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Etminan N, de Sousa DA, Tiseo C, Bourcier R, Desal H, Lindgren A, Koivisto T, Netuka D, Peschillo S, Lémeret S, Lal A, Vergouwen MDI, Rinkel GJE. European Stroke Organisation (ESO) guidelines on management of unruptured intracranial aneurysms. Eur Stroke J 2022; 7:V. [PMID: 36082246 PMCID: PMC9446328 DOI: 10.1177/23969873221099736] [Citation(s) in RCA: 37] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Accepted: 04/25/2022] [Indexed: 07/30/2023] Open
Abstract
Unruptured intracranial aneurysms (UIA) occur in around 3% of the population. Important management questions concern if and how to perform preventive UIA occlusion; if, how and when to perform follow up imaging and non-interventional means to reduce the risk of rupture. Using the Standard Operational Procedure of ESO we prepared guidelines according to GRADE methodology. Since no completed randomised trials exist, we used interim analyses of trials, and meta-analyses of observational and case-control studies to provide recommendations to guide UIA management. All recommendations were based on very low evidence. We suggest preventive occlusion if the estimated 5-year rupture risk exceeds the risk of preventive treatment. In general, we cannot recommend endovascular over microsurgical treatment, but suggest flow diverting stents as option only when there are no other low-risk options for UIA repair. To detect UIA recurrence we suggest radiological follow up after occlusion. In patients who are initially observed, we suggest radiological monitoring to detect future UIA growth, smoking cessation, treatment of hypertension, but not treatment with statins or acetylsalicylic acid with the indication to reduce the risk of aneurysm rupture. Additionally, we formulated 15 expert-consensus statements. All experts suggest to assess UIA patients within a multidisciplinary setting (neurosurgery, neuroradiology and neurology) at centres consulting >100 UIA patients per year, to use a shared decision-making process based on the team recommendation and patient preferences, and to repair UIA only in centres performing the proposed treatment in >30 patients with (ruptured or unruptured) aneurysms per year per neurosurgeon or neurointerventionalist. These UIA guidelines provide contemporary recommendations and consensus statement on important aspects of UIA management until more robust data come available.
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Affiliation(s)
- Nima Etminan
- Department of Neurosurgery, University
Hospital Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim,
Germany
| | - Diana Aguiar de Sousa
- Stroke Centre, Centro Hospitalar
Universitário Lisboa Central, Lisbon, Portugal
- CEEM and Institute of Anatomy,
Faculdade de Medicina, Universidade de Lisboa, Portugal
| | - Cindy Tiseo
- Department of Neurology and Stroke
Unit, SS Filippo e Nicola Hospital, Avezzano, Italy
| | - Romain Bourcier
- Department of Diagnostic and
Therapeutic Neuroradiology, University Hospital of Nantes, INSERM, CNRS, Université
de Nantes, l’institut du thorax, France
| | - Hubert Desal
- Department of Diagnostic and
Therapeutic Neuroradiology, University Hospital of Nantes, INSERM, CNRS, Université
de Nantes, l’institut du thorax, France
| | - Anttii Lindgren
- Department of Clinical Radiology,
Kuopio University Hospital, Kuopio, Finland
- Department of Neurosurgery, Kuopio
University Hospital, Kuopio, Finland
- Institute of Clinical Medicine, School
of Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio,
Finland
| | - Timo Koivisto
- Department of Neurosurgery, Kuopio
University Hospital, Kuopio, Finland
- Institute of Clinical Medicine, School
of Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio,
Finland
| | - David Netuka
- Department of Neurosurgery and
Neurooncology, 1st Medical Faculty, Charles University, Praha, Czech Republic
| | - Simone Peschillo
- Department of Surgical Medical
Sciences and Advanced Technologies ‘G.F. Ingrassia’ - Endovascular Neurosurgery,
University of Catania, Catania, Italy
- Endovascular Neurosurgery, Pia
Fondazione Cardinale Giovanni Panico Hospital, Tricase, LE, Italy
| | | | - Avtar Lal
- European Stroke Organisation, Basel,
Switzerland
| | - Mervyn DI Vergouwen
- Department of Neurology and
Neurosurgery, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht
University, Utrecht, The Netherlands
| | - Gabriel JE Rinkel
- Department of Neurosurgery, University
Hospital Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim,
Germany
- Department of Neurology and
Neurosurgery, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht
University, Utrecht, The Netherlands
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2
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Kayano S, Ito A, Endo T, Nemoto H, Shimada K, Niizuma K, Tominaga T. Efficacy of ultra-high-resolution computed tomographic angiography for postoperative evaluation of intracranial aneurysm after clipping surgery: A case report. Surg Neurol Int 2022; 13:85. [PMID: 35399901 PMCID: PMC8986654 DOI: 10.25259/sni_1190_2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 02/03/2022] [Indexed: 11/20/2022] Open
Abstract
Background: Following clipping surgery for intracranial aneurysm, computed tomography angiography (CTA) is often used to confirm complete aneurysm obliteration. However, artifacts from the titanium clips usually degrade the images around them. The ultra-high-resolution computed tomography (UHR-CT) system recently became available in clinical practice. Here, we report a case in which CTA using the UHR-CT system successfully pointed out a small aneurysmal remnant after the clipping surgery, which was validated by digital subtraction angiography. Case Description: A patient underwent clipping surgery for an unruptured aneurysm using two titanium alloy clips. CTA using the UHR-CT system demonstrated a small remnant aneurysm. Digital subtraction angiography confirmed the minor remnant. The UHR-CTA images were comparable to three-dimensional reconstructed images from the rotational angiography. Conclusion: We propose that UHR-CTA is a reliable postoperative assessment method for intracranial clipping surgeries.
