France
- INSERM UMR 1136, Sorbonne University, Paris, France
- GRC BioFast, Sorbonne University, Paris, France
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Tanoue S, Tanaka N, Koganemaru M, Kuhara A, Kugiyama T, Sawano M, Abe T. Head and Neck Arteriovenous Malformations: Clinical Manifestations and Endovascular Treatments. INTERVENTIONAL RADIOLOGY (HIGASHIMATSUYAMA-SHI (JAPAN) 2023; 8:23-35. [PMID: 37485489 PMCID: PMC10359175 DOI: 10.22575/interventionalradiology.2022-0009] [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: 02/26/2022] [Accepted: 04/01/2022] [Indexed: 07/25/2023]
Abstract
Arteriovenous malformations (AVMs) are vascular malformations that present high-flow direct communication between the arteries and veins, not involving the capillary beds. They can be progressive and lead to various manifestations, including abnormal skin or mucosal findings, ischemia, hemorrhage, and high-output heart failure in severe cases. AVMs often involve the head and neck region. Head and neck AVMs can present region-specific clinical manifestations, angioarchitecture, and complications, especially in cosmetic appearance and ingestion, respiratory, and neuronal functions. Therefore, when planning endovascular treatment of head and neck AVMs, physicians should consider not only the treatment strategy but also the preservation of the cosmetic appearance and critical functions. Knowledge of the functional vascular anatomy as well as treatment techniques should facilitate a successful management. This review summarizes AVMs' clinical manifestations, imaging findings, treatment strategy, and complications.
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Affiliation(s)
- Shuichi Tanoue
- Department of Radiology, Kurume University School of Medicine, Japan
| | - Norimitsu Tanaka
- Department of Radiology, Kurume University School of Medicine, Japan
| | | | - Asako Kuhara
- Department of Radiology, Kurume University School of Medicine, Japan
| | - Tomoko Kugiyama
- Department of Radiology, Kurume University School of Medicine, Japan
| | - Miyuki Sawano
- Department of Radiology, Kurume University School of Medicine, Japan
| | - Toshi Abe
- Department of Radiology, Kurume University School of Medicine, Japan
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Xiang W, Yan L, Zhao Y, Yang M, Bai S, Ma L, Pan L. Four-dimensional digital subtraction angiography to assess cerebral arteriovenous malformations. J Neuroimaging 2023; 33:67-72. [PMID: 36305629 DOI: 10.1111/jon.13065] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 10/13/2022] [Accepted: 10/13/2022] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND AND PURPOSE The performance of a novel prototype four-dimensional (4D) digital subtraction angiography (DSA) for cerebral arteriovenous malformation (AVM) diagnosis was evaluated and compared with that of two-dimensional (2D) and three-dimensional (3D) DSA. METHODS In this retrospective study, 37 consecutive cerebral AVM patients were included. The standard diagnostic results were concluded from the 2D and 3D DSA. Two 4D DSA volumes were reconstructed for each patient by a commercial and a prototype software, then evaluated by two independent experienced neurosurgeons, who were blinded to the diagnosis and treatment process. The evaluation results were compared with the diagnostic results on Spetzler-Martin (SM) Grading Scale, number of feeding arteries, number of draining veins, and intranidal aneurysms. RESULTS Complete agreement was achieved between 4D DSA and 2D and 3D DSA in SM Grading Scale and intracranial aneurysm identification (agreement coefficient: 1) for both reviewers. The agreement coefficients were .888 and .917 for both reviewers in feeding artery number determination using 4D DSA product and 4D DSA prototype, respectively. The agreement coefficients in draining vein number determination were all larger than .94 for both reviewers using both 4D DSA volumes. CONCLUSIONS The performance of this prototype 4D DSA in cerebral AVMs diagnosis was largely equivalent to that of 2D and 3D DSA combination. Four-dimensional DSA can be regarded as a very good complement for 2D DSA in cerebral AVM diagnosis.
