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Williams KA, Shields A, Setlur Nagesh SV, Chudzik M, Bednarek DR, Rudin S, Ionita C. Angiographic velocimetry analysis using contrast dilution gradient method with a 1000 frames per second photon-counting detector. J Med Imaging (Bellingham) 2023; 10:033502. [PMID: 37287600 PMCID: PMC10242414 DOI: 10.1117/1.jmi.10.3.033502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 04/11/2023] [Accepted: 05/19/2023] [Indexed: 06/09/2023] Open
Abstract
Purpose Contrast dilution gradient (CDG) analysis is a quantitative method allowing blood velocity estimation using angiographic acquisitions. Currently, CDG is restricted to peripheral vasculature due to the suboptimal temporal resolution of current imaging systems. We investigate extension of CDG methods to the flow conditions of proximal vasculature using 1000 frames per second (fps) high-speed angiographic (HSA) imaging. Approach We performed in-vitro HSA acquisitions using the XC-Actaeon detector and 3D-printed patient-specific phantoms. The CDG approach was used for blood velocity estimation expressed as the ratio of temporal and spatial contrast gradients. The gradients were extracted from 2D contrast intensity maps synthesized by plotting intensity profiles along the arterial centerline at each frame. In-vitro results obtained at various frame rates via temporal binning of 1000 fps data were retrospectively compared to computational fluid dynamics (CFD) velocimetry. Full-vessel velocity distributions were estimated at 1000 fps via parallel line expansion of the arterial centerline analysis. Results Using HSA, the CDG method displayed agreement with CFD at or above 250 fps [mean-absolute error (MAE): 2.6 ± 6.3 cm / s , p = 0.05 ]. Relative velocity distributions correlated well with CFD at 1000 fps with universal underapproximation due to effects of pulsatile contrast injection (MAE: 4.3 cm/s). Conclusions Using 1000 fps HSA, CDG-based extraction of velocities across large arteries is possible. The method is sensitive to noise; however, image processing techniques and a contrast injection, which adequately fills the vessel assist algorithm accuracy. The CDG method provides high resolution quantitative information for rapidly transient flow patterns observed in arterial circulation.
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Affiliation(s)
- Kyle A. Williams
- University at Buffalo, Department of Biomedical Engineering, Buffalo, New York, United States
- Canon Stroke and Vascular Research Center, Buffalo, New York, United States
- University at Buffalo, Department of Radiology, Buffalo, New York, United States
| | - Allison Shields
- Canon Stroke and Vascular Research Center, Buffalo, New York, United States
- University at Buffalo, Department of Radiology, Buffalo, New York, United States
| | - Swetadri Vasan Setlur Nagesh
- Canon Stroke and Vascular Research Center, Buffalo, New York, United States
- University at Buffalo, Department of Neurosurgery, Buffalo, New York, United States
| | - Mitchell Chudzik
- University at Buffalo, Department of Biomedical Engineering, Buffalo, New York, United States
- Canon Stroke and Vascular Research Center, Buffalo, New York, United States
| | - Daniel R. Bednarek
- University at Buffalo, Department of Biomedical Engineering, Buffalo, New York, United States
- Canon Stroke and Vascular Research Center, Buffalo, New York, United States
- University at Buffalo, Department of Radiology, Buffalo, New York, United States
| | - Stephen Rudin
- University at Buffalo, Department of Biomedical Engineering, Buffalo, New York, United States
- Canon Stroke and Vascular Research Center, Buffalo, New York, United States
- University at Buffalo, Department of Radiology, Buffalo, New York, United States
- University at Buffalo, Department of Neurosurgery, Buffalo, New York, United States
| | - Ciprian Ionita
- University at Buffalo, Department of Biomedical Engineering, Buffalo, New York, United States
- Canon Stroke and Vascular Research Center, Buffalo, New York, United States
- University at Buffalo, Department of Radiology, Buffalo, New York, United States
- University at Buffalo, Department of Neurosurgery, Buffalo, New York, United States
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2
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Price RD, Bhurwani MMS, Sommer KN, Monteiro A, Baig AA, Davies JM, Siddiqui AH, Ionita CN. Initial investigation of the use of angiographic parametric imaging for early prognosis of delayed cerebral ischemia in patients with subarachnoid hemorrhage. PROCEEDINGS OF SPIE--THE INTERNATIONAL SOCIETY FOR OPTICAL ENGINEERING 2022; 12036:120361Q. [PMID: 35983497 PMCID: PMC9385186 DOI: 10.1117/12.2612081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
PURPOSE Subarachnoid Hemorrhage (SAH) is a lethal hemorrhagic stroke that account for 25% of cerebrovascular deaths. As a result of the initial bleed, a chain of physiological events are initiated which may lead to Delayed Cerebral Ischemia (DCI). As of now we have no diagnostic capability to identify patients which may present DCI a few weeks after initial presentation. We propose to investigate whether a data driven approach using angiographic parametric imaging (API) may predict occurrence of the DCI. MATERIALS AND METHODS Digital Subtraction Angiographic (DSA) sequences from 125 SAH patients were used retrospectively to perform API assessment of the entire brain hemisphere where the hemorrhage was detected. Four Regions of Interests (ROIs) were placed to extract five average API biomarkers in the lateral and AP DSAs. Data driven analysis using Logistic Regression was performed for various API parameters and ROIs to find the optimal configuration to maximize the prognosis accuracy. Each model performance was evaluated using area under the curve of the receiver operator characteristic (AUROC). RESULTS Data driven approach with API has a 60% accuracy predicting DCI occurrence. We determined that location of the ROI for extraction of the API parameters is very important for the data driven model performance. Normalizing the values using the inlet velocities for each patient yield higher and more consistent results. Single API biomarkers models had poor prediction accuracies, barely better than chance. CONCLUSIONS This effectiveness exploratory study demonstrates for the first time, that prognosis of the DCI in SAH patients, is feasible and warrants a more in-depth investigation.