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Affiliation(s)
- Shingo Kayano
- Department of Radiological Technology, Tohoku University Hospital, Tohoku University, Sendai, Miyagi, Japan,
| | - Akira Ito
- Department of Neurosurgery, Tohoku University Graduate School of Medicine, Tohoku University, Sendai, Miyagi, Japan,
| | - Toshiki Endo
- Department of Neurosurgery, Tohoku University Graduate School of Medicine, Tohoku University, Sendai, Miyagi, Japan,
| | - Hitoshi Nemoto
- Department of Radiological Technology, Tohoku University Hospital, Tohoku University, Sendai, Miyagi, Japan,
| | - Kazuki Shimada
- Department of Radiological Technology, Tohoku University Hospital, Tohoku University, Sendai, Miyagi, Japan,
| | - Kuniyasu Niizuma
- Department of Neurosurgery, Tohoku University Graduate School of Medicine, Tohoku University, Sendai, Miyagi, Japan,
- Department of Neurosurgical Engineering and Translational Neuroscience, Graduate School of Biomedical Engineering, Tohoku University, Sendai, Miyagi, Japan,
- Department of Neurosurgical Engineering and Translational Neuroscience, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Teiji Tominaga
- Department of Neurosurgery, Tohoku University Graduate School of Medicine, Tohoku University, Sendai, Miyagi, Japan,
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Mera Jiménez L, Ochoa Gómez JF. Volume Reduction Techniques for the Classification of Independent Components of rs-fMRI Data: a Study with Convolutional Neural Networks. Neuroinformatics 2022; 20:73-90. [PMID: 33829386 DOI: 10.1007/s12021-021-09524-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/31/2021] [Indexed: 01/05/2023]
Abstract
In the last decade, neurosciences have had an increasing interest in resting state functional magnetic resonance imaging (rs-fMRI) as a result of its advantages, such as high spatial resolution, compared to other brain exploration techniques. To improve the technique, the elimination of artifacts through Independent Components Analysis (ICA) has been proposed, as this can separate neural signal and noise, opening possibilities for automatic classification. The main classification techniques have focused on processes based on typical machine learning. However, there are currently more robust approaches such as convolutional neural networks, which can deal with complex problems directly from the data without feature selection and even with data that does not have a simple interpretation, being limited by the amount of data necessary for training and its high computational cost. This research focused on studying four methods of volume reduction mitigating the computational cost for the training of 3 models based on convolutional neural networks. One of the reduction techniques is a novel approach that we call Reduction by Consecutive Binary Patterns (RCBP), which was shown to preserve the spatial features of the independent components. In addition, the RCBP showed networks in components associated with neuronal activity more clearly. The networks achieved accuracy above 98 % in classification, and one network was even found to be over 99 % accurate, outperforming most machine learning-based classification algorithms.
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Affiliation(s)
- Leonel Mera Jiménez
- Bioinstrumentation and Clinical Engineering Research Group, Bioengineering Program, Universidad de Antioquia, Calle 70 No. 52-21, Medellín, Colombia. .,Facultad de Ingeniería, Cl. 67 #53-108, Medellín, Colombia.
| | - John F Ochoa Gómez
- Bioinstrumentation and Clinical Engineering Research Group, Bioengineering Program, Universidad de Antioquia, Calle 70 No. 52-21, Medellín, Colombia.,Neuropsychology and Behavior Group, Medicine Program, Universidad de Antioquia, Calle 70 No. 52-21, Medellín, Colombia
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4
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Ledbetter LN, Burns J, Shih RY, Ajam AA, Brown MD, Chakraborty S, Davis MA, Ducruet AF, Hunt CH, Lacy ME, Lee RK, Pannell JS, Pollock JM, Powers WJ, Setzen G, Shaines MD, Utukuri PS, Wang LL, Corey AS. ACR Appropriateness Criteria® Cerebrovascular Diseases-Aneurysm, Vascular Malformation, and Subarachnoid Hemorrhage. J Am Coll Radiol 2021; 18:S283-S304. [PMID: 34794589 DOI: 10.1016/j.jacr.2021.08.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 08/26/2021] [Indexed: 11/22/2022]
Abstract
Cerebrovascular disease is a broad topic. This document focuses on the imaging recommendations for the varied clinical scenarios involving intracranial aneurysms, vascular malformations, and vasculitis, which all carry high risk of morbidity and mortality. Additional imaging recommendations regarding complications of these conditions, including subarachnoid hemorrhage and vasospasm, are also covered. While each variant presentation has unique imaging recommendations, the major focus of this document is neurovascular imaging techniques. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
- Luke N Ledbetter
- Director, Head and Neck Imaging, University of California Los Angeles, Los Angeles, California.