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Affiliation(s)
- Weichu Xiang
- Department of Neurosurgery, General Hospital of Central Theater Command, Wuhan, China
| | - Linhai Yan
- Department of Neurosurgery, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Yueyuan Zhao
- Department of Neurosurgery, General Hospital of Central Theater Command, Wuhan, China
| | - Ming Yang
- Department of Neurosurgery, General Hospital of Central Theater Command, Wuhan, China
| | - Sanli Bai
- Department of Neurosurgery, General Hospital of Central Theater Command, Wuhan, China
| | - Lianting Ma
- Department of Neurosurgery, General Hospital of Central Theater Command, Wuhan, China
| | - Li Pan
- Department of Neurosurgery, General Hospital of Central Theater Command, Wuhan, China
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Ishikawa K, Nishihori M, Izumi T, Oshima R, Uemura T, Kanamori F, Uda K, Yokoyama K, Araki Y, Saito R. Four-dimensional digital subtraction angiography for the vascular anatomical diagnosis of dural arteriovenous malformation: Comparison with the conventional method. Interv Neuroradiol 2022:15910199221145526. [PMID: 36523199 DOI: 10.1177/15910199221145526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2024] Open
Abstract
BACKGROUND Two-dimensional digital subtraction angiography (2D-DSA) and conventional three-dimensional digital subtraction angiography (3D-DSA) are used for the detailed analysis of dural arteriovenous fistula (DAVF). Recently, four-dimensional digital subtraction angiography (4D-DSA), a novel technology, has been attracting attention. The current study aimed to evaluate the capability of 4D-DSA in assessing anatomical angioarchitecture in DAVF. METHODS In total, 10 consecutive patients with DAVF who underwent 3D-DSA and 4D-DSA at a single institution were included in the analysis. Initially, one-slice multiplanar reconstruction (MPR) images obtained via 4D-DSA and 3D-DSA were compared to investigate the visibility of the feeding artery, fistulous point, and draining vein. Next, 4D-DSA images alone were compared and evaluated with and the MPR images of conventional 3D-DSA in terms of diagnosis of the angioarchitecture. RESULTS In total, six men and four women (with a mean age of 65.6 ± 10.0 years) were included in the study. The MPR image obtained via 3D-DSA had a significantly better visibility of the feeding artery and fistulous point than that acquired via 4D-DSA (p < 0.05). As for the draining vein, the score was equivalent and not significant. The diagnosis of the vascular architecture of only 4D-DSA images was nearly equivalent to that of MPR images of 3D-DSA. There were no inter-rater differences. CONCLUSION The MPR images obtained via 4D-DSA may be slightly inferior to those acquired via 3D-DSA in identifying fine angioarchitecture in DAVF. However, they were comparable in terms of diagnostic accuracy.
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Affiliation(s)
- Kojiro Ishikawa
- 220905Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Masahiro Nishihori
- 220905Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Takashi Izumi
- 220905Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Ryosuke Oshima
- 220905Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Takeshi Uemura
- Department of Radiological Technology, Nagoya University Hospital, Aichi, Japan
| | - Fumiaki Kanamori
- 220905Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kenji Uda
- 220905Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kinya Yokoyama
- 220905Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yoshio Araki
- 220905Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Ryuta Saito
- 220905Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
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Raman A, Uprety M, Calero MJ, Villanueva MRB, Joshaghani N, Villa N, Badla O, Goit R, Saddik SE, Dawood SN, Rabih AM, Mohammed A, Selvamani TY, Mostafa J. A Systematic Review Comparing Digital Subtraction Angiogram With Magnetic Resonance Angiogram Studies in Demonstrating the Angioarchitecture of Cerebral Arteriovenous Malformations. Cureus 2022; 14:e25803. [PMID: 35706438 PMCID: PMC9187205 DOI: 10.7759/cureus.25803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/09/2022] [Indexed: 11/05/2022] Open
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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] [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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Pérez-Alfayate R, Grasso G. State of the Art and Future Direction in Diagnosis, Molecular Biology, Genetics, and Treatment of Brain Arteriovenous Malformations. World Neurosurg 2022; 159:362-372. [PMID: 35255635 DOI: 10.1016/j.wneu.2021.08.111] [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: 07/19/2021] [Revised: 08/23/2021] [Accepted: 08/24/2021] [Indexed: 11/16/2022]
Abstract
Brain arteriovenous malformations (bAVMs) are uncommon and represent a heterogeneous group of lesions. Although these 2 facts have delayed research on this topic, knowledge about the pathophysiology, diagnosis, and treatment of bAVMs has evolved in recent years. We conducted a review of the literature to update the knowledge about diagnosis, molecular biology, genetic, pathology, and treatment by searching for the following terms: "Epidemiology AND Natural History," "risk of hemorrhage," "intracranial hemorrhage," "diagnosis," "angiogenesis," "molecular genetics," "VEGF," "KRAS," "radiosurgery," "endovascular," "microsurgery," or "surgical resection." Our understanding of bAVMs has significantly evolved in recent years. The latest investigations have helped in defining some molecular pathways involved in the pathology of bAVM. Although there is still more to learn and discover, describing these pathways will allow the creation of targeted treatments that could improve the prognosis of patients with bAVMs.
