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Maul N, Birkhold A, Wagner F, Thies M, Rohleder M, Berg P, Kowarschik M, Maier A. Simulation-informed learning for time-resolved angiographic contrast agent concentration reconstruction. Comput Biol Med 2024; 182:109178. [PMID: 39321585 DOI: 10.1016/j.compbiomed.2024.109178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 07/29/2024] [Accepted: 09/18/2024] [Indexed: 09/27/2024]
Abstract
Three-dimensional Digital Subtraction Angiography (3D-DSA) is a well-established X-ray-based technique for visualizing vascular anatomy. Recently, four-dimensional DSA (4D-DSA) reconstruction algorithms have been developed to enable the visualization of volumetric contrast flow dynamics through time-series of volumes. This reconstruction problem is ill-posed mainly due to vessel overlap in the projection direction and geometric vessel foreshortening, which leads to information loss in the recorded projection images. However, knowledge about the underlying fluid dynamics can be leveraged to constrain the solution space. In our work, we implicitly include this information in a neural network-based model that is trained on a dataset of image-based blood flow simulations. The model predicts the spatially averaged contrast agent concentration for each centerline point of the vasculature over time, lowering the overall computational demand. The trained network enables the reconstruction of relative contrast agent concentrations with a mean absolute error of 0.02±0.02 and a mean absolute percentage error of 5.31±9.25 %. Moreover, the network is robust to varying degrees of vessel overlap and vessel foreshortening. Our approach demonstrates the potential of the integration of machine learning and blood flow simulations in time-resolved angiographic contrast agent concentration reconstruction.
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Affiliation(s)
- Noah Maul
- Pattern Recognition Lab, Department of Computer Science, Friedrich-Alexander Universität Erlangen-Nürnberg, Germany; Siemens Healthineers AG, Forchheim, Germany.
| | | | - Fabian Wagner
- Pattern Recognition Lab, Department of Computer Science, Friedrich-Alexander Universität Erlangen-Nürnberg, Germany
| | - Mareike Thies
- Pattern Recognition Lab, Department of Computer Science, Friedrich-Alexander Universität Erlangen-Nürnberg, Germany
| | - Maximilian Rohleder
- Pattern Recognition Lab, Department of Computer Science, Friedrich-Alexander Universität Erlangen-Nürnberg, Germany
| | - Philipp Berg
- Research Campus STIMULATE, University of Magdeburg, Germany; Department of Medical Engineering, University of Magdeburg, Germany
| | | | - Andreas Maier
- Pattern Recognition Lab, Department of Computer Science, Friedrich-Alexander Universität Erlangen-Nürnberg, Germany
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Murazaki H, Wada T, Togao O, Obara M, Helle M, Kobayashi K, Ishigami K, Kato T. Improved temporal resolution and acceleration on 4D-MR angiography based on superselective pseudo-continuous arterial spin labeling combined with CENTRA-keyhole and view-sharing (4D-S-PACK) using an interpolation algorithm on the temporal axis and compressed sensing-sensitivity encoding (CS-SENSE). Magn Reson Imaging 2024; 109:1-9. [PMID: 38417470 DOI: 10.1016/j.mri.2024.02.011] [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: 07/04/2023] [Revised: 02/19/2024] [Accepted: 02/20/2024] [Indexed: 03/01/2024]
Abstract
PURPOSE Two major drawbacks of 4D-MR angiography based on superselective pseudo-continuous arterial spin labeling combined with CENTRA-keyhole and view-sharing (4D-S-PACK) are the low temporal resolution and long scanning time. We investigated the feasibility of increasing the temporal resolution and accelerating the scanning time on 4D-S-PACK by using CS-SENSE and PhyZiodynamics, a novel image-processing program that interpolates images between phases to generate new phases and reduces image noise. METHODS Seven healthy volunteers were scanned with a 3.0 T MR scanner to visualize the internal carotid artery (ICA) system. PhyZiodynamics is a novel image-processing that interpolates images between phases to generate new phases