| | - Judah Burns
- Panel Chair and Program Director, Diagnostic Radiology Residency Program, Montefiore Medical Center, Bronx, New York
| | - Robert Y Shih
- Panel Vice-Chair, Uniformed Services University, Bethesda, Maryland
| | - Amna A Ajam
- Ohio State University, Columbus, Ohio; Chief of Neuroradiology & MRI at WRNMMC; and Associate Chief of Neuroradiology for AIRP
| | - Michael D Brown
- Michigan State University, East Lansing, Michigan, American College of Emergency Physicians
| | - Santanu Chakraborty
- Ottawa Hospital Research Institute and the Department of Radiology, The University of Ottawa, Ottawa, Ontario, Canada, Canadian Association of Radiologists
| | - Melissa A Davis
- Director of Quality, Radiology, Emory University, Atlanta, Georgia; ACR YPS Communications Liaison
| | - Andrew F Ducruet
- Barrow Neurological Institute, Phoenix, Arizona, Neurosurgery expert
| | | | - Mary E Lacy
- University of New Mexico, Albuquerque, New Mexico, American College of Physicians
| | - Ryan K Lee
- Chair, Department of Radiology, Einstein Healthcare Network, Philadelphia, Pennsylvania
| | - Jeffrey S Pannell
- University of California San Diego Medical Center, San Diego, California
| | | | - William J Powers
- University of North Carolina School of Medicine, Chapel Hill, North Carolina; American Academy of Neurology; Chair, Writing Group, American Heart Association/American Stroke Association Guidelines for the Early Management of Patients with Acute Ischemic Stroke, 2016-2019
| | - Gavin Setzen
- Albany ENT & Allergy Services, PC, Albany, New York; American Academy of Otolaryngology-Head and Neck Surgery; President, Albany ENT & Allergy Services, PC
| | - Matthew D Shaines
- Associate Chief, Hospital Medicine, Albert Einstein College of Medicine Montefiore Medical Center, Bronx, New York; Internal medicine physician
| | - Pallavi S Utukuri
- Clinical Site Director, Department of Radiology, Allen Hospital, New York Presbyterian, New York, New York; and Columbia University Medical Center, New York, New York
| | - Lily L Wang
- University of Cincinnati Medical Center, Cincinnati, Ohio
| | - Amanda S Corey
- Specialty Chair, Atlanta VA Health Care System and Emory University, Atlanta, Georgia
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5
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Marbacher S, Kienzler JC, Mendelowitsch I, D'Alonzo D, Andereggen L, Diepers M, Remonda L, Fandino J. Comparison of Intra- and Postoperative 3-Dimensional Digital Subtraction Angiography in Evaluation of the Surgical Result After Intracranial Aneurysm Treatment. Neurosurgery 2021; 87:689-696. [PMID: 31748795 DOI: 10.1093/neuros/nyz487] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Accepted: 08/20/2019] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Postoperative three-dimensional digital subtraction angiography (3D-DSA) is the gold standard in evaluating intracranial aneurysm (IA) remnants after clipping. Should intraoperative 3D-DSA image quality be equally good as postoperative 3D-DSA, it could supplant the latter as standard of care for follow-up of clipped IA. OBJECTIVE To directly compare the quality of assessment of clipped IA by intraoperative and postoperative 3D-DSA. METHODS From a prospective cohort of 221 consecutive patients who underwent craniotomy for IA treatment in a hybrid operating room, we retrospectively studied 26 patients who had both intraoperative and postoperative 3D-DSA imaging of their clipped aneurysm. Comparison of intraoperative and postoperative 3D-DSA images (blinded for review) included parameters that affected image quality and differences between the 2 periods. RESULTS In the 26 patients with 32 clipped IAs, the mean interval was 11 ± 7 mo between intraoperative and postoperative imaging 3D-DSA examinations. Reconstruction with multiple clips was used in 14 (44%) cases. Of 15 remnants, 9 (60%) were small (<2 mm). In comparing intraoperative and postoperative 3D-DSA, no discordance or discrepancy in assessment of the surgical result was noted for any clipped IA, and overall imaging quality was excellent for both modalities. Factors affecting minor differences in image quality were not identified. CONCLUSION Compared with postoperative 3D-DSA, intraoperative 3D-DSA images achieved equally high quality and effective, immediate interpretation of the surgical clipping result. With comparable imaging quality and no discordant findings, intraoperative 3D-DSA could replace postoperative 3D-DSA to become the standard of care in IA surgery.
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Affiliation(s)
- Serge Marbacher
- Department of Neurosurgery, Kantonsspital Aarau, Aarau, Switzerland
| | - Jenny C Kienzler
- Department of Neurosurgery, Kantonsspital Aarau, Aarau, Switzerland
| | | | - Donato D'Alonzo
- Department of Neurosurgery, Kantonsspital Aarau, Aarau, Switzerland
| | - Lukas Andereggen
- Department of Neurosurgery, Kantonsspital Aarau, Aarau, Switzerland
| | - Michael Diepers
- Division of Neuroradiology, Department of Radiology, Kantonsspital Aarau, Aarau, Switzerland
| | - Luca Remonda
- Division of Neuroradiology, Department of Radiology, Kantonsspital Aarau, Aarau, Switzerland
| | - Javier Fandino
- Department of Neurosurgery, Kantonsspital Aarau, Aarau, Switzerland
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6
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Pilipenko YV, Eliava SS, Pronin IN, Okishev DN, Abramyan AA. [Completeness of brain aneurysm exclusion according to CT angiography]. ZHURNAL VOPROSY NEĬROKHIRURGII IMENI N. N. BURDENKO 2020; 84:76-85. [PMID: 33306302 DOI: 10.17116/neiro20208406176] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
OBJECTIVE To develop a classification of the completeness of brain aneurysm exclusion according to CT angiography for determining further diagnostic and curative strategy. MATERIAL AND METHODS The study included 138 patients who had 164 brain aneurysms. Clipping was carried out at the Burdenko Neurosurgery Center in 2013-2017. Titanium clips were used in 111 cases, cobalt clips - in 53 patients. RESULTS Completeness of brain aneurysm exclusion was assessed in 149 cases using CT angiography. In 15 cases, artifacts from cobalt clips impaired assessment. Total exclusion was achieved in 136 (91.3%) cases, subtotal (a remainder of residual neck) - in 10 (6.7%) cases, complete exclusion of the body and bottom (patent neck) - 2 (1.3%) patients, partial exclusion (partially patent bottom) - 1 patient (0.7%). In this series, a clip prevented complete contrast enhancement of brain aneurysm bottom in all cases. CONCLUSION CTA is a reliable method for assessing the quality of exclusion of brain aneurysm in patients with implanted titanium clips. In case of cobalt clips, stratification depending on severity of CT artifacts should be performed for data interpretation. In some cases, artifacts impair visualization of the vessels adjacent to the clips. In these patients, direct cerebral angiography or dual-energy computed tomography scanners with metal artifact suppression programs should be recommended. Follow-up is recommended for patients with remnants of residual cervix. Redo surgery is indicated for completely patent neck, as well as partial or complete contrast enhancement of aneurysm bottom.