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Affiliation(s)
- Rebeca Pérez-Alfayate
- Department of Neurosurgery, Neuroscience Institute, Hospital Clínico San Carlos, Madrid, Spain.
| | - Giovanni Grasso
- Department of Biomedicine, Neuroscience and Advanced Diagnostics (BiND), University of Palermo, Palermo, Italy
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11
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Sundararajan SH, Ranganathan S, Kishore V, Doustaly R, Patsalides A. Simulation of superselective catheterization for cerebrovascular lesions using a virtual injection software. CVIR Endovasc 2021; 4:52. [PMID: 34125300 PMCID: PMC8203774 DOI: 10.1186/s42155-021-00242-6] [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: 03/26/2021] [Accepted: 06/01/2021] [Indexed: 11/10/2022] Open
Abstract
Background This report addresses the feasibility of virtual injection software based on contrast-enhanced cone-beam CTs (CBCTs) in the context of cerebrovascular lesion embolization. Intracranial arteriovenous malformation (AVM), dural arteriovenous fistula (AVF) and mycotic aneurysm embolization cases with CBCTs performed between 2013 and 2020 were retrospectively reviewed. Cerebrovascular lesions were reviewed by 2 neurointerventionalists using a dedicated virtual injection software (EmboASSIST, GE Healthcare; Chicago, IL). Points of Interest (POIs) surrounding the vascular lesions were first identified. The software then automatically displayed POI-associated vascular traces from vessel roots to selected POIs. Vascular segments and reason for POI identification were recorded. Using 2D multiplanar reconstructions from CBCTs, the accuracy of vascular traces was assessed. Clinical utility metrics were recorded on a 3-point Likert scale from 1 (no benefit) to 3 (very beneficial). Results Nine cases (7 AVM, 1 AVF, 1 mycotic aneurysm) were reviewed, with 26 POIs selected. Three POIs were in 2nd order segments, 8 POIs in 3rd order segments and 15 POIs in 4th order segments of their respective arteries. The reviewers rated all 26 POI traces – involving a total of 90 vascular segments – as accurate. The average utility score across the 8 questions were 2.7 and 2.8 respectively from each reviewer, acknowledging the software’s potential benefit in cerebrovascular embolization procedural planning. Conclusion The operators considered CBCT-based virtual injection software clinically useful and accurate in guiding and planning cerebrovascular lesion embolization in this retrospective review. Future prospective studies in larger cohorts are warranted for validation of this modality.
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Affiliation(s)
- Sri Hari Sundararajan
- Department of Neurosurgery, Division of Interventional Neuroradiology, New York Presbyterian Hospital/Weill Cornell Medical Center, 525 East 68th St, New York, NY, 10065, USA.
| | - Srirajkumar Ranganathan
- Northwestern University Feinberg School of Medicine, 420 East Superior Street, Chicago, IL, 60611, USA
| | | | | | - Athos Patsalides
- Department of Neuro-Interventional Surgery, North Shore University Hospital, Northwell Health, 300 Community Drive, Manhasset, NY, 11030, USA
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12
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Recent progress understanding pathophysiology and genesis of brain AVM-a narrative review. Neurosurg Rev 2021; 44:3165-3175. [PMID: 33837504 PMCID: PMC8592945 DOI: 10.1007/s10143-021-01526-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 03/09/2021] [Accepted: 03/15/2021] [Indexed: 02/07/2023]
Abstract
Considerable progress has been made over the past years to better understand the genetic nature and pathophysiology of brain AVM. For the actual review, a PubMed search was carried out regarding the embryology, inflammation, advanced imaging, and fluid dynamical modeling of brain AVM. Whole-genome sequencing clarified the genetic origin of sporadic and familial AVM to a large degree, although some open questions remain. Advanced MRI and DSA techniques allow for better segmentation of feeding arteries, nidus, and draining veins, as well as the deduction of hemodynamic parameters such as flow and pressure in the individual AVM compartments. Nonetheless, complete modeling of the intranidal flow structure by computed fluid dynamics (CFD) is not possible so far. Substantial progress has been made towards understanding the embryology of brain AVM. In contrast to arterial aneurysms, complete modeling of the intranidal flow and a thorough understanding of the mechanical properties of the AVM nidus are still lacking at the present time.