and reduces image noise, and by increasing temporal resolution using PhyZiodynamics, inflow dynamic data (reference) were acquired by changing the labeling durations (100-2000 msec, 31 phases) in 4D-S-PACK. From this set of data, we selected seven time intervals to calculate interpolated time points with up to 61 intervals using ×10 for the generation of interpolated phases with PhyZiodynamics. In the denoising process of PhyZiodynamics, we processed the none, low, medium, high noise reduction dataset images. The time intensity curve (TIC), the contrast-to-noise ratio (CNR) were evaluated. In accelerating with CS-SENSE for 4D-S-PACK, 4D-S-PACK were scanned different SENSE or CS-SENSE acceleration factors: SENSE3, CS3-6. Signal intensity (SI), CNR, were evaluated for accelerating the 4D-S-PACK. With regard to arterial vascular visualization, we evaluated the middle cerebral artery (MCA: M1-4 segments). RESULTS In increasing temporal resolution, the TIC showed a similar trend between the reference dataset and the interpolated dataset. As the noise reduction weight increased, the CNR of the interpolated dataset were increased compared to that of the reference dataset. In accelerating 4D-S-PACK, the SI values of the SENSE3 dataset and CS dataset with CS3-6 were no significant differences. The image noise increased with the increase of acceleration factor, and the CNR decreased with the increase of acceleration factor. Significant differences in CNR were observed between acceleration factor of SENSE3 and CS6 for the M1-4 (P < 0.05). Visualization of small arteries (M4) became less reliable in CS5 or CS6 images. Significant differences were found for the scores of M2, M3 and M4 segments between SENSE3 and CS6. CONCLUSION With PhyZiodynamics and CS-SENSE in 4D-S-PACK, we were able to shorten the scan time while improving the temporal resolution.
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Affiliation(s)
- Hiroo Murazaki
- Division of Radiology, Department of Medical Technology, Kyushu University Hospital, Fukuoka, Japan.
| | - Tatsuhiro Wada
- Division of Radiology, Department of Medical Technology, Kyushu University Hospital, Fukuoka, Japan
| | - Osamu Togao
- Department of Molecular Imaging & Diagnosis, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | | | | | - Kouji Kobayashi
- Division of Radiology, Department of Medical Technology, Kyushu University Hospital, Fukuoka, Japan
| | - Kousei Ishigami
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Toyoyuki Kato
- Division of Radiology, Department of Medical Technology, Kyushu University Hospital, Fukuoka, Japan
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Clavero Bertomeu L, Castro Portillo L, Fernández-Conde de Paz C. Uterine Arteriovenous Malformation: Diagnostic and Therapeutic Challenges. Diagnostics (Basel) 2024; 14:1084. [PMID: 38893611 PMCID: PMC11172076 DOI: 10.3390/diagnostics14111084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Revised: 03/26/2024] [Accepted: 05/21/2024] [Indexed: 06/21/2024] Open
Abstract
Uterine arteriovenous malformations are a rare cause of puerperal haemorrhage, but their incidence is increasing due to both improved diagnosis and the more frequent use of uterine surgery in recent years. The use of ultrasound, both B-mode and Doppler, is recommended for diagnosis and follow-up, as it has been shown to be the simplest and most cost-effective method. Endometrial thickening associated with an anechoic and vascular intramiometrial structure is very useful for diagnosis and can help to exclude other causes of dysfunctional bleeding. Pulsed Doppler shows low-resistance vessels and high pulsatility indices with a high peak systolic velocity (PSV). In a healthy myometrium, the vessels have a peak systolic velocity of 9-40 cm/s and a resistance index between 0.6 and 0.8, whereas in the case of AVMs, the systolic and diastolic velocities are 4-6 times higher (PSV 25-110 cm/s with a mean of 60 cm/s and a resistance index of 0.27-0.75 with a mean of 0.41). For treatment, we must individualise each case, taking into account haemodynamic stability, the patient's reproductive wishes, and the severity of the AVM as assessed by its size and PSV.