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Affiliation(s)
| | | | - I N Pronin
- Burdenko Center of Neurosurgery, Moscow, Russia
| | - D N Okishev
- Burdenko Center of Neurosurgery, Moscow, Russia
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İnci S, Akbay A, Aslan T. In Reply to the Letter to the Editor Regarding "The Longest Angiographic and Clinical Follow-Up of Microsurgically Treated Giant Intracranial Aneurysms: Experience with 70 Cases". World Neurosurg 2020; 140:463. [PMID: 32797979 DOI: 10.1016/j.wneu.2020.05.249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 05/27/2020] [Indexed: 11/15/2022]
Affiliation(s)
- Servet İnci
- Department of Neurosurgery, School of Medicine, Hacettepe University, Ankara, Turkey.
| | - Atilla Akbay
- Department of Neurosurgery, School of Medicine, Hacettepe University, Ankara, Turkey
| | - Tulay Aslan
- Department of Neurosurgery, School of Medicine, Hacettepe University, Ankara, Turkey
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Kim JJ, Cho KC, Suh SH, Chung J, Jang CK, Joo JY, Kim YB. Evaluation of the angiographic outcomes after clipping of intracranial aneurysms: determination of predisposing factors for occurrence of aneurysm remnants. Neurol Res 2020; 42:354-360. [PMID: 32100635 DOI: 10.1080/01616412.2020.1732594] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Objectives: Aneurysm remnants after microsurgical clipping have a risk of regrowth and rupture and have not been validated in the era of three-dimensional angiography. Therefore, this study aimed to evaluate the angiographic outcome using three-dimensional rotational images and determine the predictors for remnants after microsurgical clipping.Methods: Between January 2014 and May 2017, 139 aneurysms in 106 patients who were treated with microsurgical clipping, were eligible for this study. For the determination of aneurysm remnants after microsurgical clipping, the angiographic outcomes were evaluated using follow-up digital subtraction angiography within 7 days for unruptured aneurysms or within 2 weeks for ruptured aneurysms. According to the Sindou classification, the aneurysm remnants were dichotomized, and subgroup analysis was performed to identify the predictors of aneurysm remnants after clipping with various imaging parameters and clinical information.Results: The overall rate of aneurysm remnants was 29.5% (41/139), in which retreatments were needed in 6.5% (9/139). The neck size and maximum diameter of aneurysms were independent predisposing factors for the aneurysm remnants that need retreatment (OR: 2.30; p < 0.001; OR: 1.38; p < 0.001, respectively).Conclusions: This study demonstrated a low incidence of aneurysm remnants after microsurgical clipping which need to retreatment. However, selective postoperative angiography could provide us clear information of surgical result and evidence for long-term follow-up for some aneurysms with larger neck size (>5.7 mm) and maximum diameter (>7.1 mm).
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Affiliation(s)
- Jung-Jae Kim
- Department of Neurosurgery, Ewha Womans University Seoul Hospital, Ewha Womans University College of Medicine, Seoul, South Korea
| | - Kwang-Chun Cho
- Department of Neurosurgery, International St. Mary's Hospital, Catholic Kwandong University College of Medicine, Incheon, South Korea
| | - Sang Hyun Suh
- Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Joonho Chung
- Department of Neurosurgery, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Chang Ki Jang
- Department of Neurosurgery, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Jin-Yang Joo
- Department of Neurosurgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Yong Bae Kim
- Department of Neurosurgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
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İnci S, Akbay A, Aslan T. The Longest Angiographic and Clinical Follow-Up of Microsurgically Treated Giant Intracranial Aneurysms: Experience with 70 Cases. World Neurosurg 2020; 134:e412-e421. [DOI: 10.1016/j.wneu.2019.10.085] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 10/13/2019] [Accepted: 10/14/2019] [Indexed: 02/07/2023]
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10
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Kim HJ, Yoon DY, Kim ES, Yun EJ, Jeon HJ, Lee JY, Cho BM. 256-row multislice CT angiography in the postoperative evaluation of cerebral aneurysms treated with titanium clips: using three-dimensional rotational angiography as the standard of reference. Eur Radiol 2019; 30:2152-2160. [PMID: 31844961 DOI: 10.1007/s00330-019-06560-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 10/13/2019] [Accepted: 10/30/2019] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To assess the diagnostic accuracy of 256-row multislice computed tomographic angiography (CTA) compared with three-dimensional rotational angiography (3DRA) in the postoperative evaluation of cerebral aneurysms treated with titanium clips. METHODS A total of 128 patients (42 men, 86 women; mean age, 57.6 years) with 143 cerebral aneurysms treated using titanium clips underwent both CTA and 3DRA. Two reviewers retrospectively evaluated the following parameters on CTA and 3DRA: (1) residual/recurrent aneurysm (absent or present), (2) patency of parent artery (patent or occluded/severe stenotic (> 70%)), and (3) patency of adjacent branch (patent or occluded/absent). RESULTS A total of 24 residual/recurrent aneurysms were detected by 3DRA. The sensitivity, specificity, and accuracy of CTA for the detection of residual/recurrent aneurysms were 83.3%, 100%, and 97.2% for reviewer 1 and 79.2%, 100%, and 96.5% for reviewer 2, respectively. The sensitivity, specificity, and accuracy of CTA for the evaluation of patency of parent artery were 100%, 100%, and 100%, respectively, for both reviewers. The sensitivity, specificity, and accuracy of CTA for evaluation of the patency of adjacent branch were 85.1%, 100%, and 92.3% for reviewer 1 and 82.4%, 100%, and 90.9% for reviewer 2, respectively. CONCLUSION A 256-row multislice CTA is a valuable non-invasive tool for assessment of cerebral aneurysms treated with titanium clips. KEY POINTS • A 256-row multislice CTA is an accurate imaging technique for the postoperative assessment of cerebral aneurysms treated with titanium clips. • Sensitivity of CTA for the detection of residual/recurrent aneurysms was 79-83% compared with 3DRA. • CTA is still limited in detecting residual/recurrent aneurysms of < 2 mm and small adjacent branches.
