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Wang J, Sun J, Xu J, Lu S, Wang H, Huang C, Zhang F, Yu Y, Gao X, Wang M, Wang Y, Ruan X, Pan Y. Detection of Intracranial Aneurysms Using Multiphase CT Angiography with a Deep Learning Model. Acad Radiol 2023; 30:2477-2486. [PMID: 36737273 DOI: 10.1016/j.acra.2022.12.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 12/27/2022] [Accepted: 12/27/2022] [Indexed: 02/04/2023]
Abstract
RATIONALE AND OBJECTIVES Determine the effect of a multiphase fusion deep-learning model with automatic phase selection in detection of intracranial aneurysm (IA) from computed tomography angiography (CTA) images. MATERIALS AND METHODS CTA images of intracranial arteries from patients at Ningbo First Hospital were retrospectively analyzed. Images were randomly classified as training data, internal validation data, or test data. CTA images from cases examined by digital subtraction angiography (DSA) were examined for independent validation. A deep-learning model was constructed by automatic phase selection of multiphase fusion, and compared to the single-phase algorithm to evaluate algorithm sensitivity. RESULTS We analyzed 1110 patients (1493 aneurysms) as training data, 139 patients (174 aneurysms) as internal validation data, and 134 patients (175 aneurysms) as test data. The sensitivity of the multiphase analysis of the internal validation data, test data, and independent validation data were greater than from the single-phase analysis. The recall of the multiphase selection was greater or equal to that of single-phase selection in the aneurysm position, shape, size, and rupture status. Use of the test data to determine the presence and absence of aneurysm rupture led to a recall from multiphase selection of 94.8% and 87.6% respectively; both of these values were greater than those from single-phase selection (89.6% and 79.4%). CONCLUSION A multiphase fusion deep learning model with automatic phase selection provided automated detection of IAs with high sensitivity.
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Affiliation(s)
- Jinglu Wang
- Department of Radiology, Ningbo First Hospital, Ningbo, Zhejiang Province, People's Republic of China
| | - Jie Sun
- Department of Neurosurgery, Ningbo First Hospital, Ningbo, Zhejiang Province, People's Republic of China
| | - Jingxu Xu
- Deepwise AI Lab, Beijing Deepwise & League of PHD Technology Co., Ltd, Beijing, People's Republic of China
| | - Shiyu Lu
- Deepwise AI Lab, Beijing Deepwise & League of PHD Technology Co., Ltd, Beijing, People's Republic of China
| | - Hao Wang
- Deepwise AI Lab, Beijing Deepwise & League of PHD Technology Co., Ltd, Beijing, People's Republic of China
| | - Chencui Huang
- Deepwise AI Lab, Beijing Deepwise & League of PHD Technology Co., Ltd, Beijing, People's Republic of China
| | - Fandong Zhang
- Deepwise AI Lab, Beijing Deepwise & League of PHD Technology Co., Ltd, Beijing, People's Republic of China
| | - Yizhou Yu
- Deepwise AI Lab, Beijing Deepwise & League of PHD Technology Co., Ltd, Beijing, People's Republic of China
| | - Xiang Gao
- Department of Neurosurgery, Ningbo First Hospital, Ningbo, Zhejiang Province, People's Republic of China
| | - Ming Wang
- Department of Radiology, Ningbo First Hospital, Ningbo, Zhejiang Province, People's Republic of China
| | - Yu Wang
- Department of Radiology, Ningbo First Hospital, Ningbo, Zhejiang Province, People's Republic of China
| | - Xinzhong Ruan
- Department of Radiology, Ningbo First Hospital, Ningbo, Zhejiang Province, People's Republic of China
| | - Yuning Pan
- Department of Radiology, Ningbo First Hospital, Ningbo, Zhejiang Province, People's Republic of China; Key Laboratory of Precision Medicine for Atherosclerotic Diseases of Zhejiang Province, People's Republic of China.