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Affiliation(s)
- Roman D Price
- Department of Biomedical Engineering, University at Buffalo, Buffalo NY 14228
- Canon Stroke and Vascular Research Center, Buffalo, NY 14203
| | - Mohammad Mahdi Shiraz Bhurwani
- Department of Biomedical Engineering, University at Buffalo, Buffalo NY 14228
- Canon Stroke and Vascular Research Center, Buffalo, NY 14203
| | - Kelsey N Sommer
- Department of Biomedical Engineering, University at Buffalo, Buffalo NY 14228
- Canon Stroke and Vascular Research Center, Buffalo, NY 14203
- QAS.AI Incorporated, Buffalo NY 14203
| | - Andrei Monteiro
- Canon Stroke and Vascular Research Center, Buffalo, NY 14203
- University at Buffalo Neurosurgery, University at Buffalo Jacobs School of Medicine, Buffalo NY 14228
| | - Ammad A Baig
- Canon Stroke and Vascular Research Center, Buffalo, NY 14203
- University at Buffalo Neurosurgery, University at Buffalo Jacobs School of Medicine, Buffalo NY 14228
| | - Jason M Davies
- Canon Stroke and Vascular Research Center, Buffalo, NY 14203
- University at Buffalo Neurosurgery, University at Buffalo Jacobs School of Medicine, Buffalo NY 14228
- QAS.AI Incorporated, Buffalo NY 14203
- University Dept. of Biomedical Informatics, University at Buffalo, Buffalo, NY 14214
| | - Adnan H Siddiqui
- Canon Stroke and Vascular Research Center, Buffalo, NY 14203
- University at Buffalo Neurosurgery, University at Buffalo Jacobs School of Medicine, Buffalo NY 14228
- University Dept. of Biomedical Informatics, University at Buffalo, Buffalo, NY 14214
| | - Ciprian N Ionita
- Department of Biomedical Engineering, University at Buffalo, Buffalo NY 14228
- Canon Stroke and Vascular Research Center, Buffalo, NY 14203
- University at Buffalo Neurosurgery, University at Buffalo Jacobs School of Medicine, Buffalo NY 14228
- QAS.AI Incorporated, Buffalo NY 14203
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3
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Bhurwani MMS, Sommer KN, Ionita CN. Recovery of complete time density curves from incomplete angiographic data using recurrent neural networks. PROCEEDINGS OF SPIE--THE INTERNATIONAL SOCIETY FOR OPTICAL ENGINEERING 2022; 12036:1203617. [PMID: 35983496 PMCID: PMC9385185 DOI: 10.1117/12.2611225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Quantitative angiography is a 2D/3D x-ray imaging modality that summarizes hemodynamic information using time density curve (TDC) based parameters. Estimation of the TDC parameters are susceptible to errors due to various factors including, patient motion, incomplete temporal data, imaging trigger errors etc. In this study, we tested the feasibility of using recurrent neural networks (RNN) to recover complete TDC temporal information from incomplete sequences and evaluate quantitative parameters generated from the corrected TDCs. Digital subtraction angiograms (DSAs) were collected from patients undergoing endovascular treatments and angiographic parametric imaging (API) parameters were calculated from each DSA. Each set of API parameters was used to simulate a TDC resulting in a dataset of 760 TDCs. One-third of each TDC was continuously masked from pseudo-random points past the peak height (PH) point to simulate missing/artifact information. An RNN was developed, trained and tested to generate completed/corrected TDCs. The RNN recovered complete TDC temporal information with an average mean squared error of 0.0086±0.002. Average mean absolute errors were calculated between each API parameter generated from the ground truth TDCs and RNN corrected TDCs, these were 11.02%±0.91 for time to peak, 10.97%±0.69 for mean transit time, 5.65%±0.76 for PH, and 15.08%±0.98 for area under the TDC. The change in API parameters was not clinically significant and the predictive power of the API parameters was retained. This study proved the feasibility of using RNNs to mitigate motion artifacts and incomplete angiographic acquisitions to extract accurate quantitative parameters.
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Affiliation(s)
- Mohammad Mahdi Shiraz Bhurwani
- Department of Biomedical Engineering, University at Buffalo, Buffalo NY 14228
- Canon Stroke and Vascular Research Center, Buffalo, NY 14203
| | - Kelsey N Sommer
- Department of Biomedical Engineering, University at Buffalo, Buffalo NY 14228
- Canon Stroke and Vascular Research Center, Buffalo, NY 14203
- QAS.AI Incorporated, Buffalo NY 14203
| | - Ciprian N Ionita
- Department of Biomedical Engineering, University at Buffalo, Buffalo NY 14228
- Canon Stroke and Vascular Research Center, Buffalo, NY 14203
- University at Buffalo Neurosurgery, University at Buffalo Jacobs School of Medicine, Buffalo NY 14228
- QAS.AI Incorporated, Buffalo NY 14203
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Lu YH, Cai Y, Zhang Y, Wang R, Li ZY. Digital Subtraction Angiography Contrast Material Transport as a Direct Assessment for Blood Perfusion of Middle Cerebral Artery Stenosis. Front Physiol 2021; 12:716173. [PMID: 34421658 PMCID: PMC8375590 DOI: 10.3389/fphys.2021.716173] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 07/05/2021] [Indexed: 11/13/2022] Open
Abstract
Digital subtraction angiography (DSA) is a fluoroscopic technique used extensively in interventional radiology for visualizing blood vessels. It has also been used to evaluate blood perfusion. However, the perfusion obtained in previous techniques was extracted from signal intensity rather than by the transport of contrast material (CM) through blood flow. The main aim of this study is to evaluate the morphological effects on the hemodynamics and the CM concentration in the middle cerebral artery (MCA) stenosis. We proposed a quantitative parameter, i.e., contrast material remaining time (CMRT), to describe the variation in the transport of CM over time. Computational fluid dynamics simulations were performed on both reconstructive synthetic and patient-derived models. In the synthetic models, we evaluated the variation of flow patterns and the transport of CM with different degrees of stenosis and the location of the lesion. It was found that an increase in the degree of stenosis (from 30 to 80%) resulted in a significant increase in CMRT at the anterior cerebral artery (ACA) outlet (p = 0.0238) and a significant decrease in CMRT at the MCA outlet (p = 0.012). The patient-derived models were reconstructed from the pre- and post-interventional DSA images of a patient with MCA stenosis. Both blood flow velocity and CMRT increased at the ACA outlet but decreased at the MCA outlet. The perfusion analysis demonstrated that the perfusion function was improved after interventional surgery. In conclusion, changes in stenotic degree at MCA may lead to apparent differences in the hemodynamic distribution and the transport of CM. CMRT could be a quantitative indicator to evaluate the changes in blood perfusion after the intervention for MCA stenosis.
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Affiliation(s)
- Yun-Hao Lu
- School of Biological Sciences and Medical Engineering, Southeast University, Nanjing, China
| | - Yan Cai
- School of Biological Sciences and Medical Engineering, Southeast University, Nanjing, China
| | - Yi Zhang
- Center of Interventional Radiology and Vascular Surgery, Department of Radiology, Zhongda Hospital, Medical School, Southeast University, Nanjing, China
| | - Rui Wang
- Center of Interventional Radiology and Vascular Surgery, Department of Radiology, Zhongda Hospital, Medical School, Southeast University, Nanjing, China
| | - Zhi-Yong Li
- School of Biological Sciences and Medical Engineering, Southeast University, Nanjing, China.,School of Mechanical, Medical and Process Engineering, Queensland University of Technology, Brisbane, QLD, Australia
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5
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Williams KA, Podgorsak AR, Bhurwani MMS, Rava RA, Sommer KN, Ionita CN. The Aneurysm Occlusion Assistant, an AI platform for real time surgical guidance of intracranial aneurysms. PROCEEDINGS OF SPIE--THE INTERNATIONAL SOCIETY FOR OPTICAL ENGINEERING 2021; 11601. [PMID: 34334875 DOI: 10.1117/12.2581003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Purpose In recent years, endovascular treatment has become the dominant approach to treat intracranial aneurysms (IAs). Despite tremendous improvement in surgical devices and techniques, 10-30% of these surgeries require retreatment. Previously, we developed a method which combines quantitative angiography with data-driven modeling to predict aneurysm occlusion within a fraction of a second. This is the first report on a semi-autonomous system, which can predict the surgical outcome of an IA immediately following device placement, allowing for therapy adjustment. Additionally, we previously reported various algorithms which can segment IAs, extract hemodynamic parameters via angiographic parametric imaging, and perform occlusion predictions. Methods We integrated these features into an Aneurysm Occlusion Assistant (AnOA) utilizing the Kivy library's graphical instructions and unique language properties for interface development, while the machine learning algorithms were entirely developed within Keras, Tensorflow and skLearn. The interface requires pre- and post-device placement angiographic data. The next steps for aneurysm segmentation, angiographic analysis and prediction have been integrated allowing either autonomous or interactive use. Results The interface allows for segmentation of IAs and cranial vasculature with a dice index of ~0.78 and prediction of aneurysm occlusion at six months with an accuracy 0.84, in 6.88 seconds. Conclusion This is the first report on the AnOA to guide endovascular treatment of IAs. While this initial report is on a stand-alone platform, the software can be integrated in the angiographic suite allowing direct communication with the angiographic system for a completely autonomous surgical guidance solution.