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Affiliation(s)
- Luisa Clavero Bertomeu
- Department of Obstetrics and Gynecology, Valme University Hospital, 41014 Sevilla, Spain
| | - Laura Castro Portillo
- Department of Obstetrics and Gynecology, Valme University Hospital, 41014 Sevilla, Spain
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Shields A, Williams K, Bhurwani MMS, Nagesh SVS, Chivukula VK, Bednarek DR, Rudin S, Davies J, Siddiqui AH, Ionita CN. Enhancing cerebral vasculature analysis with pathlength-corrected 2D angiographic parametric imaging: A feasibility study. Med Phys 2024; 51:2633-2647. [PMID: 37864843 PMCID: PMC10994741 DOI: 10.1002/mp.16808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Revised: 09/09/2023] [Accepted: 09/27/2023] [Indexed: 10/23/2023] Open
Abstract
BACKGROUND 2D angiographic parametric imaging (API) quantitatively extracts imaging biomarkers related to contrast flow and is conventionally applied to 2D digitally subtracted angiograms (DSA's). In the interventional suite, API is typically performed using 1-2 projection views and is limited by vessel overlap, foreshortening, and depth-integration of contrast motion. PURPOSE This work explores the use of a pathlength-correction metric to overcome the limitations of 2D-API: the primary objective was to study the effect of converting 3D contrast flow to projected contrast flow using a simulated angiographic framework created with computational fluid dynamics (CFD) simulations, thereby removing acquisition variability. METHODS The pathlength-correction framework was applied to in-silico angiograms, generating a reference (i.e., ground-truth) volumetric contrast distribution in four patient-specific intracranial aneurysm geometries. Biplane projections of contrast flow were created from the reference volumetric contrast distributions, assuming a cone-beam geometry. A Parker-weighted reconstruction was performed to obtain a binary representation of the vessel structure in 3D. Standard ray tracing techniques were then used to track the intersection of a ray from the focal spot with each voxel of the reconstructed vessel wall to a pixel in the detector plane. The lengths of each ray through the 3D vessel lumen were then projected along each ray-path to create a pathlength-correction map, where the pixel intensity in the detector plane corresponds to the vessel width along each source-detector ray. By dividing the projection sequences with this correction map, 2D pathlength-corrected in-silico angiograms were obtained. We then performed voxel-wise (3D) API on the ground-truth contrast distribution and compared it to pixel-wise (2D) API, both with and without pathlength correction for each biplane view. The percentage difference (PD) between the resultant API biomarkers in each dataset were calculated within the aneurysm region of interest (ROI). RESULTS Intensity-based API parameters, such as the area under the curve (AUC) and peak height (PH), exhibited notable changes in magnitude and spatial distribution following pathlength correction: these now accurately represent conservation of mass of injected contrast media within each arterial geometry and accurately reflect regions of stagnation and recirculation in each aneurysm ROI. Improved agreement was observed between these biomarkers in the pathlength-corrected biplane maps: the maximum PD within the aneurysm ROI is 3.3% with pathlength correction and 47.7% without pathlength correction. As expected, improved agreement with ROI-averaged ground-truth 3D counterparts was observed for all aneurysm geometries, particularly large aneurysms: the maximum PD for both AUC and PH was 5.8%. Temporal parameters (mean transit time, MTT, time-to-peak, TTP, time-to-arrival, TTA) remained unaffected after pathlength correction. CONCLUSIONS This study indicates that the values of intensity-based API parameters obtained with conventional 2D-API, without pathlength correction, are highly dependent on the projection orientation, and uncorrected API should be avoided for hemodynamic analysis. The proposed metric can standardize 2D API-derived biomarkers independent of projection orientation, potentially improving the diagnostic value of all acquired 2D-DSA's. Integration of a pathlength correction map into the imaging process can allow for improved interpretation of biomarkers in 2D space, which may lead to improved diagnostic accuracy during procedures involving the cerebral vasculature.