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Affiliation(s)
- Hye Jeong Kim
- Department of Radiology, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, 1, Singil-ro, Yeongdeungpo-gu, Seoul, 07441, South Korea
| | - Dae Young Yoon
- Department of Radiology, Kangdong Seong-Sim Hospital, Hallym University College of Medicine, 150, Seongan-ro, Gangdong-gu, Seoul, 05355, South Korea.
| | - Eun Soo Kim
- Department of Radiology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, 22, Gwanpyeong-ro 170 beon-gil, Dongan-gu, Anyang-si, Gyeonggi-do, 14068, South Korea
| | - Eun Joo Yun
- Department of Radiology, Kangdong Seong-Sim Hospital, Hallym University College of Medicine, 150, Seongan-ro, Gangdong-gu, Seoul, 05355, South Korea
| | - Hong Jun Jeon
- Department of Neurosurgery, Kangdong Seong-Sim Hospital, Hallym University College of Medicine, 150, Seongan-ro, Gangdong-gu, Seoul, 05355, South Korea
| | - Jong Young Lee
- Department of Neurosurgery, Kangdong Seong-Sim Hospital, Hallym University College of Medicine, 150, Seongan-ro, Gangdong-gu, Seoul, 05355, South Korea
| | - Byung-Moon Cho
- Department of Neurosurgery, Kangdong Seong-Sim Hospital, Hallym University College of Medicine, 150, Seongan-ro, Gangdong-gu, Seoul, 05355, South Korea
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11
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Marbacher S, Mendelowitsch I, Grüter BE, Diepers M, Remonda L, Fandino J. Comparison of 3D intraoperative digital subtraction angiography and intraoperative indocyanine green video angiography during intracranial aneurysm surgery. J Neurosurg 2019; 131:64-71. [PMID: 30004279 DOI: 10.3171/2018.1.jns172253] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2017] [Accepted: 01/16/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVE During the last decade, improvements in real-time, high-resolution imaging of surgically exposed cerebral vasculature have been realized with the successful introduction of intraoperative indocyanine green video angiography (ICGVA) and technical advances in intraoperative digital subtraction angiography (DSA). With the availability of 3D intraoperative DSA (3D-iDSA) in hybrid operating rooms, the present study offers a contemporary comparison for rates of accuracy and discordance. METHODS In this retrospective study of prospectively collected data, 140 consecutive patients underwent microsurgical treatment of intracranial aneurysms (IAs) in a hybrid operating room. Variables analyzed included patient demographics, aneurysm-specific characteristics, intraoperative ICGVA and 3D-iDSA findings, and the need for intraoperative clip readjustment. The authors defined the discordance rate of the two modalities as a false-negative finding that necessitated clip repositioning after 3D-iDSA. RESULTS In 120 patients, ICGVA and 3D-iDSA were used to evaluate 134 IA obliterations. Of 215 clips used, 29 (14%) were repositioned intraoperatively, improving the surgical result in all 29 patients (24%). Repositioning was prompted by visual inspection and microvascular Doppler ultrasonography in 8 (28%), ICGVA in 13 (45%), and 3D-iDSA in 7 (24%) patients. Clip repositioning was needed in 7 patients (6%) based on 3D-iDSA, yielding an ICGVA accuracy rate of 94%. Five (71%) of the ICGVA-3D-iDSA discordances that prompted clip repositioning occurred at the anterior communicating artery complex. CONCLUSIONS A combination of vascular monitoring techniques most often achieved correct intraoperative interpretation of complete IA occlusion and parent artery integrity. Compared with 3D-iDSA imaging, ICGVA demonstrated high accuracy. Despite the relatively low discordance rate, iDSA was confirmed to be the gold standard. Improved imaging quality, including 3D-iDSA, supports its routine use in IA surgery, obviating the need for postoperative DSA.
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Affiliation(s)
| | | | | | - Michael Diepers
- 2Division of Neuroradiology, Department of Radiology, Kantonsspital Aarau, Switzerland
| | - Luca Remonda
- 2Division of Neuroradiology, Department of Radiology, Kantonsspital Aarau, Switzerland
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Hanihara M, Yoshioka H, Kanemaru K, Hashimoto K, Shimizu M, Nishigaya K, Fukamachi A, Kinouchi H. Long-Term Clinical and Angiographic Outcomes of Wrap-Clipping for Ruptured Blood Blister-Like Aneurysms of the Internal Carotid Artery Using Advanced Monitoring. World Neurosurg 2019; 126:e439-e446. [DOI: 10.1016/j.wneu.2019.02.070] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Revised: 02/06/2019] [Accepted: 02/07/2019] [Indexed: 10/27/2022]
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13
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Uricchio M, Gupta S, Jakowenko N, Levito M, Vu N, Doucette J, Liew A, Papatheodorou S, Khawaja AM, Aglio LS, Aziz-Sultan MA, Zaidi H, Smith TR, Mekary RA. Computed Tomography Angiography Versus Digital Subtraction Angiography for Postclipping Aneurysm Obliteration Detection. Stroke 2019; 50:381-388. [DOI: 10.1161/strokeaha.118.023614] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Matthew Uricchio
- From the School of Pharmacy, MCPHS University, Boston, MA (M.U., N.J., M.L., N.V., J.D., R.A.M.)