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Affiliation(s)
- Kyle A Williams
- Department of Biomedical Engineering, University at Buffalo, Buffalo, NY 14228.,Canon Stroke and Vascular Research Center, Buffalo, NY 14208
| | - Alexander R Podgorsak
- Department of Biomedical Engineering, University at Buffalo, Buffalo, NY 14228.,Canon Stroke and Vascular Research Center, Buffalo, NY 14208
| | - Mohammad Mahdi Shiraz Bhurwani
- Department of Biomedical Engineering, University at Buffalo, Buffalo, NY 14228.,Canon Stroke and Vascular Research Center, Buffalo, NY 14208
| | - Ryan A Rava
- Department of Biomedical Engineering, University at Buffalo, Buffalo, NY 14228.,Canon Stroke and Vascular Research Center, Buffalo, NY 14208
| | - Kelsey N Sommer
- Department of Biomedical Engineering, University at Buffalo, Buffalo, NY 14228.,Canon Stroke and Vascular Research Center, Buffalo, NY 14208
| | - Ciprian N Ionita
- Department of Biomedical Engineering, University at Buffalo, Buffalo, NY 14228.,Canon Stroke and Vascular Research Center, Buffalo, NY 14208.,University at Buffalo Neurosurgery, University at Buffalo Jacobs School of Medicine, Buffalo, NY 14228
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6
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Bhurwani MMS, Snyder KV, Waqas M, Mokin M, Rava RA, Podgorsak AR, Sommer KN, Davies JM, Levy EI, Siddiqui AH, Ionita CN. Use of biplane quantitative angiographic imaging with ensemble neural networks to assess reperfusion status during mechanical thrombectomy. PROCEEDINGS OF SPIE--THE INTERNATIONAL SOCIETY FOR OPTICAL ENGINEERING 2021; 11597. [PMID: 33707812 DOI: 10.1117/12.2580358] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Digital subtraction angiography (DSA) is the main imaging modality used to assess reperfusion during mechanical thrombectomy (MT) when treating large vessel occlusion (LVO) ischemic strokes. To improve this visual and subjective assessment, hybrid models combining angiographic parametric imaging (API) with deep learning tools have been proposed. These models use convolutional neural networks (CNN) with single view individual API maps, thus restricting use of complementary information from multiple views and maps resulting in loss of relevant clinical information. This study investigates use of ensemble networks to combine hemodynamic information from multiple bi-plane API maps to assess level of reperfusion. Three-hundred-eighty-three anteroposterior (AP) and lateral view DSAs were retrospectively collected from patients who underwent MTs of anterior circulation LVOs. API peak height (PH) and area under time density curve (AUC) maps were generated. CNNs were developed to classify maps as adequate/inadequate reperfusion as labeled by two neuro-interventionalists. Outputs from individual networks were combined by weighting each output, using a grid search algorithm. Ensembled, AP-AUC, AP-PH, lateral-AUC, and lateral-PH networks achieved accuracies of 83.0% (95% confidence-interval: 81.2%-84.8%), 74.4% (72.0%-76.7%), 74.2% (72.8%-75.7%), 74.9% (72.2%-77.7%), and 76.9% (74.4%-79.5%); area under receiver operating characteristic curves of 0.86 (0.84-0.88), 0.81 (0.79-0.83), 0.83 (0.81-0.84), 0.82 (0.8-0.84), and 0.84 (0.82-0.87); and Matthews correlation coefficients of 0.66 (0.63-0.70), 0.48 (0.43-0.53), 0.49 (0.46-0.52), 0.51 (0.45-0.56), and 0.54 (0.49-0.59) respectively. Ensembled network performance was significantly better than individual networks (McNemar's p-value<0.05). This study proved feasibility of using ensemble networks to combine hemodynamic information from multiple bi-plane API maps to assess level of reperfusion during MTs.
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Affiliation(s)
- Mohammad Mahdi Shiraz Bhurwani
- Department of Biomedical Engineering, University at Buffalo, Buffalo, NY 14260.,Canon Stroke and Vascular Research Center, Buffalo, NY 14203
| | - Kenneth V Snyder
- Canon Stroke and Vascular Research Center, Buffalo, NY 14203.,University Dept. of Neurosurgery, University at Buffalo, Buffalo, NY 14203
| | - Muhammad Waqas
- Canon Stroke and Vascular Research Center, Buffalo, NY 14203.,University Dept. of Neurosurgery, University at Buffalo, Buffalo, NY 14203
| | - Maxim Mokin
- Department of Neurosurgery and Brain Repair, University of South Florida, Tampa, FL 33606
| | - Ryan A Rava
- Department of Biomedical Engineering, University at Buffalo, Buffalo, NY 14260.,Canon Stroke and Vascular Research Center, Buffalo, NY 14203
| | - Alexander R Podgorsak
- Department of Biomedical Engineering, University at Buffalo, Buffalo, NY 14260.,Canon Stroke and Vascular Research Center, Buffalo, NY 14203
| | - Kelsey N Sommer
- Department of Biomedical Engineering, University at Buffalo, Buffalo, NY 14260.,Canon Stroke and Vascular Research Center, Buffalo, NY 14203
| | - Jason M Davies
- Canon Stroke and Vascular Research Center, Buffalo, NY 14203.,University Dept. of Neurosurgery, University at Buffalo, Buffalo, NY 14203.,University Dept. of Biomedical Informatics, University at Buffalo, Buffalo, NY 14214
| | - Elad I Levy
- Canon Stroke and Vascular Research Center, Buffalo, NY 14203.,University Dept. of Neurosurgery, University at Buffalo, Buffalo, NY 14203
| | - Adnan H Siddiqui
- Canon Stroke and Vascular Research Center, Buffalo, NY 14203.,University Dept. of Neurosurgery, University at Buffalo, Buffalo, NY 14203
| | - Ciprian N Ionita
- Department of Biomedical Engineering, University at Buffalo, Buffalo, NY 14260.,Canon Stroke and Vascular Research Center, Buffalo, NY 14203.,University Dept. of Neurosurgery, University at Buffalo, Buffalo, NY 14203
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Hoffman C, Periyasamy S, Longhurst C, Medero R, Roldan-Alzate A, Speidel MA, Laeseke PF. A technique for intra-procedural blood velocity quantitation using time-resolved 2D digital subtraction angiography. CVIR Endovasc 2021; 4:11. [PMID: 33411087 PMCID: PMC7790988 DOI: 10.1186/s42155-020-00199-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 12/15/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND 2D digital subtraction angiography (DSA) is utilized qualitatively to assess blood velocity changes that occur during arterial interventions. Quantitative angiographic metrics, such as blood velocity, could be used to standardize endpoints during angiographic interventions. PURPOSE To assess the accuracy and precision of a quantitative 2D DSA (qDSA) technique and to determine its feasibility for in vivo measurements of blood velocity. MATERIALS AND METHODS A quantitative DSA technique was developed to calculate intra-procedural blood velocity. In vitro validation was performed by comparing velocities from the qDSA method and an ultrasonic flow probe in a bifurcation phantom. Parameters of interest included baseline flow rate, contrast injection rate, projection angle, and magnification. In vivo qDSA analysis was completed in five different branches of the abdominal aorta in two 50 kg swine and compared to 4D Flow MRI. Linear regression, Bland-Altman, Pearson's correlation coefficient and chi squared tests were used to assess the accuracy and precision of the technique. RESULTS In vitro validation showed strong correlation between qDSA and flow probe velocities over a range of contrast injection and baseline flow rates (slope = 1.012, 95% CI [0.989,1.035], Pearson's r = 0.996, p < .0001). The application of projection angle and magnification corrections decreased variance to less than 5% the average baseline velocity (p = 0.999 and p = 0.956, respectively). In vivo validation showed strong correlation with a small bias between qDSA and 4D Flow MRI velocities for all five abdominopelvic arterial vessels of interest (slope = 1.01, Pearson's r = 0.880, p = <.01, Bias = 0.117 cm/s). CONCLUSION The proposed method allows for accurate and precise calculation of blood velocities, in near real-time, from time resolved 2D DSAs.