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13
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Gong Y, Cao C, Guo Y, Chang B, Sheng Z, Shen W, Zou Y, Lu X, Xing J, Xia S. Quantification of intracranial arterial stenotic degree evaluated by high-resolution vessel wall imaging and time-of-flight MR angiography: reproducibility, and diagnostic agreement with DSA. Eur Radiol 2021; 31:5479-5489. [PMID: 33585995 DOI: 10.1007/s00330-021-07719-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 12/17/2020] [Accepted: 01/27/2021] [Indexed: 12/20/2022]
Abstract
OBJECTIVES The purpose of this study was to compare the reproducibility and diagnostic agreement of high-resolution vessel wall imaging (HR-VWI) and time-of-flight magnetic resonance angiography (TOF-MRA) with digital subtraction angiography (DSA) to evaluate intracranial arterial stenosis. METHODS We retrospectively enrolled patients who underwent HR-VWI and TOF-MRA with suspected intracranial artery disease and had DSA results from our institutional imaging database. Two neuroradiologists separately and independently evaluated anonymous image data for the stenotic lesions. DSA was analyzed by two neurointerventionalists and it served as a standard criterion. The reproducibility of these two MR techniques was determined by the intraclass correlation coefficients (ICCs). The diagnostic agreement to DSA was assessed by the concordance correlation coefficients (CCCs). RESULTS A total of 246 lesions from 106 individuals were analyzed for stenotic degrees. The total intra-observer and inter-observer reproducibility of HR-VWI was excellent for identifying stenosis and better than of TOF-MRA. The overall concordance of HR-VWI with DSA was excellent with CCC = 0.932, whereas TOF-MRA was 0.694. In addition, HR-VWI could provide additional vessel wall information. CONCLUSIONS HR-VWI has more advantages over TOF-MRA, such as better reproducibilities and diagnostic agreements with DSA to analyze intracranial arterial stenosis. It provides additional information that helps in clinical diagnosis and management. KEY POINTS • High-resolution vessel wall imaging can assess intracranial arterial stenosis with a better reproducibility than TOF-MRA and has a higher diagnostic agreement with DSA. • High-resolution vessel wall imaging had a higher diagnostic agreement with DSA compared with TOF-MRA. • Apart from evaluating vascular stenosis, HR-VWI provided additional vessel wall information to help in clinical diagnosis.
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Affiliation(s)
- Yan Gong
- Department of Radiology, First Central Clinical College, Tianjin Medical University, Tianjin, 300192, China.,Department of Radiology, Tianjin Medical University Nankai Hospital, Tianjin, 300100, China
| | - Chen Cao
- Department of Radiology, First Central Clinical College, Tianjin Medical University, Tianjin, 300192, China.,Department of Radiology, Tianjin Huanhu Hospital, Key Laboratory for Cerebral Artery and Neural Degeneration of Tianjin, Tianjin, 300350, China
| | - Yu Guo
- Department of Radiology, Tianjin First Central Hospital, School of Medical, Nankai University, Tianjin, 300192, China
| | - Binge Chang
- Department of Neurosurgery, Tianjin First Central Hospital, School of Medical, Nankai University, Tianjin, 300192, China
| | - Zhiguo Sheng
- Department of Neurosurgery, Tianjin First Central Hospital, School of Medical, Nankai University, Tianjin, 300192, China
| | - Wen Shen
- Department of Radiology, Tianjin First Central Hospital, School of Medical, Nankai University, Tianjin, 300192, China
| | - Ying Zou
- Department of Radiology, First Central Clinical College, Tianjin Medical University, Tianjin, 300192, China.,Department of Radiology, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, 300381, China
| | - Xiudi Lu
- Department of Radiology, First Central Clinical College, Tianjin Medical University, Tianjin, 300192, China.,Department of Radiology, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, 300381, China
| | - Jiahua Xing
- School of Medicine, Nankai University, Tianjin, 300071, China
| | - Shuang Xia
- Department of Radiology, Tianjin First Central Hospital, School of Medical, Nankai University, Tianjin, 300192, China.
