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Gahide G, Hadjadj S, Therasse E, Kauffmann C, Gilbert P, Oliva VL, Tardif JC, Lespérance J, Cloutier G, Soulez G. Value of C-Arm Computed Tomography to Evaluate Stent Deployment During Femoro-Popliteal Revascularization. Cardiovasc Intervent Radiol 2015; 38:1458-67. [PMID: 25962988 DOI: 10.1007/s00270-015-1108-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2014] [Accepted: 03/05/2015] [Indexed: 11/28/2022]
Abstract
PURPOSE To compare the accuracy of C-arm computed tomography (CT) and digital subtraction angiography (DSA) in detecting incomplete stent expansion (ISE) after superficial femoral artery (SFA) stenting using intravascular ultrasound (IVUS) as a gold standard. MATERIALS Fifty patients with symptomatic SFA occlusive disease requiring angioplasty were prospectively included. Once technical success (<30 % residual stenosis) was obtained on post-procedural DSA, C-arm CT and IVUS were acquired. DSA and C-arm CT examinations were reviewed by 2 investigators and correlated with IVUS. C-arm CT image quality was rated on a four-point scale. Doppler ultrasound was performed at 1-year follow-up. RESULTS The ankle-brachial index was 0.69 ± 0.10 and 0.99 ± 0.40, respectively, pre- and post-procedure. C-arm CT imaging quality was rated as good or excellent in 80%. In-stent minimal luminal diameter (MLD) was evaluated at 4.71 ± 0.7 mm on DSA, 3.39 ± 0.6 mm on IVUS, and 3.12 ± 0.9 mm on C-arm CT. Compared to IVUS, DSA demonstrated an overestimation of MLD (p = 0.0001), an underestimation of ISE (DSA = 18.8% ± 7.6; IVUS = 29.8% ± 9) (p < 0.0001), and a poor inter-technique intra-class correlation coefficient (ICC = 0.24). No difference was observed between IVUS and C-arm CT in ISE as calculated by diameter (29.8 ± 9 vs. 28.2 ± 12.5%, p = 0.5) and area (30.2 ± 8.4 vs. 33.3 ± 9.5%, p = 0.2). Inter-technique ICC between C-arm CT and IVUS was 0.72 [95%CI 0.49; 0.85] for MLA measurements. The inter-observer ICC for MLD and MLA measurements on C-arm CT were, respectively, estimated at 0.75 [95% CI 0.40, 0.89] and 0.77 [95% CI 0.43, 0.90)]. CONCLUSIONS C-arm CT presents a better correlation with IVUS than DSA to determine lumen diameter and ISE immediately after percutaneous revascularization.
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Affiliation(s)
- Gerald Gahide
- Centre de Recherche Etienne LeBel, Centre Hospitalier de l'Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Sofiane Hadjadj
- Clinical Image Processing Laboratory (LCTI), Centre de Recherche de l'Université de Montréal (CRCHUM), Montreal, QC, Canada
| | - Eric Therasse
- Clinical Image Processing Laboratory (LCTI), Centre de Recherche de l'Université de Montréal (CRCHUM), Montreal, QC, Canada.,Department of Radiology, Radio-Oncology and Nuclear Medicine, Université de Montréal, Montreal, QC, Canada.,Department of Radiology, Centre Hospitalier de l'Université de Montréal (CHUM), 1560 Sherbrooke Street East, Montreal, QC, H2L 4M1, Canada
| | - Claude Kauffmann
- Clinical Image Processing Laboratory (LCTI), Centre de Recherche de l'Université de Montréal (CRCHUM), Montreal, QC, Canada.,Department of Radiology, Radio-Oncology and Nuclear Medicine, Université de Montréal, Montreal, QC, Canada
| | - Patrick Gilbert
- Department of Radiology, Radio-Oncology and Nuclear Medicine, Université de Montréal, Montreal, QC, Canada.,Department of Radiology, Centre Hospitalier de l'Université de Montréal (CHUM), 1560 Sherbrooke Street East, Montreal, QC, H2L 4M1, Canada
| | - Vincent L Oliva
- Department of Radiology, Radio-Oncology and Nuclear Medicine, Université de Montréal, Montreal, QC, Canada.,Department of Radiology, Centre Hospitalier de l'Université de Montréal (CHUM), 1560 Sherbrooke Street East, Montreal, QC, H2L 4M1, Canada