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Affiliation(s)
- Carson Hoffman
- Department of Medical Physics, University of Wisconsin - Madison, 1111 Highland Ave, Madison, WI, 53705, USA
| | - Sarvesh Periyasamy
- Department of Biomedical Engineering, University of Wisconsin - Madison, 1111 Highland Ave, Madison, WI, 53705, USA
| | - Colin Longhurst
- Department of Biostatistics and Medical Informatics, University of Wisconsin - Madison, 1111 Highland Ave, Madison, WI, 53705, USA
| | - Rafael Medero
- Department of Mechanical Engineering, University of Wisconsin - Madison, 1111 Highland Ave, Madison, WI, 53705, USA
| | - Alejandro Roldan-Alzate
- Department of Biomedical Engineering, University of Wisconsin - Madison, 1111 Highland Ave, Madison, WI, 53705, USA.,Department of Mechanical Engineering, University of Wisconsin - Madison, 1111 Highland Ave, Madison, WI, 53705, USA.,Department of Radiology, University of Wisconsin - Madison, 1111 Highland Ave, Madison, WI, 53705, USA
| | - Michael A Speidel
- Department of Medical Physics, University of Wisconsin - Madison, 1111 Highland Ave, Madison, WI, 53705, USA
| | - Paul F Laeseke
- Section of Interventional Radiology, Department of Radiology, University of Wisconsin - Madison, 600 Highland Ave, Madison, WI, 53792, USA.
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Augustin AM, Thein I, Rickert N, Klink T, Bley TA, Kickuth R. Evaluation of superficial femoral artery-lesions after percutaneous transluminal angioplasty: color-coded summation images vs. monochromatic digital subtraction angiography. BMC Med Imaging 2020; 20:67. [PMID: 32552680 PMCID: PMC7302343 DOI: 10.1186/s12880-020-00468-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Accepted: 06/10/2020] [Indexed: 11/23/2022] Open
Abstract
Background Percutaneous transluminal angioplasty (PTA) is increasingly requested in the therapy of peripheral arterial occlusive disease. The evaluation of the technical result after balloon angioplasty with regard to bailout stenting is highly dependent on the operators´ subjective assessment and mainly based on the monochromatic digital subtraction angiography (DSA) images. The aim of this study was to compare color-coded single image as a novel diagnostic tool with monochromatic DSA for the analysis of flow limitation and need for stent implantation after PTA of superficial femoral artery (SFA) stenoses. Methods During a period of 18 months, 213 SFA lesions were treated by PTA with a standard balloon in 170 patients, resulting in a total of 193 endovascular procedures. The median age of the patients was 77 years (range, 35–96 years). Median length of the treated lesions was 10.5 cm (range, 1.0–50 cm). Three interventional radiologists retrospectively evaluated the results of balloon angioplasty with monochromatic as well as post-processed color-coded DSA images for flow limitations to decide if subsequent stent implantation was necessary. Consensus reading of two experienced interventional radiologists 2 months after the initial review served as reference standard to perform a receiver operating characteristics (ROC) analysis. Results ROC analysis for readers A, B and C showed area under the curve (AUC) values of 0.797, 0.865 and 0.804 for color-coded DSA and AUC values of 0.792, 0.843 and 0.872 for monochromatic DSA: a significant advantage of color-coded over conventional monochromatic DSA was not found for readers A and B (p > 0.05). Results of reader C were significantly better in the assessment of monochromatic images (p = 0.023). Diagnostic confidence using color-coded images was slightly higher than in monochromatic images (κ = 0.486 vs. κ = 0.459). Conclusions In this study, color coded DSA did not reveal to be superior to conventional monochromatic DSA when evaluating results of PTA and when deciding whether stent implantation is necessary or not. This technology, however, requires further experiences with special regard to homogeneously trained radiologists and to the time requirement.
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Affiliation(s)
- Anne Marie Augustin
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Würzburg, Germany.
| | - Irina Thein
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Würzburg, Germany
| | - Nicole Rickert
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Würzburg, Germany
| | - Thorsten Klink
- Department of Diagnostic and Interventional Radiology, Hospital Bayreuth GmbH, Bayreuth, Germany
| | - Thorsten Alexander Bley
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Würzburg, Germany
| | - Ralph Kickuth
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Würzburg, Germany
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Rava RA, Mokin M, Snyder KV, Waqas M, Siddiqui AH, Davies JM, Levy EI, Ionita CN. Performance of angiographic parametric imaging in locating infarct core in large vessel occlusion acute ischemic stroke patients. J Med Imaging (Bellingham) 2020; 7:016001. [PMID: 32064301 PMCID: PMC7012174 DOI: 10.1117/1.jmi.7.1.016001] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 01/27/2020] [Indexed: 12/26/2022] Open
Abstract
Purpose: Biomarkers related to hemodynamics can be quantified using angiographic parametric imaging (API), which is a quantitative imaging method that uses digital subtraction angiography (DSA). We aimed to assess the accuracy of API in locating infarct core within large vessel occlusion (LVO) acute ischemic stroke (AIS) patients. Approach: Data were retrospectively collected for 25 LVO AIS patients who achieved successful recanalization. DSA data from lateral and anteroposterior (AP) views were loaded into API software to generate hemodynamic parameter maps. Relative differences in hemispherical regions for each API parameter were calculated. Ground truth infarct core locations were obtained using 24-h follow-up fluid-attenuation inversion recovery (FLAIR) MRI imaging. FLAIR MRI infarct locations were registered with DSA images to determine infarct regions in API parameter maps. Relative differences across hemispheres for each API parameter were plotted against each other. A support vector machine was used to determine the optimal hyperplane for classifying regions as infarct or healthy tissue. Results: For the lateral and AP views, respectively, the most accurate classification of infarct regions came from plotting mean transit time (MTT) versus peak height (PH) [ accuracy = 0.8125 ± 0.0012 (95%)], the area under the receiver operator characteristic curve ( AUROC ) = 0.8946 ± 0.0000 (95%), and plotting MTT versus the area under the curve (AUC) [ accuracy = 0.7957 ± 0.0011 (95%), AUROC = 0.8759 ± 0.0000 (95%)]. Conclusions: API provides accurate assessment of locating ischemic core in AIS LVO patients and has the potential for clinical benefit by determining infarct core location and growth in real time for intraoperative decision making.
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Affiliation(s)
- Ryan A. Rava
- University at Buffalo, Department of Biomedical Engineering, Buffalo, New York, United States
- Canon Stroke and Vascular Research Center, Buffalo, New York, United States
| | - Maxim Mokin
- University of South Florida, Department of Neurosurgery, Tampa, Florida, United States
| | - Kenneth V. Snyder
- Canon Stroke and Vascular Research Center, Buffalo, New York, United States
- University at Buffalo, Department of Neurosurgery, Buffalo, New York, United States
| | - Muhammad Waqas
- Canon Stroke and Vascular Research Center, Buffalo, New York, United States
- University at Buffalo, Department of Neurosurgery, Buffalo, New York, United States
| | - Adnan H. Siddiqui
- Canon Stroke and Vascular Research Center, Buffalo, New York, United States
- University at Buffalo, Department of Neurosurgery, Buffalo, New York, United States
| | - Jason M. Davies
- Canon Stroke and Vascular Research Center, Buffalo, New York, United States
- University at Buffalo, Department of Neurosurgery, Buffalo, New York, United States
- University at Buffalo, Department of Bioinformatics, Buffalo, New York, United States
| | - Elad I. Levy
- Canon Stroke and Vascular Research Center, Buffalo, New York, United States
- University at Buffalo, Department of Neurosurgery, Buffalo, New York, United States
| | - Ciprian N. Ionita
- University at Buffalo, Department of Biomedical Engineering, Buffalo, New York, United States
- Canon Stroke and Vascular Research Center, Buffalo, New York, United States
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10
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Sadasivan C, Fiorella D. Preliminary in vitro angiographic comparison of the flow diversion behavior of Evolve and Pipeline devices. J Neurointerv Surg 2019; 12:616-620. [DOI: 10.1136/neurintsurg-2019-015455] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 10/29/2019] [Accepted: 10/31/2019] [Indexed: 11/04/2022]
Abstract
Background and purposeFlow diverters are increasingly used to treat a broad category of cerebral aneurysms. We conducted an in vitro study to angiographically compare the flow diversion effect of Surpass Evolve from Stryker Neurovascular with the Pipeline Shield Embolization Device from Medtronic Neurovascular.MethodsThree copies each of three carotid aneurysm geometries were manufactured from silicone. Evolve and Pipeline flow diverters were deployed in one copy of each geometry; the third copy was used as Control. High-speed angiography was acquired under pulsatile flow in each replica, contrast concentration-time curves within the aneurysms were recorded, and the curves were quantified with six parameters. The parameters were statistically evaluated to compare the flow diversion effect of both devices.ResultsThe Evolve showed greater flow diversion trends in almost all intra-geometry comparisons than the Pipeline. When aggregated over the three geometries, the Evolve was statistically significantly better than the Pipeline in four of the six parameters, and about the same or better (not statistically significant) than the Pipeline in the other two parameters.ConclusionsThe Evolve device demonstrated greater in vitro flow diversion effects than Pipeline. Comparative efficacy of the devices will need to be adjudicated based on clinical outcomes.