| | - Saksham Gupta
- Computational Neurosciences Outcomes Center, Department of Neurosurgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA (S.G., A.M.K., L.S.A., M.A.A.-S., H.Z., T.R.S., R.A.M.)
| | - Nicholas Jakowenko
- From the School of Pharmacy, MCPHS University, Boston, MA (M.U., N.J., M.L., N.V., J.D., R.A.M.)
| | - Marissa Levito
- From the School of Pharmacy, MCPHS University, Boston, MA (M.U., N.J., M.L., N.V., J.D., R.A.M.)
| | - Nguyen Vu
- From the School of Pharmacy, MCPHS University, Boston, MA (M.U., N.J., M.L., N.V., J.D., R.A.M.)
| | - Joanne Doucette
- From the School of Pharmacy, MCPHS University, Boston, MA (M.U., N.J., M.L., N.V., J.D., R.A.M.)
| | - Aaron Liew
- National University of Ireland, Galway (A.L.)
| | | | - Ayaz M. Khawaja
- Computational Neurosciences Outcomes Center, Department of Neurosurgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA (S.G., A.M.K., L.S.A., M.A.A.-S., H.Z., T.R.S., R.A.M.)
| | - Linda S. Aglio
- Computational Neurosciences Outcomes Center, Department of Neurosurgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA (S.G., A.M.K., L.S.A., M.A.A.-S., H.Z., T.R.S., R.A.M.)
- Department of Anesthesiology, Perioperative and Pain Management, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA (L.S.A.)
| | - Mohammad Ali Aziz-Sultan
- Computational Neurosciences Outcomes Center, Department of Neurosurgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA (S.G., A.M.K., L.S.A., M.A.A.-S., H.Z., T.R.S., R.A.M.)
| | - Hasan Zaidi
- Computational Neurosciences Outcomes Center, Department of Neurosurgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA (S.G., A.M.K., L.S.A., M.A.A.-S., H.Z., T.R.S., R.A.M.)
| | - Timothy R. Smith
- Computational Neurosciences Outcomes Center, Department of Neurosurgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA (S.G., A.M.K., L.S.A., M.A.A.-S., H.Z., T.R.S., R.A.M.)
| | - Rania A. Mekary
- From the School of Pharmacy, MCPHS University, Boston, MA (M.U., N.J., M.L., N.V., J.D., R.A.M.)
- Computational Neurosciences Outcomes Center, Department of Neurosurgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA (S.G., A.M.K., L.S.A., M.A.A.-S., H.Z., T.R.S., R.A.M.)
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14
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Huang CQ, Kang DZ, Yu LH, Zheng SF, Yao PS, Lin YX, Lin ZY. The classification of intracranial aneurysm neck: a single center research experience. Chin Neurosurg J 2018; 4:39. [PMID: 32922899 PMCID: PMC7398182 DOI: 10.1186/s41016-018-0138-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Accepted: 09/19/2018] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND There is associating with incidence of unfavorable outcomes compared to microsurgical clippings. We are in order to investigate the outcomes of microsurgical clipping for intracranial aneurysms and determine the ideal clipping methods for different aneurysm subtypes. METHOD Retrospectively analyzed the clinical characteristics and follow-up data (completely recorded) of 123 patients with 128 aneurysms were treated. 20 cases were treated as control group from October 2013 to December 2013. Since January 2014, aneurysms were classified base on the 20 cases of aneurysm imaging data. 103 patients were treated as experimental group, the classification of aneurysms previously proposed was used to estimate the way of surgery, and the guiding value of the genotype was verified according to the intraoperative findings. The proposed aneurysm classification is based on the virtual surface of the aneurysm and the parent artery, the aneurysm neck was classified as follows: subtype I, the curved surface of the neck is a single curved surface; subtype II, the neck is hyperboloid; subtype III, neck is a three-curved surface. Aneurysms were divided into further subtypes according to the ratio of the width of the aneurysm neck surface and the length of the artery circumference: subtype A, the ratio of the aneurysm neck surface to the parent artery was not more than 0.5; subtype B, more than 0.5. There are some clamping methods include simple, sliding, interlocking and hybrid. RESULTS In the control group, patients did not undergo a suitable clipping scheme without classification of aneurysm neck (unclassed clipping). While causing the occurrence of occlusion adverse events, including neck residual, Tumor artery stenosis, electrophysiological changes, the lack of blood supply and so on. The experimental[page1image12073600]group was analyzed by using a predetermined clipping scheme (classed clipping), and the use of aneurysms clamps was approximately the same as expected. Compared the preoperative assessment with the actual situation, the consistency of the control group was 50% and the experimental group was 96%. Adverse events of classed clipping is 2%, another is 60%. There is a significant difference between the two groups (P < 0.05).Classed clipping of subject IA and IB are simple (mean 1.2 and 1.3 clips); classed clipping of subject IIA is simple and interlocking(mean 1.2 clips); classed clipping of subject IIB is sliding and hybrid(mean 2.05 clips); classed clipping of subject IIIA and IIIB are hybrid(mean 2.3 clips). CONCLUSION There is a higher consistency in surgery through the above classification of preoperative assessment of clipping. There was no adverse event of intracranial aneurysm clipping in the clipping mode selected by the above classification, and satisfactory surgical clipping rate was achieved and no recurrence was found.
