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Muszynski P, Hak JF, Kerleroux B, Gory B, Anxionnat R, Zhu F. Virtual diluted cone beam CT for device apposition assessment during endovascular treatment of intracranial aneurysm: A technical note. J Neuroradiol 2024; 51:224-229. [PMID: 38262518 DOI: 10.1016/j.neurad.2024.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 12/01/2023] [Accepted: 01/16/2024] [Indexed: 01/25/2024]
Abstract
The increasing use of embolization devices with suboptimal radio-opacity to treat intracranial aneurysm underscores the need for advanced imaging techniques to characterize device-vessel interactions more accurately. Contrast-diluted cone-beam CT is commonly used in neurointervention but requires additional technical refinements to improve endovascular treatment assessment. In this technical note, we describe the virtual dilution cone beam CT (VDCBCT), a technique that synthetizes non-contrast and contrast-enhanced CBCT images to virtually dilute iodinated contrast agents, thereby facilitating a more accurate assessment of embolization device apposition. Through a set of intracranial aneurysms treated with different embolization devices, we describe the VDCBCT protocol and its usefulness for device apposition confidence. VDCBCT may enhance the global understanding of neurovascular embolization treatments by providing improved visualization of target vessels and low-radio-opacity embolization devices, obviating the need for contrast dilution.
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Affiliation(s)
- Patricio Muszynski
- Department of Diagnostic and Interventional Neuroradiology, CHRU Nancy, France
| | - Jean François Hak
- Department of Neuroradiology, APHM La Timone, Marseille, France; LiiE, Aix Marseille University, Marseille, France; CERIMED, Aix Marseille University, 27 Bd Jean Moulin, Marseille 13005, France
| | - Basile Kerleroux
- Department of Neuroradiology, APHM La Timone, Marseille, France; Department of Radiology, Bastia Hospital, France
| | - Benjamin Gory
- Department of Diagnostic and Interventional Neuroradiology, CHRU Nancy, France; IADI, INSERM U1254, Université de Lorraine, Nancy, France
| | - René Anxionnat
- Department of Diagnostic and Interventional Neuroradiology, CHRU Nancy, France; IADI, INSERM U1254, Université de Lorraine, Nancy, France
| | - François Zhu
- Department of Diagnostic and Interventional Neuroradiology, CHRU Nancy, France; IADI, INSERM U1254, Université de Lorraine, Nancy, France.
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Kocer N, Kandemirli SG, Ruijters D, Mantatzis M, Kizilkilic O, Islak C. A technical note on intra-arterial cone-beam computed tomography for the evaluation of flow-diverter stents: Image quality differences between diluted and non-diluted contrast medium. Interv Neuroradiol 2019; 26:164-169. [DOI: 10.1177/1591019919890929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Design of flow-diverter stents for flexibility, tractability, and low profile limits their radiopacity on conventional digital subtraction angiography. Cone-beam computed tomography (CBCT) offers higher spatial resolution for the evaluation of flow-diverter stents. However, CBCT requires optimal dilution and timing of contrast medium for simultaneous visualization of the stent, arterial lumen, and vessel wall. There are only limited data on the effects of different contrast dilutions on CBCT image quality in neurointerventional applications. Materials and methods In our institution, intra-arterial CBCTs were acquired during stent deployment and at follow-ups with 10% diluted contrast. We had recently started acquiring intra-arterial CBCTs with non-diluted contrast. Retrospective analysis of our flow-diverter data identified eight cases with different aneurysm locations who had intra-arterial CBCT with 10% diluted contrast immediately after flow-diverter stent deployment and with non-diluted contrast technique during follow-ups. For each case, the image quality between diluted and non-diluted contrast techniques was compared qualitatively by assessing stent visualization and quantitatively by plotting gray-scale intensity values along the vessel lumen. Results In two sets of CBCT images per each case, there was no substantial difference between diluted and non-diluted CBTC techniques for the evaluation of stent architecture and lumen opacification. Gray-scale intensity values perpendicular to the lumen revealed similar intensity values along the neighboring parenchyma, vessel wall, and lumen for the two different contrast techniques. Conclusion Intra-arterial CBCT angiography can be performed without contrast dilution and still achieve adequate image quality in certain cerebral aneurysms treated with flow diverter. The non-diluted contrast technique avoids the time loss during preparation of diluted contrast and installation of diluted contrast to the injector in angiography suites with a single power injector.
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Affiliation(s)
- Naci Kocer
- Division of Neuroradiology, Department of Radiology, Cerrahapasa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Sedat G Kandemirli
- Division of Neuroradiology, Department of Radiology, Cerrahapasa Medical Faculty, Istanbul University, Istanbul, Turkey
- Department of Radiology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Daniel Ruijters
- Philips Healthcare, Image Guided Therapy Systems Innovation, Best, the Netherlands
| | - Michalis Mantatzis
- Division of Neuroradiology, Department of Radiology, Democritus University of Thrace, Komotini, Greece
| | - Osman Kizilkilic
- Division of Neuroradiology, Department of Radiology, Cerrahapasa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Civan Islak
- Division of Neuroradiology, Department of Radiology, Cerrahapasa Medical Faculty, Istanbul University, Istanbul, Turkey
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