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11
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Sadasivan C, Dholakia R, Peeling L, Gölitz P, Doerfler A, Lieber BB, Fiorella DJ, Woo HH. Angiographic assessment of the efficacy of flow diverter treatment for cerebral aneurysms. Interv Neuroradiol 2019; 25:655-663. [PMID: 31296064 DOI: 10.1177/1591019919860829] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND The recent growth of neuro-endovascular treatment has rekindled interest in the use of angiographic techniques for flow assessment. Aneurysm treatment with flow diverters is particularly amenable to such analysis. We analyze contrast time-density curves - recorded within aneurysms before (pre) and immediately after (post) flow diverter implantation to estimate six-month treatment outcomes. METHODS Fifty-six patients with 65 aneurysms were treated with flow diverters at two institutions. A region of interest was drawn around the aneurysm perimeter in image sequences taken both pre and post angiography, and the temporal variation in grayscale intensity within the aneurysm (time-density curve) was recorded. Eleven parameters were quantified from each time-density curve. Aneurysm occlusion status was recorded six months post treatment. The change in parameters from pre to post treatment was statistically evaluated between aneurysm occluded and non-occluded groups. RESULTS Of the 11 parameters, eight were significantly different before and immediately after flow diversion. Considering the entire data set, none of the parameters was statistically different between the occluded and non-occluded groups. However, subgroup analyses showed that four variables were significantly different between the aneurysm occluded and non-occluded groups. The sensitivity of these variables to predict aneurysm occlusion at six months ranged from 60% to 89%, while the specificity ranged from 55% to 70%. CONCLUSIONS Device-induced intra-aneurysmal flow alterations quantified by simple aneurysmal time-density curves can potentially be used to predict long-term outcomes of flow diversion. Large multi-center studies will be required to confirm these findings. Patient-to-patient variability in coagulation may need to be incorporated for clinically relevant predictive values.
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Affiliation(s)
- Chander Sadasivan
- Department of Neurosurgery, Stony Brook University Medical Center, Stony Brook, USA
| | - Ronak Dholakia
- Department of Neurosurgery, Stony Brook University Medical Center, Stony Brook, USA
| | - Lissa Peeling
- Department of Neurosurgery, Stony Brook University Medical Center, Stony Brook, USA
| | - Philipp Gölitz
- Department of Neuroradiology, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Arnd Doerfler
- Department of Neuroradiology, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Baruch B Lieber
- Department of Neurosurgery, Stony Brook University Medical Center, Stony Brook, USA
| | - David J Fiorella
- Department of Neurosurgery, Stony Brook University Medical Center, Stony Brook, USA
| | - Henry H Woo
- Department of Neurosurgery, Stony Brook University Medical Center, Stony Brook, USA
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12
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Sonig A, Setlur Nagesh SV, Fennell VS, Gandhi S, Rangel-Castilla L, Ionita CN, Snyder KV, Hopkins LN, Bednarek DR, Rudin S, Siddiqui AH, Levy EI. A Patient Dose-Reduction Technique for Neuroendovascular Image-Guided Interventions: Image-Quality Comparison Study. AJNR Am J Neuroradiol 2018; 39:734-741. [PMID: 29449282 DOI: 10.3174/ajnr.a5552] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Accepted: 12/06/2017] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE The ROI-dose-reduced intervention technique represents an extension of ROI fluoroscopy combining x-ray entrance skin dose reduction with spatially different recursive temporal filtering to reduce excessive image noise in the dose-reduced periphery in real-time. The aim of our study was to compare the image quality of simulated neurointerventions with regular and reduced radiation doses using a standard flat panel detector system. MATERIALS AND METHODS Ten 3D-printed intracranial aneurysm models were generated on the basis of a single patient vasculature derived from intracranial DSA and CTA. The incident dose to each model was reduced using a 0.7-mm-thick copper attenuator with a circular ROI hole (10-mm diameter) in the middle mounted inside the Infinix C-arm. Each model was treated twice with a primary coiling intervention using ROI-dose-reduced intervention and regular-dose intervention protocols. Eighty images acquired at various intervention stages were shown twice to 2 neurointerventionalists who independently scored imaging qualities (visibility of aneurysm-parent vessel morphology, associated vessels, and/or devices used). Dose-reduction measurements were performed using an ionization chamber. RESULTS A total integral dose reduction of 62% per frame was achieved. The mean scores for regular-dose intervention and ROI dose-reduced intervention images did not differ significantly, suggesting similar image quality. Overall intrarater agreement for all scored criteria was substantial (Kendall τ = 0.62887; P < .001). Overall interrater agreement for all criteria was fair (κ = 0.2816; 95% CI, 0.2060-0.3571). CONCLUSIONS Substantial dose reduction (62%) with a live peripheral image was achieved without compromising feature visibility during neuroendovascular interventions.
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Affiliation(s)
- A Sonig
- From the Departments of Neurosurgery (A.S., V.S.F., L.R.-C., C.N.I., K.V.S., L.N.H., D.R.B., S.R., A.H.S., E.I.L.).,Department of Neurosurgery (A.S., V.S.F., S.G., L.R.-C., K.V.S., L.N.H., S.R., A.H.S., E.I.L.), Gates Vascular Institute at Kaleida Health, Buffalo, New York
| | - S V Setlur Nagesh
- Toshiba Stroke and Vascular Research Center (S.V.S.N., C.N.I., L.N.H., D.R.B., S.R., A.H.S., E.I.L.)
| | - V S Fennell
- From the Departments of Neurosurgery (A.S., V.S.F., L.R.-C., C.N.I., K.V.S., L.N.H., D.R.B., S.R., A.H.S., E.I.L.).,Department of Neurosurgery (A.S., V.S.F., S.G., L.R.-C., K.V.S., L.N.H., S.R., A.H.S., E.I.L.), Gates Vascular Institute at Kaleida Health, Buffalo, New York
| | - S Gandhi
- Neurology (S.G., K.V.S.), Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York.,Department of Neurosurgery (A.S., V.S.F., S.G., L.R.-C., K.V.S., L.N.H., S.R., A.H.S., E.I.L.), Gates Vascular Institute at Kaleida Health, Buffalo, New York.,Buffalo Neuroimaging Analysis Center (S.G.), Buffalo, New York
| | - L Rangel-Castilla
- From the Departments of Neurosurgery (A.S., V.S.F., L.R.-C., C.N.I., K.V.S., L.N.H., D.R.B., S.R., A.H.S., E.I.L.).,Department of Neurosurgery (A.S., V.S.F., S.G., L.R.-C., K.V.S., L.N.H., S.R., A.H.S., E.I.L.), Gates Vascular Institute at Kaleida Health, Buffalo, New York
| | - C N Ionita
- From the Departments of Neurosurgery (A.S., V.S.F., L.R.-C., C.N.I., K.V.S., L.N.H., D.R.B., S.R., A.H.S., E.I.L.).,Toshiba Stroke and Vascular Research Center (S.V.S.N., C.N.I., L.N.H., D.R.B., S.R., A.H.S., E.I.L.).,Department of Biomedical Engineering (C.N.I., S.R.)