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Affiliation(s)
- Cai-Qiang Huang
- Department of Neurosurgery, The First Affiliated Hospital, Fujian Medical University, No.20 Changzhou Road,Taijiang District, Fuzhou, 350004 Fujian Province China
| | - De-Zhi Kang
- Department of Neurosurgery, The First Affiliated Hospital, Fujian Medical University, No.20 Changzhou Road,Taijiang District, Fuzhou, 350004 Fujian Province China
| | - Liang-Hong Yu
- Department of Neurosurgery, The First Affiliated Hospital, Fujian Medical University, No.20 Changzhou Road,Taijiang District, Fuzhou, 350004 Fujian Province China
| | - Shu-Fa Zheng
- Department of Neurosurgery, The First Affiliated Hospital, Fujian Medical University, No.20 Changzhou Road,Taijiang District, Fuzhou, 350004 Fujian Province China
| | - Pei-Sen Yao
- Department of Neurosurgery, The First Affiliated Hospital, Fujian Medical University, No.20 Changzhou Road,Taijiang District, Fuzhou, 350004 Fujian Province China
| | - Yuan-Xiang Lin
- Department of Neurosurgery, The First Affiliated Hospital, Fujian Medical University, No.20 Changzhou Road,Taijiang District, Fuzhou, 350004 Fujian Province China
| | - Zhang-Ya Lin
- Department of Neurosurgery, The First Affiliated Hospital, Fujian Medical University, No.20 Changzhou Road,Taijiang District, Fuzhou, 350004 Fujian Province China
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15
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Kotowski M, Farzin B, Fahed R, Guilbert F, Chagnon M, Darsaut TE, Daniel RT, Raymond J. Residual Cerebral Aneurysms After Microsurgical Clipping: A New Scale, an Agreement Study, and a Systematic Review of the Literature. World Neurosurg 2018; 121:e302-e321. [PMID: 30261387 DOI: 10.1016/j.wneu.2018.09.100] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 09/10/2018] [Accepted: 09/12/2018] [Indexed: 12/16/2022]
Abstract
OBJECTIVE The surgical repair of a cerebral aneurysm does not always lead to complete occlusion. A standardized repeatable method of reporting results of surgical clipping is desirable. Our purpose was to systematically review methods of classifying aneurysm remnants, provide a new scale with precise definitions of categories, and perform an agreement study to assess the variability in adjudicating remnants after aneurysm clipping. METHODS A systematic review was performed to identify ways to report angiographic results of surgical clipping between 1963 and 2017. Postclipping angiographic results of 43 patients were also independently evaluated by 10 raters of various experience and backgrounds using a new 4-category scale. Agreement between responses were analyzed using κ statistics. RESULTS The systematic review yielded 63 articles with 37 different nomenclatures using 2-6 categories. The reliability of judging the presence of an aneurysm remnant on catheter angiography was studied only twice, with only 2 raters each time, with contradictory results. Interobserver agreement using the new 4-category scale was moderate (κ = 0.52; 95% confidence interval, 0.43-0.62) for all observers, but improved to substantial (κ = 0.62; 95% confidence interval, 0.47-0.76) when results were dichotomized (grade 0/1 vs. 2/3). CONCLUSIONS Various classification schemes to evaluate angiographic results after surgical clipping exist in the literature, but they lack standardization. Adjudication using fewer, better defined categories may yield more reliable agreement.
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Affiliation(s)
- Marc Kotowski
- Department of Radiology, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, Quebec, Canada; Faculty of Biology and Medicine, Université de Lausanne, Lausanne, Switzerland
| | - Behzad Farzin
- Department of Radiology, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, Quebec, Canada
| | - Robert Fahed
- Department of Radiology, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, Quebec, Canada; Interventional Neuroradiology Unit, Fondati Rothschild Hospital, Paris, France
| | - François Guilbert
- Department of Radiology, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, Quebec, Canada
| | - Miguel Chagnon
- Department of Mathematics and Statistics, Université de Montréal, Montreal, Quebec, Canada
| | - Tim E Darsaut
- University of Alberta Hospital, Mackenzie Health Sciences Centre, Division of Neurosurgery, Department of Surgery, Edmonton, Canada
| | - Roy T Daniel
- Faculty of Biology and Medicine, Université de Lausanne, Lausanne, Switzerland; Department of Clinical Neurosciences, Neurosurgery Unit, Centre hospitalier universitaire vaudois (CHUV), Lausanne, Switzerland
| | - Jean Raymond
- Department of Radiology, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, Quebec, Canada.
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16
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Vascular assessment after clipping surgery using four-dimensional CT angiography. Neurosurg Rev 2018; 42:107-114. [PMID: 29502322 DOI: 10.1007/s10143-018-0962-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Revised: 02/08/2018] [Accepted: 02/26/2018] [Indexed: 12/29/2022]
Abstract
Recent advances in computed tomography angiography (CTA) enable repeated imaging follow up for post-clipping surgery. The purpose of this study was to clarify the critical volume and configuration of the aneurysmal clip in the postoperative evaluation using volume rendering (VR) imaging, and present four-dimensional (4D)-CTA for these larger metal artifacts. A total of 44 patients with cerebral aneurysm, treated using clipping surgery, were included in this study. The metal artifact volume was assessed using CTA and the association between the type of clips and its metal artifact volume was analyzed. A VR image and a 4D-CTA were then produced, and the diagnostic accuracy of arteries around the clip or residual aneurysm on these images was evaluated. In the receiver operating characteristic (ROC) curve analysis, the cutoff value for metal artifacts was 2.32 mm3 as determined through a VR image. Patients were divided into two groups. Group 1 included patients with a simple and small clip, and group 2 included patients with multiple, large or fenestrated clips. The metal artifact volume was significantly larger in group 2, and the group incorporated the cutoff value. Post-clipping status on the VR image was significantly superior in group 1 compared with group 2. In group 2, the imaging quality of post-clipping status on 4D-CTA was superior in 92.9% of patients. The metal artifact volume was dependent on the number, size, or configuration of the clip used. In group 2, evaluation using a 4D-CTA eliminated the effect of the metal artifacts.
