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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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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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Chen KK, Lin CJ, Guo WY, Chu WF, Wu YT. Estimating blood flow velocity using time-resolved 3D angiography and a derived physical law of contrast media. Physiol Meas 2021; 42:025007. [PMID: 33498022 DOI: 10.1088/1361-6579/abe022] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Four-dimensional (4D) digital subtraction angiography (DSA) offers a method for evaluating hemodynamics. It is, however, unclear how the delivered contrast medium interacts with the physiological blood flow, and how hemodynamic information may be inferred from the mixture of the contrast medium and blood. In this study, we present a theoretical explanation of contrast dynamics, and an accompanying algorithm for estimating blood flow velocity. APPROACH We retrospectively recruited 23 patients who underwent both 4D DSA and magnetic resonance (MR) phase-contrast imaging. The 4D DSA-reconstructed contrast dynamics were first studied for the internal carotid arteries. Using physical laws governing fluid motion within a curved tube, we showed that the reconstructed contrast dynamics obeyed a simple advection equation. We then proposed an algorithm for estimating the contrast dynamics using angiographic data, and subsequently estimated the axial blood flow velocity using an advection equation. MAIN RESULTS The estimated velocities were compared using three techniques: the Fourier technique, Lin's method, and MR phase contrast. Testing with noise-corrupted artificial data showed that the proposed algorithm was noise resistant. The velocities of 23 patients computed by 4D DSA using the proposed algorithm showed a moderate correlation with the MR phase contrast (r = 0.61), and good correlations with the other two techniques (r = 0.75 and r = 0.72). SIGNIFICANCE The proposed algorithm and has been applied to blood vessel segments with poor signal-to-noise ratios and axial lengths of less than 3 cm, and has a physical basis for computing axial flow velocities using an advection equation. The results of the proposed algorithm are consistent with existing methods.
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Affiliation(s)
- Ko-Kung Chen
- Taipei Veterans General Hospital, Department of Radiology, Taipei, Taiwan
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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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Narsinh KH, Mueller K, Nelson J, Massachi J, Murph DC, Copelan AZ, Hetts SW, Halbach VV, Higashida RT, Abla AA, Amans MR, Dowd CF, Kim H, Cooke DL. Interrater Reliability in the Measurement of Flow Characteristics on Color-Coded Quantitative DSA of Brain AVMs. AJNR Am J Neuroradiol 2020; 41:2303-2310. [PMID: 33122213 DOI: 10.3174/ajnr.a6846] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Accepted: 08/05/2020] [Indexed: 12/28/2022]
Abstract
BACKGROUND AND PURPOSE Hemodynamic features of brain AVMs may portend increased hemorrhage risk. Previous studies have suggested that MTT is shorter in ruptured AVMs as assessed on quantitative color-coded parametric DSA. This study assesses the interrater reliability of MTT measurements obtained using quantitative color-coded DSA. MATERIALS AND METHODS Thirty-five color-coded parametric DSA images of 34 brain AVMs were analyzed by 4 neuroradiologists with experience in interventional neuroradiology. Hemodynamic features assessed included MTT of the AVM and TTP of the dominant feeding artery and draining vein. Agreement among the 4 raters was assessed using the intraclass correlation coefficient. RESULTS The interrater reliability among the 4 raters was poor (intraclass correlation coefficient = 0.218; 95% CI, 0.062-0.414; P value = .002) as it related to MTT assessment. When the analysis was limited to cases in which the raters selected the same image to analyze and selected the same primary feeding artery and the same primary draining vein, interrater reliability improved to fair (intraclass correlation coefficient = 0.564; 95% CI, 0.367-0.717; P < .001). CONCLUSIONS Interrater reliability in deriving color-coded parametric DSA measurements such as MTT is poor so minor differences among raters may result in a large variance in MTT and TTP results, partly due to the sensitivity and 2D nature of the technique. Reliability can be improved by defining a standard projection, feeding artery, and draining vein for analysis.
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Affiliation(s)
- K H Narsinh
- From the Department of Radiology and Biomedical Imaging (K.H.N., J.M., D.C.M., A.Z.C., S.W.H., V.V.H., R.T.H., M.R.A., C.F.D., D.L.C.)
| | - K Mueller
- Siemens Medical Solutions (K.M.), Malvern, Pennsylvania
| | - J Nelson
- Center for Cerebrovascular Research (J.N., H.K.), Department of Anesthesiology
| | - J Massachi
- From the Department of Radiology and Biomedical Imaging (K.H.N., J.M., D.C.M., A.Z.C., S.W.H., V.V.H., R.T.H., M.R.A., C.F.D., D.L.C.)
| | - D C Murph
- From the Department of Radiology and Biomedical Imaging (K.H.N., J.M., D.C.M., A.Z.C., S.W.H., V.V.H., R.T.H., M.R.A., C.F.D., D.L.C.)
| | - A Z Copelan
- From the Department of Radiology and Biomedical Imaging (K.H.N., J.M., D.C.M., A.Z.C., S.W.H., V.V.H., R.T.H., M.R.A., C.F.D., D.L.C.)
| | - S W Hetts
- From the Department of Radiology and Biomedical Imaging (K.H.N., J.M., D.C.M., A.Z.C., S.W.H., V.V.H., R.T.H., M.R.A., C.F.D., D.L.C.)
| | - V V Halbach
- From the Department of Radiology and Biomedical Imaging (K.H.N., J.M., D.C.M., A.Z.C., S.W.H., V.V.H., R.T.H., M.R.A., C.F.D., D.L.C.)
| | - R T Higashida
- From the Department of Radiology and Biomedical Imaging (K.H.N., J.M., D.C.M., A.Z.C., S.W.H., V.V.H., R.T.H., M.R.A., C.F.D., D.L.C.)
| | - A A Abla
- Department of Neurological Surgery (A.A.A.), University of California San Francisco, San Francisco, California
| | - M R Amans
- From the Department of Radiology and Biomedical Imaging (K.H.N., J.M., D.C.M., A.Z.C., S.W.H., V.V.H., R.T.H., M.R.A., C.F.D., D.L.C.)
| | - C F Dowd
- From the Department of Radiology and Biomedical Imaging (K.H.N., J.M., D.C.M., A.Z.C., S.W.H., V.V.H., R.T.H., M.R.A., C.F.D., D.L.C.)
| | - H Kim
- Center for Cerebrovascular Research (J.N., H.K.), Department of Anesthesiology
| | - D L Cooke
- From the Department of Radiology and Biomedical Imaging (K.H.N., J.M., D.C.M., A.Z.C., S.W.H., V.V.H., R.T.H., M.R.A., C.F.D., D.L.C.)
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