| | - K V Snyder
- From the Departments of Neurosurgery (A.S., V.S.F., L.R.-C., C.N.I., K.V.S., L.N.H., D.R.B., S.R., A.H.S., E.I.L.).,Radiology (K.V.S., L.N.H., D.R.B., S.R., A.H.S., E.I.L.).,Neurology (S.G., K.V.S.), Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York.,Department of Neurosurgery (A.S., V.S.F., S.G., L.R.-C., K.V.S., L.N.H., S.R., A.H.S., E.I.L.), Gates Vascular Institute at Kaleida Health, Buffalo, New York
| | - L N Hopkins
- From the Departments of Neurosurgery (A.S., V.S.F., L.R.-C., C.N.I., K.V.S., L.N.H., D.R.B., S.R., A.H.S., E.I.L.).,Radiology (K.V.S., L.N.H., D.R.B., S.R., A.H.S., E.I.L.).,Department of Neurosurgery (A.S., V.S.F., S.G., L.R.-C., K.V.S., L.N.H., S.R., A.H.S., E.I.L.), Gates Vascular Institute at Kaleida Health, Buffalo, New York.,Toshiba Stroke and Vascular Research Center (S.V.S.N., C.N.I., L.N.H., D.R.B., S.R., A.H.S., E.I.L.).,Jacobs Institute (L.N.H., A.H.S.), Buffalo, New York
| | - D R Bednarek
- From the Departments of Neurosurgery (A.S., V.S.F., L.R.-C., C.N.I., K.V.S., L.N.H., D.R.B., S.R., A.H.S., E.I.L.).,Radiology (K.V.S., L.N.H., D.R.B., S.R., A.H.S., E.I.L.).,Toshiba Stroke and Vascular Research Center (S.V.S.N., C.N.I., L.N.H., D.R.B., S.R., A.H.S., E.I.L.)
| | - S Rudin
- From the Departments of Neurosurgery (A.S., V.S.F., L.R.-C., C.N.I., K.V.S., L.N.H., D.R.B., S.R., A.H.S., E.I.L.).,Radiology (K.V.S., L.N.H., D.R.B., S.R., A.H.S., E.I.L.).,Department of Neurosurgery (A.S., V.S.F., S.G., L.R.-C., K.V.S., L.N.H., S.R., A.H.S., E.I.L.), Gates Vascular Institute at Kaleida Health, Buffalo, New York.,Toshiba Stroke and Vascular Research Center (S.V.S.N., C.N.I., L.N.H., D.R.B., S.R., A.H.S., E.I.L.).,Department of Biomedical Engineering (C.N.I., S.R.).,Department of Mechanical and Aerospace Engineering (S.R.).,Department of Electrical Engineering (S.R.), University at Buffalo, State University of New York, Buffalo, New York
| | - A H Siddiqui
- From the Departments of Neurosurgery (A.S., V.S.F., L.R.-C., C.N.I., K.V.S., L.N.H., D.R.B., S.R., A.H.S., E.I.L.).,Radiology (K.V.S., L.N.H., D.R.B., S.R., A.H.S., E.I.L.).,Department of Neurosurgery (A.S., V.S.F., S.G., L.R.-C., K.V.S., L.N.H., S.R., A.H.S., E.I.L.), Gates Vascular Institute at Kaleida Health, Buffalo, New York.,Toshiba Stroke and Vascular Research Center (S.V.S.N., C.N.I., L.N.H., D.R.B., S.R., A.H.S., E.I.L.).,Jacobs Institute (L.N.H., A.H.S.), Buffalo, New York
| | - E I Levy
- From the Departments of Neurosurgery (A.S., V.S.F., L.R.-C., C.N.I., K.V.S., L.N.H., D.R.B., S.R., A.H.S., E.I.L.) .,Radiology (K.V.S., L.N.H., D.R.B., S.R., A.H.S., E.I.L.).,Department of Neurosurgery (A.S., V.S.F., S.G., L.R.-C., K.V.S., L.N.H., S.R., A.H.S., E.I.L.), Gates Vascular Institute at Kaleida Health, Buffalo, New York.,Toshiba Stroke and Vascular Research Center (S.V.S.N., C.N.I., L.N.H., D.R.B., S.R., A.H.S., E.I.L.)
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13
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Meess KM, Izzo RL, Dryjski ML, Curl RE, Harris LM, Springer M, Siddiqui AH, Rudin S, Ionita CN. 3D Printed Abdominal Aortic Aneurysm Phantom for Image Guided Surgical Planning with a Patient Specific Fenestrated Endovascular Graft System. PROCEEDINGS OF SPIE--THE INTERNATIONAL SOCIETY FOR OPTICAL ENGINEERING 2017. [PMID: 28638171 DOI: 10.1117/12.2253902] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Following new trends in precision medicine, Juxatarenal Abdominal Aortic Aneurysm (JAAA) treatment has been enabled by using patient-specific fenestrated endovascular grafts. The X-ray guided procedure requires precise orientation of multiple modular endografts within the arteries confirmed via radiopaque markers. Patient-specific 3D printed phantoms could familiarize physicians with complex procedures and new devices in a risk-free simulation environment to avoid periprocedural complications and improve training. Using the Vascular Modeling Toolkit (VMTK), 3D Data from a CTA imaging of a patient scheduled for Fenestrated EndoVascular Aortic Repair (FEVAR) was segmented to isolate the aortic lumen, thrombus, and calcifications. A stereolithographic mesh (STL) was generated and then modified in Autodesk MeshMixer for fabrication via a Stratasys Eden 260 printer in a flexible photopolymer to simulate arterial compliance. Fluoroscopic guided simulation of the patient-specific FEVAR procedure was performed by interventionists using all demonstration endografts and accessory devices. Analysis compared treatment strategy between the planned procedure, the simulation procedure, and the patient procedure using a derived scoring scheme. RESULTS With training on the patient-specific 3D printed AAA phantom, the clinical team optimized their procedural strategy. Anatomical landmarks and all devices were visible under x-ray during the simulation mimicking the clinical environment. The actual patient procedure went without complications. CONCLUSIONS With advances in 3D printing, fabrication of patient specific AAA phantoms is possible. Simulation with 3D printed phantoms shows potential to inform clinical interventional procedures in addition to CTA diagnostic imaging.