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Pjontek R, Önenköprülü B, Scholz B, Kyriakou Y, Schubert GA, Nikoubashman O, Othman A, Wiesmann M, Brockmann MA. Metal artifact reduction for flat panel detector intravenous CT angiography in patients with intracranial metallic implants after endovascular and surgical treatment. J Neurointerv Surg 2015; 8:824-9. [PMID: 26346458 PMCID: PMC4975832 DOI: 10.1136/neurintsurg-2015-011787] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Accepted: 07/13/2015] [Indexed: 11/03/2022]
Abstract
BACKGROUND Flat panel detector CT angiography with intravenous contrast agent injection (IV CTA) allows high-resolution imaging of cerebrovascular structures. Artifacts caused by metallic implants like platinum coils or clips lead to degradation of image quality and are a significant problem. OBJECTIVE To evaluate the influence of a prototype metal artifact reduction (MAR) algorithm on image quality in patients with intracranial metallic implants. METHODS Flat panel detector CT after intravenous application of 80 mL contrast agent was performed with an angiography system (Artis zee; Siemens, Forchheim, Germany) using a 20 s rotation protocol (200° rotation angle, 20 s acquisition time, 496 projections). The data before and after MAR of 26 patients with a total of 34 implants (coils, clips, stents) were independently evaluated by two blinded neuroradiologists. RESULTS MAR improved the assessability of the brain parenchyma and small vessels (diameter <1 mm) in the neighborhood of metallic implants and at a distance of 6 cm (p<0.001 each, Wilcoxon test). Furthermore, MAR significantly improved the assessability of parent vessel patency and potential aneurysm remnants (p<0.005 each, McNemar test). MAR, however, did not improve assessability of stented vessels. CONCLUSIONS When an intravenous contrast protocol is used, MAR significantly ameliorates the assessability of brain parenchyma, vessels, and treated aneurysms in patients with intracranial coils or clips.
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Affiliation(s)
- Rastislav Pjontek
- Department of Diagnostic and Interventional Neuroradiology, University Hospital RWTH Aachen, Aachen, Germany
| | - Belgin Önenköprülü
- Department of Diagnostic and Interventional Neuroradiology, University Hospital RWTH Aachen, Aachen, Germany
| | - Bernhard Scholz
- Healthcare, Imaging & Therapy Division, Siemens AG, Forchheim, Germany
| | - Yiannis Kyriakou
- Healthcare, Imaging & Therapy Division, Siemens AG, Forchheim, Germany
| | - Gerrit A Schubert
- Department of Neurosurgery, University Hospital RWTH Aachen, Aachen, Germany
| | - Omid Nikoubashman
- Department of Diagnostic and Interventional Neuroradiology, University Hospital RWTH Aachen, Aachen, Germany Institute of Neuroscience and Medicine 4, Medical Imaging Physics, Forschungszentrum Jülich, Jülich, Germany
| | - Ahmed Othman
- Department of Diagnostic and Interventional Neuroradiology, University Hospital RWTH Aachen, Aachen, Germany
| | - Martin Wiesmann
- Department of Diagnostic and Interventional Neuroradiology, University Hospital RWTH Aachen, Aachen, Germany
| | - Marc A Brockmann
- Department of Diagnostic and Interventional Neuroradiology, University Hospital RWTH Aachen, Aachen, Germany
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Doerfler A, Gölitz P, Engelhorn T, Kloska S, Struffert T. Flat-Panel Computed Tomography (DYNA-CT) in Neuroradiology. From High-Resolution Imaging of Implants to One-Stop-Shopping for Acute Stroke. Clin Neuroradiol 2015; 25 Suppl 2:291-7. [PMID: 26091842 DOI: 10.1007/s00062-015-0423-x] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Accepted: 06/09/2015] [Indexed: 10/23/2022]
Abstract
Originally aimed at improving standard radiography by providing higher absorption efficiency and a wider dynamic range, flat-panel detector technology has meanwhile got widely accepted in the neuroradiological community. Especially flat-panel detector computed tomography (FD-CT) using rotational C-arm mounted flat-panel detector technology is capable of volumetric imaging with a high spatial resolution. By providing CT-like images of the brain within the angio suite, FD-CT is able to rapidly visualize hemorrhage and may thus improve complication management without the need of patient transfer. As "Angiographic CT" FD-CT may be helpful during many diagnostic and neurointerventional procedures and for noninvasive monitoring and follow-up. In addition, spinal interventions and high-resolution imaging of the temporal bone might also benefit from FD-CT. Finally, using novel dynamic perfusion and angiographic protocols, FD-CT may provide functional information on brain perfusion and vasculature with the potential to replace standard imaging in selected acute stroke patients.
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Affiliation(s)
- A Doerfler
- Department of Neuroradiology, University Erlangen-Nuremberg, Schwabachanlage 6 (Kopfklinikum), 91052, Erlangen, Germany.
| | - P Gölitz
- Department of Neuroradiology, University Erlangen-Nuremberg, Schwabachanlage 6 (Kopfklinikum), 91052, Erlangen, Germany
| | - T Engelhorn
- Department of Neuroradiology, University Erlangen-Nuremberg, Schwabachanlage 6 (Kopfklinikum), 91052, Erlangen, Germany
| | - S Kloska
- Department of Neuroradiology, University Erlangen-Nuremberg, Schwabachanlage 6 (Kopfklinikum), 91052, Erlangen, Germany
| | - T Struffert
- Department of Neuroradiology, University Erlangen-Nuremberg, Schwabachanlage 6 (Kopfklinikum), 91052, Erlangen, Germany
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Surgery of brain aneurysm in a BrainSuite® theater: A review of 105 cases. Clin Neurol Neurosurg 2015; 133:34-9. [DOI: 10.1016/j.clineuro.2015.03.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2014] [Revised: 02/28/2015] [Accepted: 03/07/2015] [Indexed: 02/07/2023]
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