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14
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Falk KL, Schafer S, Speidel MA, Strother CM. 4D-DSA: Development and Current Neurovascular Applications. AJNR Am J Neuroradiol 2021; 42:214-220. [PMID: 33243899 PMCID: PMC7872169 DOI: 10.3174/ajnr.a6860] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 07/30/2020] [Indexed: 11/07/2022]
Abstract
Originally described by Davis et al in 2013, 4D-Digital Subtraction Angiography (4D-DSA) has developed into a commercially available application of DSA in the angiography suite. 4D-DSA provides the user with 3D time-resolved images, allowing observation of a contrast bolus at any desired viewing angle through the vasculature and at any time point during the acquisition (any view at any time). 4D-DSA mitigates some limitations that are intrinsic to both 2D- and 3D-DSA images. The clinical applications for 4D-DSA include evaluations of AVMs and AVFs, intracranial aneurysms, and atherosclerotic occlusive disease. Recent advances in blood flow quantification using 4D-DSA indicate that these data provide both the velocity and geometric information necessary for the quantification of blood flow. In this review, we will discuss the development, acquisition, reconstruction, and current neurovascular applications of 4D-DSA volumes.
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Affiliation(s)
- K L Falk
- From the School of Medicine and Public Health (K.L.R.)
- Department of Biomedical Engineering (K.L.R.)
| | - S Schafer
- Siemens Healthineers (S.S.), Malvern, Pennsylvania
| | - M A Speidel
- Medical Physics (M.A.S.), University of Wisconsin-Madison, Madison, Wisconsin
| | - C M Strother
- Radiology (C.M.S.), University of Wisconsin-Madison, Madison, Wisconsin
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15
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Settecase F, Rayz VL. Advanced vascular imaging techniques. HANDBOOK OF CLINICAL NEUROLOGY 2021; 176:81-105. [DOI: 10.1016/b978-0-444-64034-5.00016-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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16
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Yu JF, Pung L, Minami H, Mueller K, Khangura R, Darflinger R, Hetts SW, Cooke DL. Virtual 2D angiography from four-dimensional digital subtraction angiography (4D-DSA): A feasibility study. Interv Neuroradiol 2020; 27:307-313. [PMID: 32985291 DOI: 10.1177/1591019920961604] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Digital subtraction angiography (DSA) remains the gold standard for angiographic evaluation of cerebrovascular pathology, however, multiple acquisitions requiring additional time and radiation are often needed. In contrast, 3D-DSA provides volumetric information from a single injection but neglects temporal information. Four-dimensional-DSA (4D-DSA) combines temporal information of 2D-DSA with volumetric information of 3D-DSA to provide time-resolved tomographic 3D reconstructions, potentially reducing procedure time and radiation. This work evaluates the diagnostic quality of virtual single-frame 4D-DSA relative to 2D-DSA images by assessing clinicians' ability to evaluate cerebrovascular pathology. METHODS Single-frame images of four projections from 4D-DSA and their corresponding 2D-DSA images (n = 15) were rated by two neurointerventional radiologists. Images were graded based on diagnostic quality (0 = non-diagnostic, 1 = poor, 2 = acceptable, 3 = good). Dose area product (DAP) for each case was recorded for all 2D-DSA, 4D-DSA acquisitions, and the overall procedure. RESULTS The mean diagnostic quality of all four 4D-DSA projections from both raters was 1.75 while the mean of 2D-DSA projections was 2.8. Student's t-test revealed significant difference in diagnostic quality between 4D-DSA and 2D-DSA at all four projections (p < 0.001). On average 4D-DSA acquisitions accounted for 30% dose compared to the overall average aggregated dose per procedure. CONCLUSIONS The difference in image quality between virtual single-frame 4D-DSA and their respective 2D-DSA images is statistically significant. Furthermore, 4D-DSA acquisitions require less radiation dose than conventional procedures with 2D-DSA acquisitions.