| | - Jean-Claude Tardif
- Research Center, Montreal Heart Institute, Université de Montréal, Montreal, QC, Canada
| | - Jacques Lespérance
- Research Center, Montreal Heart Institute, Université de Montréal, Montreal, QC, Canada
| | - Guy Cloutier
- Department of Radiology, Radio-Oncology and Nuclear Medicine, Université de Montréal, Montreal, QC, Canada.,Laboratory of Biorheology and Medical Ultrasonics, Centre de Recherche de l'Université de Montréal (CRCHUM), Montreal, QC, Canada.,Institute of Biomedical Engineering, University of Montreal, Montreal, QC, Canada
| | - Gilles Soulez
- Clinical Image Processing Laboratory (LCTI), Centre de Recherche de l'Université de Montréal (CRCHUM), Montreal, QC, Canada. .,Department of Radiology, Radio-Oncology and Nuclear Medicine, Université de Montréal, Montreal, QC, Canada. .,Department of Radiology, Centre Hospitalier de l'Université de Montréal (CHUM), 1560 Sherbrooke Street East, Montreal, QC, H2L 4M1, Canada. .,Institute of Biomedical Engineering, University of Montreal, Montreal, QC, Canada.
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Perisinakis K, Manousaki E, Zourari K, Tsetis D, Tzedakis A, Papadakis A, Karantanas A, Damilakis J. Accuracy of multislice CT angiography for the assessment of in-stent restenoses in the iliac arteries at reduced dose: a phantom study. Br J Radiol 2011; 84:244-50. [PMID: 21325364 PMCID: PMC3473874 DOI: 10.1259/bjr/63029326] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2009] [Revised: 01/22/2010] [Accepted: 03/10/2010] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE We investigated the potential of low-dose CT angiography for accurate assessment of in-stent restenoses (ISRs) of the iliac artery. METHOD A Rando anthropomorphic phantom (Alderson Research Labs, Stanford, CA), custom-made wax simulating hyperplastic tissue and a nitinol stent were used to simulate a patient with clinically relevant iliac artery ISRs. The cylindrical lumen was filled with a solution of iodine contrast medium diluted in saline, representing a patient's blood during CT angiography. The phantom was subjected to standard- and low-dose angiographic exposures using a modern multidetector (MD) CT scanner. The percentage of ISR was determined using the profile along a line normal to the lumen axis on reconstructed images of 2 and 5 mm slice thickness. Percentage ISRs derived using the standard- and low-dose protocols were compared. In a preliminary study, seven patients with stents were subjected to standard- and low-dose MDCT angiography during follow-up. The resulting images were assessed and compared by two experienced radiologists. RESULTS The accuracy in measuring the percentage ISR was found to be better than 12% for all simulated stenoses. The differences between percentage ISRs measured on images obtained at 120 kVp/160 mAs and 80 kVp/80 mAs were below 6%. Patient image sets acquired using low-exposure factors were judged to be of satisfactory diagnostic quality. The assessment of ISR did not differ significantly between image sets acquired using the standard factors and those acquired using the low-exposure factors, although the mean reduction in patient effective dose was 48%. CONCLUSION A reduction in exposure factors during MDCT angiography of the iliac artery is possible without affecting the accuracy in the determination of ISRs.
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Affiliation(s)
- K Perisinakis
- Department of Medical Physics, Faculty of Medicine, University of Crete, Heraklion, Crete, Greece.
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