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Affiliation(s)
- Allison Shields
- Medical Physics Program, University at Buffalo, Buffalo, New York, USA 14203
- Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, New York, USA 14203
| | - Kyle Williams
- Medical Physics Program, University at Buffalo, Buffalo, New York, USA 14203
- Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, New York, USA 14203
| | | | - Swetadri Vasan Setlur Nagesh
- Medical Physics Program, University at Buffalo, Buffalo, New York, USA 14203
- Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, New York, USA 14203
| | - Venkat Keshav Chivukula
- Department of Biomedical Engineering, Florida Institute of Technology, Melbourne, Florida, USA 32901
| | - Daniel R. Bednarek
- Medical Physics Program, University at Buffalo, Buffalo, New York, USA 14203
- Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, New York, USA 14203
| | - Stephen Rudin
- Medical Physics Program, University at Buffalo, Buffalo, New York, USA 14203
- Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, New York, USA 14203
| | - Jason Davies
- Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, New York, USA 14203
- Department of Neurosurgery, University at Buffalo, Buffalo, New York, USA 14203
| | - Adnan H Siddiqui
- Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, New York, USA 14203
- Department of Neurosurgery, University at Buffalo, Buffalo, New York, USA 14203
| | - Ciprian N. Ionita
- Medical Physics Program, University at Buffalo, Buffalo, New York, USA 14203
- Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, New York, USA 14203
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Whitehead JF, Hoffman CA, Wagner MG, Minesinger GM, Nikolau EP, Laeseke PF, Speidel MA. Interleaved x-ray imaging: A method for simultaneous acquisition of quantitative and diagnostic digital subtraction angiography. Med Phys 2024; 51:2468-2478. [PMID: 37856176 PMCID: PMC10994749 DOI: 10.1002/mp.16794] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 09/26/2023] [Accepted: 09/27/2023] [Indexed: 10/20/2023] Open
Abstract
BACKGROUND Flow altering angiographic procedures suffer from ill-defined, qualitative endpoints. Quantitative digital subtraction angiography (qDSA) is an emerging technology that aims to address this issue by providing intra-procedural blood velocity measurements from time-resolved, 2D angiograms. To date, qDSA has used 30 frame/s DSA imaging, which is associated with high radiation dose rate compared to clinical diagnostic DSA (up to 4 frame/s). PURPOSE The purpose of this study is to demonstrate an interleaved x-ray imaging method which decreases the radiation dose rate associated with high frame rate qDSA while simultaneously providing low frame rate diagnostic DSA images, enabling the acquisition of both datasets in a single image sequence with a single injection of contrast agent. METHODS Interleaved x-ray imaging combines low radiation dose image frames acquired at a high rate with high radiation dose image frames acquired at a low rate. The feasibility of this approach was evaluated on an x-ray system equipped with research prototype software for x-ray tube control. qDSA blood velocity quantification was evaluated in a flow phantom study for two lower dose interleaving protocols (LD1:3.7 ± 0.02 mGy / s $3.7 \pm 0.02\ {\mathrm{mGy}}/{\mathrm{s}}$ and LD2:1.7 ± 0.04 mGy / s $1.7 \pm 0.04{\mathrm{\ mGy}}/{\mathrm{s}}$ ) and one conventional (full dose) protocol (11.4 ± 0.04 mGy / s ) $11.4 \pm 0.04{\mathrm{\ mGy}}/{\mathrm{s}})$ . Dose was measured at the interventional reference point. Fluid velocities ranging from 24 to 45 cm/s were investigated. Gold standard velocities were measured using an ultrasound flow probe. Linear regression and Bland-Altman analysis were used to compare ultrasound and qDSA. RESULTS The LD1 and LD2 interleaved protocols resulted in dose rate reductions of -67.7% and -85.5%, compared to the full dose qDSA scan. For the full dose protocol, the Bland-Altman limits of agreement (LOA) between qDSA and ultrasound velocities were [0.7, 6.7] cm/s with a mean difference of 3.7 cm/s. The LD1 interleaved protocol results were similar (LOA: [0.3, 6.9] cm/s, bias: 3.6 cm/s). The LD2 interleaved protocol resulted in slightly larger LOA: [-2.5, 5.5] cm/s with a decrease in the bias: 1.5 cm/s. Linear regression analysis showed a strong correlation between ultrasound and qDSA derived velocities using the LD1 protocol, with aR 2 ${R}^2$ of0.96 $0.96$ , a slope of1.05 $1.05$ and an offset of1.9 $1.9$ cm/s. Similar values were also found for the LD2 protocol, with aR 2 ${R}^2$ of0.93 $0.93$ , a slope of0.98 $0.98$ and an offset of2.0 $2.0$ cm/s. CONCLUSIONS The interleaved method enables simultaneous acquisition of low-dose high-rate images for intra-procedural blood velocity quantification (qDSA) and high-dose low-rate images for vessel morphology evaluation (diagnostic DSA).