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Affiliation(s)
- Jay F Yu
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA
| | - Leland Pung
- Siemens Medical Solutions Inc., Malvern, PA, USA
| | | | | | - Rajkamal Khangura
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA
| | - Robert Darflinger
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA
| | - Steven W Hetts
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA
| | - Daniel L Cooke
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA
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17
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Clarençon F, Lenck S, Shotar E, Boch AL, Lefevre E, Premat K, Amador MDM, Sourour NA. Four-dimensional digital subtraction angiography for exploration of spinal cord vascular malformations: preliminary experience. J Neurointerv Surg 2020; 13:69-74. [PMID: 32586909 DOI: 10.1136/neurintsurg-2020-015909] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 05/07/2020] [Accepted: 05/12/2020] [Indexed: 11/03/2022]
Abstract
BACKGROUND The precise understanding of the angioarchitecture of spinal vascular malformations (SVMs) is often difficult to reach with conventional digital subtraction angiography (DSA). The purpose of our study was to evaluate the potential of four-dimensional DSA (4D-DSA) (Siemens Healthcare) in the exploration of SVMs. METHODS We retrospectively studied all patients who underwent spinal DSA, including 4D-DSA acquisition, from July 2018 to June 2019 at a single institution. All spinal DSA acquisitions were performed under general anesthesia. 4D-DSA acquisitions were acquired with the protocol '12 s DSA Dyna4D Neuro'. 12 mL of iodixanol 320 mg iodine/mL were injected via a 5 F catheter (1 mL/s during the 12 s 4D-DSA acquisition). Inter-rater (three independent reviewers) and intermodality agreements were assessed. RESULTS Nine consecutive patients (six men, three women, mean age 55.3±19.8 years) with 10 SVMs (spinal dural arteriovenous fistulas n=3, spinal epidural arteriovenous fistulas n=2, spinal pial arteriovenous fistulas n=2, and spinal arteriovenous malformations n=2; one patient had two synchronous pial fistulas) had spinal DSA, including 4D-DSA acquisition. Inter-rater agreement was good and moderate for the venous drainage pattern and the SVM subtype, respectively. In 9 of 10 cases, the quality of the acquisition was graded as good. Satisfactory concordance between 4D-DSA and the selective microcatheterization was observed in 90% of cases for the location of the shunt point. CONCLUSION 4D-DSA acquisition may be helpful for a better understanding of the angioarchitecture of SVMs. Larger series are warranted to confirm these preliminary results.
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Affiliation(s)
- Frédéric Clarençon
- Sorbonne Université, Paris, Île-de-France, France .,Neuroradiology, Hôpital Universitaire Pitié Salpêtrière, Paris, Île-de-France, France
| | - Stéphanie Lenck
- Neuroradiology, Hôpital Universitaire Pitié Salpêtrière, Paris, Île-de-France, France
| | - Eimad Shotar
- Neuroradiology, Hôpital Universitaire Pitié Salpêtrière, Paris, Île-de-France, France
| | - Anne-Laure Boch
- Neurosurgery, Hôpital Universitaire Pitié-Salpêtrière, Paris, Île-de-France, France
| | - Etienne Lefevre
- Sorbonne Université, Paris, Île-de-France, France.,Neurosurgery, Hôpital Universitaire Pitié-Salpêtrière, Paris, Île-de-France, France
| | - Kevin Premat
- Sorbonne Université, Paris, Île-de-France, France.,Neuroradiology, Hôpital Universitaire Pitié Salpêtrière, Paris, Île-de-France, France
| | - Maria Del Mar Amador
- Neurology, Hôpital Universitaire Pitié-Salpêtrière, Paris, Île-de-France, France
| | - Nader-Antoine Sourour
- Neuroradiology, Hôpital Universitaire Pitié Salpêtrière, Paris, Île-de-France, France
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18
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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: 1.0] [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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Li Y, Garrett JW, Li K, Wu Y, Johnson K, Schafer S, Strother C, Chen GH. Time-resolved C-arm cone beam CT angiography (TR-CBCTA) imaging from a single short-scan C-arm cone beam CT acquisition with intra-arterial contrast injection. Phys Med Biol 2018; 63:075001. [PMID: 29494345 DOI: 10.1088/1361-6560/aab346] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Time-resolved C-arm cone-beam CT (CBCT) angiography (TR-CBCTA) images can be generated from a series of CBCT acquisitions that satisfy data sufficiency condition in analytical image reconstruction theory. In this work, a new technique was developed to generate TR-CBCTA images from a single short-scan CBCT data acquisition with contrast media injection. The reconstruction technique enabling this application is a previously developed image reconstruction technique, synchronized multi-artifact reduction with tomographic reconstruction (SMART-RECON). In this new application, the acquired short-scan CBCT projection data were sorted into a union of several sub-sectors of view angles and each sub-sector of view angles corresponds to an individual image volume to be reconstructed. The SMART-RECON method was then used to jointly reconstruct all of these individual image volumes under two constraints: (1) each individual image volume is maximally consistent with the measured cone-beam projection data within the corresponding view angle sector and (2) the nuclear norm of the image matrix is minimized. The difference between these reconstructed individual image volumes is used to generated the desired subtracted angiograms. To validate the technique, numerical simulation data generated from a fractal tree angiogram phantom were used to quantitatively study the accuracy of the proposed method and retrospective in vivo human subject studies were used to demonstrate the feasibility of generating TR-CBCTA in clinical practice.
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Affiliation(s)
- Yinsheng Li
- Department of Medical Physics, School of Medicine and Public Health, University of Wisconsin-Madison, WI 53705, United States of America
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20
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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: 2.1] [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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