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Northam WT, Slingerland AL, Orbach DB, Smith ER. Magnetic Resonance Imaging/Angiography Versus Catheter Angiography for Annual Follow-up of Pediatric Moyamoya Patients: A Cost Outcomes Analysis. Neurosurgery 2023; 92:1243-1248. [PMID: 36744923 DOI: 10.1227/neu.0000000000002357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 11/08/2022] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Digital subtraction angiography (DSA) assesses revascularization in pediatric moyamoya patients after surgery, but MRI and angiography (MRI/A) may provide comparable data. OBJECTIVE To evaluate DSA and MRI/A with respect to clinical utility in postoperative follow-up, complication profile, and relative cost at 1 year. METHODS All pediatric moyamoya patients who received bilateral indirect revascularization between 2011 and 2020 were retrospectively reviewed at 1 institution. Patients who underwent MRI/A-only, DSA-only, or both after 1 year were compared. RESULTS Eighty-two patients were included. At 1 year, patients who underwent either MRI/A (n = 29) or DSA (n = 40) had no significant differences in detection rate of new at-risk hypovascular territories (6.9% vs 2.5%, P = .568) or need for subsequent revascularization beyond the mean 40 ± 24-month follow-up period (3.4% vs 5.0%, P > .9). Among patients who underwent both MRI/A and DSA (n = 13), both studies identified the same at-risk territories. No patients experienced MRI/A-related complications, compared with 3 minor DSA-related complications. The use of MRI/A yielded a 6.5-fold reduction in cost per study vs DSA at 1 year. CONCLUSION Using DSA to follow moyamoya patients after indirect revascularization is generally safe but associated with a low rate of minor complications and a 6.5-fold greater financial cost relative to MRI/A. These data support changing practice to eliminate the use of DSA when following routine bilateral moyamoya cases in the absence of clinical symptoms or specific concerns. Using MRI/A as the primary postoperative follow-up modality in this select population provides noninferior care and greater patient access, while reducing cost and potentially decreasing risk.
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Affiliation(s)
- Weston T Northam
- Department of Neurosurgery, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Anna L Slingerland
- Department of Neurosurgery, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Darren B Orbach
- Department of Neurosurgery, Boston Children's Hospital, Boston, Massachusetts, USA
- Department of Radiology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Edward R Smith
- Department of Neurosurgery, Boston Children's Hospital, Boston, Massachusetts, USA
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Chen J, Han M, Feng X, Peng F, Tong X, Niu H, Zhang D, Liu A. Cost effectiveness of screening for intracranial aneurysms among patients with bicuspid aortic valve: a Markov modelling study. BMJ Open 2021; 11:e051236. [PMID: 34907052 PMCID: PMC8672010 DOI: 10.1136/bmjopen-2021-051236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE Bicuspid aortic valve (BAV) is common and 7.7%-9.8% of patients with BAV have intracranial aneuryms (IAs) which might lead to a devastating subarachnoid haemorrhage (SAH). We aimed to evaluate different screening and follow-up strategies using magnetic resonance angiography for IAs among patients with BAV. METHODS A decision-analytic model was built to evaluate the costs and effectiveness of different management strategies from the Chinese healthcare payer's perspective. The evaluated strategies included natural history without screening for possible IAs, regular screening and no follow-up for detected IAs, and regular screening with regular follow-up (Screen strategy/Follow-up strategy). Base case calculation, as well as probabilistic, one-way, and two-way sensitivity analyses, were performed. RESULTS According to the base case calculation, natural history had the least cost and effectiveness while Every 5 years (y)/Annual gained the highest cost and effectiveness. Every 10y/Biennial was cost effective when compared with Every 10y/Every 5y under the willingness-to-pay threshold of ¥211 743 (US$30 162). Probabilistic sensitivity analysis showed that Every 10y/Biennial was superior in 88.3% of the cases when compared with Every 10y/Every 5y. One-way and two-way sensitivity analyses proved that Every 10y/Biennial was the dominant strategy under most circumstances. CONCLUSIONS Screening for possible IAs among patients with BAV and follow-up for detected IAs would increase the effectiveness. Every 10y/Biennial was the optimal strategy from the Chinese healthcare payer's perspective.
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Affiliation(s)
- Jigang Chen
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Mingyang Han
- Department of Neurosurgery, The Third Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Xin Feng
- Department of Neurosurgery, Beijing Hospital, Beijing, China
| | - Fei Peng
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xin Tong
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Hao Niu
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Danfeng Zhang
- Department of Neurosurgery, Naval Medical University, Shanghai, China
| | - Aihua Liu
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
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