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Affiliation(s)
- Joseph F. Whitehead
- Department of Medical Physics, University of Wisconsin - Madison, Madison, Wisconsin, 53705, United States of America
| | - Carson A. Hoffman
- Department of Radiology, University of Wisconsin - Madison, Madison, Wisconsin, 53792, United States of America
| | - Martin G. Wagner
- Department of Radiology, University of Wisconsin - Madison, Madison, Wisconsin, 53792, United States of America
| | - Grace M. Minesinger
- Department of Medical Physics, University of Wisconsin - Madison, Madison, Wisconsin, 53705, United States of America
| | - Ethan P. Nikolau
- Department of Medical Physics, University of Wisconsin - Madison, Madison, Wisconsin, 53705, United States of America
| | - Paul F. Laeseke
- Department of Radiology, University of Wisconsin - Madison, Madison, Wisconsin, 53792, United States of America
| | - Michael A. Speidel
- Department of Medical Physics, University of Wisconsin - Madison, Madison, Wisconsin, 53705, United States of America
- Department of Medicine, University of Wisconsin - Madison, Madison, Wisconsin, 53705, United States of America
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Li Y, Feng J, Xiang J, Li Z, Liang D. AIRPORT: A Data Consistency Constrained Deep Temporal Extrapolation Method To Improve Temporal Resolution In Contrast Enhanced CT Imaging. IEEE TRANSACTIONS ON MEDICAL IMAGING 2024; 43:1605-1618. [PMID: 38133967 DOI: 10.1109/tmi.2023.3344712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2023]
Abstract
Typical tomographic image reconstruction methods require that the imaged object is static and stationary during the time window to acquire a minimally complete data set. The violation of this requirement leads to temporal-averaging errors in the reconstructed images. For a fixed gantry rotation speed, to reduce the errors, it is desired to reconstruct images using data acquired over a narrower angular range, i.e., with a higher temporal resolution. However, image reconstruction with a narrower angular range violates the data sufficiency condition, resulting in severe data-insufficiency-induced errors. The purpose of this work is to decouple the trade-off between these two types of errors in contrast-enhanced computed tomography (CT) imaging. We demonstrated that using the developed data consistency constrained deep temporal extrapolation method (AIRPORT), the entire time-varying imaged object can be accurately reconstructed with 40 frames-per-second temporal resolution, the time window needed to acquire a single projection view data using a typical C-arm cone-beam CT system. AIRPORT is applicable to general non-sparse imaging tasks using a single short-scan data acquisition.