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Affiliation(s)
- Karen M Meess
- The Jacobs Institute, Buffalo, NY 14203.,CUBRC Inc., Buffalo, NY 14225.,Department of Biomedical Engineering, University at Buffalo, Buffalo, NY 14228.,Toshiba Stroke and Vascular Research Center, University at Buffalo, Buffalo, NY 14203
| | - Richard L Izzo
- The Jacobs Institute, Buffalo, NY 14203.,Department of Biomedical Engineering, University at Buffalo, Buffalo, NY 14228.,Toshiba Stroke and Vascular Research Center, University at Buffalo, Buffalo, NY 14203
| | - Maciej L Dryjski
- Department of Vascular Surgery, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY 14203
| | - Richard E Curl
- Department of Vascular Surgery, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY 14203
| | - Linda M Harris
- Department of Vascular Surgery, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY 14203
| | | | - Adnan H Siddiqui
- The Jacobs Institute, Buffalo, NY 14203.,Toshiba Stroke and Vascular Research Center, University at Buffalo, Buffalo, NY 14203.,Department of Neurosurgery, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY 14203
| | - Stephen Rudin
- Department of Biomedical Engineering, University at Buffalo, Buffalo, NY 14228.,Toshiba Stroke and Vascular Research Center, University at Buffalo, Buffalo, NY 14203.,Department of Neurosurgery, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY 14203.,Department of Radiology, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY 14203
| | - Ciprian N Ionita
- Department of Biomedical Engineering, University at Buffalo, Buffalo, NY 14228.,Toshiba Stroke and Vascular Research Center, University at Buffalo, Buffalo, NY 14203
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14
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Ma L, Chen XL, Chen Y, Wu CX, Ma J, Zhao YL. Subsequent haemorrhage in children with untreated brain arteriovenous malformation: Higher risk with unbalanced inflow and outflow angioarchitecture. Eur Radiol 2016; 27:2868-2876. [PMID: 27900505 DOI: 10.1007/s00330-016-4645-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Revised: 09/30/2016] [Accepted: 10/11/2016] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Children with brain arteriovenous malformations (bAVMs) are at risk of life-threatening haemorrhage in their early lives. Our aim was to analyse various angioarchitectural features of bAVM to predict the risk of subsequent haemorrhage during follow-up in children. METHODS We identified all consecutive children admitted to our institution for bAVMs between July 2009 and September 2015. Children with at least 1 month of treatment-free follow-up after diagnosis were included in further analysis. Annual rates of AVM rupture as well as several potential risk factors for subsequent haemorrhage were analysed using Kaplan-Meier analyses and Cox proportional hazards regression models. RESULTS We identified 110 paediatric patients with a mean follow-up period of 2.1 years (range, 1 month-15.4 years). The average annual risk of haemorrhage from untreated AVMs was 4.3 % in children. No generalised venous ectasia in conjunction with fast arteriovenous shunt was predictive of subsequent haemorrhage (RR, 7.55; 95 % CI 1.96-29.06). The annual rupture risk was 11.1 % in bAVMs without generalised venous ectasia but with fast arteriovenous shunt. CONCLUSIONS bAVM angiographic features suggesting unbalanced inflow and outflow might be helpful to identify children at higher risk for future haemorrhage. KEY POINTS • Haemorrhage risk stratification is important for children with untreated brain AVM. • Angiographic features suggesting unbalanced inflow and outflow predict paediatric brain AVM haemorrhage. • Identifying AVMs with high rupture risk help patient selection and tailoring treatment.
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Affiliation(s)
- Li Ma
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, No. 6 Tiantan Xili, Dongcheng District, Beijing, People's Republic of China, 100050.,Center for Cerebrovascular Research, Department of Anesthesia and Perioperative Care, University of California San Francisco, San Francisco, CA, USA.,China National Clinical Research Center for Neurological Diseases, Beijing, People's Republic of China
| | - Xiao-Lin Chen
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, No. 6 Tiantan Xili, Dongcheng District, Beijing, People's Republic of China, 100050.,Center for Cerebrovascular Research, Department of Anesthesia and Perioperative Care, University of California San Francisco, San Francisco, CA, USA.,China National Clinical Research Center for Neurological Diseases, Beijing, People's Republic of China
| | - Yu Chen
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, No. 6 Tiantan Xili, Dongcheng District, Beijing, People's Republic of China, 100050.,China National Clinical Research Center for Neurological Diseases, Beijing, People's Republic of China
| | - Chun-Xue Wu
- Department of Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, No. 6 Tiantan Xili, Dongcheng District, Beijing, People's Republic of China, 100050
| | - Jun Ma
- Department of Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, No. 6 Tiantan Xili, Dongcheng District, Beijing, People's Republic of China, 100050.
| | - Yuan-Li Zhao
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, No. 6 Tiantan Xili, Dongcheng District, Beijing, People's Republic of China, 100050. .,China National Clinical Research Center for Neurological Diseases, Beijing, People's Republic of China. .,Stroke Center, Beijing Institute for Brain Disorders, Beijing, People's Republic of China. .,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, People's Republic of China.
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15
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Izzo RL, O'Hara RP, Iyer V, Hansen R, Meess KM, Nagesh SVS, Rudin S, Siddiqui AH, Springer M, Ionita CN. 3D Printed Cardiac Phantom for Procedural Planning of a Transcatheter Native Mitral Valve Replacement. PROCEEDINGS OF SPIE--THE INTERNATIONAL SOCIETY FOR OPTICAL ENGINEERING 2016; 9789. [PMID: 28615797 DOI: 10.1117/12.2216952] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
3D printing an anatomically accurate, functional flow loop phantom of a patient's cardiac vasculature was used to assist in the surgical planning of one of the first native transcatheter mitral valve replacement (TMVR) procedures. CTA scans were acquired from a patient about to undergo the first minimally-invasive native TMVR procedure at the Gates Vascular Institute in Buffalo, NY. A python scripting library, the Vascular Modeling Toolkit (VMTK), was used to segment the 3D geometry of the patient's cardiac chambers and mitral valve with severe stenosis, calcific in nature. A stereolithographic (STL) mesh was generated and AutoDesk Meshmixer was used to transform the vascular surface into a functioning closed flow loop. A Stratasys Objet 500 Connex3 multi-material printer was used to fabricate the phantom with distinguishable material features of the vasculature and calcified valve. The interventional team performed a mock procedure on the phantom, embedding valve cages in the model and imaging the phantom with a Toshiba Infinix INFX-8000V 5-axis C-arm bi-Plane angiography system. RESULTS After performing the mock-procedure on the cardiac phantom, the cardiologists optimized their transapical surgical approach. The mitral valve stenosis and calcification were clearly visible. The phantom was used to inform the sizing of the valve to be implanted. CONCLUSION With advances in image processing and 3D printing technology, it is possible to create realistic patient-specific phantoms which can act as a guide for the interventional team. Using 3D printed phantoms as a valve sizing method shows potential as a more informative technique than typical CTA reconstruction alone.
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Affiliation(s)
- Richard L Izzo
- The Jacobs Institute, 875 Ellicott Street, 5 Floor, Buffalo, NY.,Biomedical Engineering, University at Buffalo, 332 Bonner Hall, Buffalo, NY
| | - Ryan P O'Hara
- The Jacobs Institute, 875 Ellicott Street, 5 Floor, Buffalo, NY.,Biomedical Engineering, University at Buffalo, 332 Bonner Hall, Buffalo, NY
| | - Vijay Iyer
- The Jacobs Institute, 875 Ellicott Street, 5 Floor, Buffalo, NY.,Interventional Cardiology, University at Buffalo, 875 Ellicott Street, Suite 7030, Buffalo, NY
| | - Rose Hansen
- Interventional Cardiology, University at Buffalo, 875 Ellicott Street, Suite 7030, Buffalo, NY
| | - Karen M Meess
- The Jacobs Institute, 875 Ellicott Street, 5 Floor, Buffalo, NY.,Biomedical Engineering, University at Buffalo, 332 Bonner Hall, Buffalo, NY
| | - S V Setlur Nagesh
- Toshiba Stroke and Vascular Research Center, 875 Ellicott Street, 8 Floor, Buffalo, NY
| | - Stephen Rudin
- Toshiba Stroke and Vascular Research Center, 875 Ellicott Street, 8 Floor, Buffalo, NY
| | - Adnan H Siddiqui
- The Jacobs Institute, 875 Ellicott Street, 5 Floor, Buffalo, NY.,University at Buffalo Neurosurgery, 100 High Street, Section B4, Buffalo, NY
| | | | - Ciprian N Ionita
- Biomedical Engineering, University at Buffalo, 332 Bonner Hall, Buffalo, NY.,Toshiba Stroke and Vascular Research Center, 875 Ellicott Street, 8 Floor, Buffalo, NY
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16
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Balasubramoniam A, Bednarek DR, Rudin S, Ionita CN. Sensitivity evaluation of DSA-based parametric imaging using Doppler ultrasound in neurovascular phantoms. PROCEEDINGS OF SPIE--THE INTERNATIONAL SOCIETY FOR OPTICAL ENGINEERING 2016. [PMID: 28649163 DOI: 10.1117/12.2216907] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
An evaluation of the relation between parametric imaging results obtained from Digital Subtraction Angiography (DSA) images and blood-flow velocity measured using Doppler ultrasound in patient-specific neurovascular phantoms is provided. A silicone neurovascular phantom containing internal carotid artery, middle cerebral artery and anterior communicating artery was embedded in a tissue equivalent gel. The gel prevented movement of the vessels when blood mimicking fluid was pumped through it to obtain Colour Doppler images. The phantom was connected to a peristaltic pump, simulating physiological flow conditions. To obtain the parametric images, water was pumped through the phantom at various flow rates (100, 120 and 160 ml/min) and 10 ml contrast boluses were injected. DSA images were obtained at 10 frames/sec from the Toshiba C-arm and DSA image sequences were input into LabVIEW software to get parametric maps from time-density curves. The parametric maps were compared with velocities determined by Doppler ultrasound at the internal carotid artery. The velocities measured by the Doppler ultrasound were 38, 48 and 65 cm/s for flow rates of 100, 120 and 160 ml/min, respectively. For the 20% increase in flow rate, the percentage change of blood velocity measured by Doppler ultrasound was 26.3%. Correspondingly, there was a 20% decrease of Bolus Arrival Time (BAT) and 14.3% decrease of Mean Transit Time (MTT), showing strong inverse correlation with Doppler measured velocity. The parametric imaging parameters are quite sensitive to velocity changes and are well correlated to the velocities measured by Doppler ultrasound.