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Wagner MG, Whitehead JF, Periyasamy S, Laeseke PF, Speidel MA. Spatiotemporal frequency domain analysis for blood velocity measurement during embolization procedures. Med Phys 2024; 51:1726-1737. [PMID: 37665770 PMCID: PMC10909916 DOI: 10.1002/mp.16715] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Revised: 08/22/2023] [Accepted: 08/23/2023] [Indexed: 09/06/2023] Open
Abstract
BACKGROUND Currently, determining procedural endpoints and treatment efficacy of vascular interventions is largely qualitative and relies on subjective visual assessment of digital subtraction angiography (DSA) images leading to large interobserver variabilities and poor reproducibility. Quantitative metrics such as the residual blood velocity in embolized vessel branches could help establish objective and reproducible endpoints. Recently, velocity quantification techniques based on a contrast enhanced X-ray sequence such as qDSA and 4D DSA have been proposed. These techniques must be robust, and, to avoid radiation dose concerns, they should be compatible with low dose per frame image acquisition. PURPOSE To develop and evaluate a technique for robust blood velocity quantification from low dose contrast enhanced X-ray image sequences that leverages the oscillating signal created by pulsatile blood flow. METHODS The proposed spatiotemporal frequency domain (STF) approach quantifies velocities from time attenuation maps (TAMs) representing the oscillating signal over time for all points along a vessel centerline. Due to the time it takes a contrast bolus to travel along the vessel centerline, the resulting TAM resembles a sheared sine wave. The shear angle is related to the velocity and can be determined in the spatiotemporal frequency domain after applying the 2D Fourier transform to the TAM. The approach was evaluated in a straight tube phantom using three different radiation dose levels and compared to ultrasound transit-time-based measurements. The STF velocity results were also compared to previously published approaches for the measurement of blood velocity from contrast enhanced X-ray sequences including shifted least squared (SLS) and phase shift (PHS). Additionally, an in vivo porcine study (n = 8) was performed where increasing amounts of embolic particles were injected into a hepatic or splenic artery with intermittent velocity measurements after each injection to monitor the resulting reduction in velocity. RESULTS At the lowest evaluated dose level (average air kerma rate 1.3 mGy/s at the interventional reference point), the Pearson correlation between ultrasound and STF velocity measurements was99 % $99\%$ . This was significantly higher (p < 0.0001 $p < 0.0001$ ) than corresponding correlation results between ultrasound and the previously published SLS and PHS approaches (91 $\hskip.001pt 91$ and93 % $93\%$ , respectively). In the in vivo study, a reduction in velocity was observed in85.7 % $85.7\%$ of cases after injection of 1 mL,96.4 % $96.4\%$ after 3 mL, and100.0 % $100.0\%$ after 4 mL of embolic particles. CONCLUSIONS The results show good agreement of the spatiotemporal frequency domain approach with ultrasound even in low dose per frame image sequences. Additionally, the in vivo study demonstrates the ability to monitor the physiological changes due to embolization. This could provide quantitative metrics during vascular procedures to establish objective and reproducible endpoints.
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Affiliation(s)
- Martin G Wagner
- Department of Radiology, University of Wisconsin, Madison, Wisconsin, USA
- Department of Medical Physics, University of Wisconsin, Madison, Wisconsin, USA
| | - Joseph F Whitehead
- Department of Medical Physics, University of Wisconsin, Madison, Wisconsin, USA
| | - Sarvesh Periyasamy
- Department of Radiology, University of Wisconsin, Madison, Wisconsin, USA
| | - Paul F Laeseke
- Department of Radiology, University of Wisconsin, Madison, Wisconsin, USA
| | - Michael A Speidel
- Department of Medical Physics, University of Wisconsin, Madison, Wisconsin, USA
- Department of Medicine, University of Wisconsin, Madison, Wisconsin, USA
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Fujimura S, Yamanaka Y, Kan I, Nagao M, Otani K, Karagiozov K, Fukudome K, Ishibashi T, Takao H, Motosuke M, Yamamoto M, Murayama Y. Experimental study using phantom models of cerebral aneurysms and 4D-DSA to measure blood flow on 3D-color-coded images. Technol Health Care 2024; 32:3217-3230. [PMID: 38968064 DOI: 10.3233/thc-231906] [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] [Indexed: 07/07/2024]
Abstract
BACKGROUND The current 3D-iFlow application can only measure the arrival time of contrast media through intensity values. If the flow rate could be estimated by 3D-iFlow, patient-specific hemodynamics could be determined within the scope of normal diagnostic management, eliminating the need for additional resources for blood flow rate estimation. OBJECTIVE The aim of this study is to develop and validate a method for measuring the flow rate by data obtained from 3D-iFlow images - a prototype application in Four-dimensional digital subtraction angiography (4D-DSA). METHODS Using phantom model and experimental circuit with circulating glycerin solution, an equation for the relationship between contrast media intensity and flow rate was developed. Applying the equation to the aneurysm phantom models, the derived flow rate was evaluated. RESULTS The average errors between the derived flow rate and setting flow rate became larger when the glycerin flow and the X-rays from the X-ray tube of the angiography system were parallel to each other or when the measurement point included overlaps with other contrast enhanced areas. CONCLUSION Although the error increases dependent on the imaging direction and overlap of contrast enhanced area, the developed equation can estimate the flow rate using the image intensity value measured on 3D-iFlow based on 4D-DSA.
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Affiliation(s)
- Soichiro Fujimura
- Department of Mechanical Engineering, Tokyo University of Science, Tokyo, Japan
- Division of Innovation for Medical Information Technology, The Jikei University School of Medicine, Tokyo, Japan
- Department of Mechanical Engineering, Tokyo University of Science, Tokyo, Japan
| | - Yuma Yamanaka
- Division of Innovation for Medical Information Technology, The Jikei University School of Medicine, Tokyo, Japan
- Graduate School of Mechanical Engineering, Tokyo University of Science, Tokyo, Japan
- Department of Mechanical Engineering, Tokyo University of Science, Tokyo, Japan
| | - Issei Kan
- Department of Neurosurgery, The Jikei University School of Medicine, Tokyo, Japan
| | - Masahiro Nagao
- Graduate School of Mechanical Engineering, Tokyo University of Science, Tokyo, Japan
| | - Katharina Otani
- Department of Neurosurgery, The Jikei University School of Medicine, Tokyo, Japan
- Siemens Healthcare K.K., Tokyo, Japan
| | - Kostadin Karagiozov
- Department of Neurosurgery, The Jikei University School of Medicine, Tokyo, Japan
| | - Koji Fukudome
- Department of Mechanical Engineering, Kanazawa Institute of Technology, Ishikawa, Japan
| | - Toshihiro Ishibashi
- Department of Neurosurgery, The Jikei University School of Medicine, Tokyo, Japan
| | - Hiroyuki Takao
- Division of Innovation for Medical Information Technology, The Jikei University School of Medicine, Tokyo, Japan
- Department of Neurosurgery, The Jikei University School of Medicine, Tokyo, Japan
| | - Masahiro Motosuke
- Department of Mechanical Engineering, Tokyo University of Science, Tokyo, Japan
| | - Makoto Yamamoto
- Department of Mechanical Engineering, Tokyo University of Science, Tokyo, Japan
| | - Yuichi Murayama
- Department of Neurosurgery, The Jikei University School of Medicine, Tokyo, Japan
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Patel A, Patel D, Al-Bahou R, Thakkar R, Kioutchoukova I, Foreman M, Foster D, Lucke-Wold B. Updates on Neuronavigation: Emerging tools for tumor resection. GENERAL SURGERY (SINGAPORE) 2023; 7:10.18282/gs.v7i1.3352. [PMID: 38274640 PMCID: PMC10810325 DOI: 10.18282/gs.v7i1.3352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/27/2024]
Abstract
Multiple studies have been conducted to properly elucidate the various tools available to help enhance the resection of tumor tissue, aneurysms, and arteriovenous malformations (AVM). Diffusion tensor imaging (DTI) tractography is useful in providing a map of the tumor borders, allowing the optimal preservation of function and structure of specific regions of the brain. During neurosurgery, especially craniotomies, the possibility of the brain shifting due to swelling or gravity is high. Thus, tools for intraoperative imaging such as high-frequency linear array ultrasound transducers and doppler ultrasonography are utilized for high resolution images and detecting frequency shifts. 4D-digital subtraction angiography (DSA) is another technique used to create spatial resolutions and 3D maps for aneurysms. These similar techniques can also be utilized to assess the integrity of white matter in AVM. By implementing effective evaluation strategies, healthcare professionals can make informed decisions regarding treatment options, preventive measures, and long-term care plans tailored to individual patients.