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Affiliation(s)
- A Balasubramoniam
- Toshiba Stroke and Vascular Research Center, University at Buffalo, Buffalo, NY 14214
| | - D R Bednarek
- Toshiba Stroke and Vascular Research Center, University at Buffalo, Buffalo, NY 14214
| | - S Rudin
- Toshiba Stroke and Vascular Research Center, University at Buffalo, Buffalo, NY 14214
| | - C N Ionita
- Toshiba Stroke and Vascular Research Center, University at Buffalo, Buffalo, NY 14214
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17
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Ellis JA, Banu M, Hossain SS, Singh-Moon R, Lavine SD, Bruce JN, Joshi S. Reassessing the Role of Intra-Arterial Drug Delivery for Glioblastoma Multiforme Treatment. JOURNAL OF DRUG DELIVERY 2015; 2015:405735. [PMID: 26819758 PMCID: PMC4706947 DOI: 10.1155/2015/405735] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/06/2015] [Accepted: 11/16/2015] [Indexed: 12/16/2022]
Abstract
Effective treatment for glioblastoma (GBM) will likely require targeted delivery of several specific pharmacological agents simultaneously. Intra-arterial (IA) delivery is one technique for targeting the tumor site with multiple agents. Although IA chemotherapy for glioblastoma (GBM) has been attempted since the 1950s, the predicted benefits remain unproven in clinical practice. This review focuses on innovative approaches to IA drug delivery in treating GBM. Guided by novel in vitro and in vivo optical measurements, newer pharmacokinetic models promise to better define the complex relationship between background cerebral blood flow and drug injection parameters. Advanced optical technologies and tracers, unique nanoparticles designs, new cellular targets, and rational drug formulations are continuously modifying the therapeutic landscape for GBM. Personalized treatment approaches are emerging; however, such tailored approaches will largely depend on effective drug delivery techniques and on the ability to simultaneously deliver multidrug regimens. These new paradigms for tumor-selective drug delivery herald dramatic improvements in the effectiveness of IA chemotherapy for GBM. Therefore, within this context of so-called "precision medicine," the role of IA delivery for GBM is thoroughly reassessed.
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Affiliation(s)
- Jason A. Ellis
- Department of Neurological Surgery, Columbia University Medical Center, New York, NY 10032, USA
| | - Matei Banu
- Department of Neurological Surgery, Columbia University Medical Center, New York, NY 10032, USA
| | - Shaolie S. Hossain
- Department of Molecular Cardiology, Texas Heart Institute, Houston, TX 77030, USA
| | - Rajinder Singh-Moon
- School of Engineering and Applied Science, Columbia University, New York, NY 10032, USA
| | - Sean D. Lavine
- Department of Neurological Surgery, Columbia University Medical Center, New York, NY 10032, USA
| | - Jeffrey N. Bruce
- Department of Neurological Surgery, Columbia University Medical Center, New York, NY 10032, USA
| | - Shailendra Joshi
- Department of Anesthesiology, Columbia University Medical Center, New York, NY 10032, USA
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Yoganand A, Wood RP, Jimenez C, Siddiqui A, Snyder K, Nagesh SVS, Bednarek DR, Rudin S, Baier R, Ionita CN. Angiographic analysis for phantom simulations of endovascular aneurysm treatments with a new fully retrievable asymmetric flow diverter. PROCEEDINGS OF SPIE--THE INTERNATIONAL SOCIETY FOR OPTICAL ENGINEERING 2015; 9417. [PMID: 26869741 DOI: 10.1117/12.2082079] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Digital Subtraction Angiography (DSA) is the main diagnostic tool for intracranial aneurysms (IA) flow-diverter (FD) assisted treatment. Based on qualitative contrast flow evaluation, interventionists decide on subsequent steps. We developed a novel fully Retrievable Asymmetric Flow-Diverter (RAFD) which allows controlled deployment, repositioning and detachment achieve optimal flow diversion. The device has a small low porosity or solid region which is placed such that it would achieve maximum aneurysmal in-jet flow deflection with minimum impairment to adjacent vessels. We tested the new RAFD using a flow-loop with an idealized and a patient specific IA phantom in carotid-relevant physiological conditions. We positioned the deflection region at three locations: distally, center and proximally to the aneurysm orifice and analyzed aneurysm dome flow using DSA derived maps for mean transit time (MTT) and bolus arrival times (BAT). Comparison between treated and untreated (control) maps quantified the RAFD positioning effect. Average MTT, related to contrast presence in the aneurysm dome increased, indicating flow decoupling between the aneurysm and parent artery. Maximum effect was observed in the center and proximal position (~75%) of aneurysm models depending on their geometry. BAT maps, correlated well with inflow jet direction and magnitude. Reduction and jet dispersion as high as about 50% was observed for various treatments. We demonstrated the use of DSA data to guide the placement of the RAFD and showed that optimum flow diversion within the aneurysm dome is feasible. This could lead to more effective and a safer IA treatment using FDs.
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Affiliation(s)
- Aradhana Yoganand
- Department of Biomedical Engineering, State University of New York at Buffalo; Toshiba Stroke and Vascular Research Center, State University of New York at Buffalo
| | - Rachel P Wood
- Department of Biomedical Engineering, State University of New York at Buffalo; Toshiba Stroke and Vascular Research Center, State University of New York at Buffalo
| | - Carlos Jimenez
- Toshiba Stroke and Vascular Research Center, State University of New York at Buffalo; University of Antioquia-GIB-Eafit, Medellin, Colombia
| | - Adnan Siddiqui
- Toshiba Stroke and Vascular Research Center, State University of New York at Buffalo
| | - Kenneth Snyder
- Toshiba Stroke and Vascular Research Center, State University of New York at Buffalo
| | - S V Setlur Nagesh
- Toshiba Stroke and Vascular Research Center, State University of New York at Buffalo
| | - D R Bednarek
- Toshiba Stroke and Vascular Research Center, State University of New York at Buffalo
| | - S Rudin
- Toshiba Stroke and Vascular Research Center, State University of New York at Buffalo
| | - Robert Baier
- Toshiba Stroke and Vascular Research Center, State University of New York at Buffalo
| | - Ciprian N Ionita
- Department of Biomedical Engineering, State University of New York at Buffalo; Toshiba Stroke and Vascular Research Center, State University of New York at Buffalo
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