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Affiliation(s)
- Anjali Patel
- College of Medicine, University of Florida, Gainesville, FL 32610, USA
| | - Drashti Patel
- College of Medicine, University of Florida, Gainesville, FL 32610, USA
| | - Raja Al-Bahou
- College of Medicine, University of Florida, Gainesville, FL 32610, USA
| | - Rajvi Thakkar
- College of Medicine, University of Florida, Gainesville, FL 32610, USA
| | | | - Marco Foreman
- College of Medicine, University of Florida, Gainesville, FL 32610, USA
| | - Devon Foster
- College of Medicine, Florida International University, Miami, FL 33199, USA
| | - Brandon Lucke-Wold
- Department of Neurosurgery, University of Florida, Gainesville, FL 32610, USA
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Samp PF, Keil F, du Mesnil R, Birkhold A, Kowarschik M, Hattingen E, Berkefeld J. 4D-DSA for Assessment of the Angioarchitecture and Grading of Cranial Dural AVF. AJNR Am J Neuroradiol 2023; 44:1291-1295. [PMID: 37827722 PMCID: PMC10631524 DOI: 10.3174/ajnr.a8008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 08/30/2023] [Indexed: 10/14/2023]
Abstract
BACKGROUND AND PURPOSE Time-resolved 3D rotational angiography (4D-DSA) has been used to demonstrate details of the angioarchitecture of AVM, whereas it has rarely been used to describe features of dural AVF. In this exploratory study, we analyzed dural AVFs with a novel 4D software prototype, developed and provided by Siemens, to determine whether identification of the location of the fistulous point, grading, and treatment planning were feasible. MATERIALS AND METHODS 4D-DSA volumes were calculated from existing 3D rotational angiography data sets of patients with dural AVFs. The 4D-DSA volumes were displayed in a virtual DSA mode and MPR or MIP in 3 orthogonal planes and compared with 2D-DSA by 2 experienced neuroradiologists. Fusions with unenhanced CT or MR images were used to improve visualization of adjacent anatomic structures. RESULTS Comparison with 2D-DSA showed that evaluation of the fistulous point and grading according to the classification of Borden, Cognard, or Barrow was feasible in 26 of 27 cases. In 8 of 27 cases, 4D-DSA was considered advantageous for determining the fistulous point and the course of the draining vein in the dural AVF with cortical venous drainage, especially in the frontoethmoidal and frontoparietal regions. In 6 cases, the display of angioarchitecture was considered inferior to that of 2D-DSA due to motion artifacts, suboptimal selection of the injected vessel, and lack of temporal resolution. CONCLUSIONS Detailed analysis of dural AVFs according to the standardized display of 4D-DSA volumes was feasible and helpful in understanding the angioarchitecture in selected cases. Further improvement and validation of the 4D software should solidify the complementary role of 4D-DSA to conventional 2D-DSA series.
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Affiliation(s)
- P F Samp
- From the Institute of Neuroradiology (P.F.S., F.K., R.d.M., E.H., J.B.), University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - F Keil
- From the Institute of Neuroradiology (P.F.S., F.K., R.d.M., E.H., J.B.), University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - R du Mesnil
- From the Institute of Neuroradiology (P.F.S., F.K., R.d.M., E.H., J.B.), University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - A Birkhold
- Siemens Healthcare (A.B., M.K.), Forchheim, Germany
| | - M Kowarschik
- Siemens Healthcare (A.B., M.K.), Forchheim, Germany
| | - E Hattingen
- From the Institute of Neuroradiology (P.F.S., F.K., R.d.M., E.H., J.B.), University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - J Berkefeld
- From the Institute of Neuroradiology (P.F.S., F.K., R.d.M., E.H., J.B.), University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt am Main, Germany
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11
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Krogager ME, Dahl RH, Poulsgaard L, Fugleholm K, Sehested T, Mikkelsen R, Tranum-Jensen J, Mathiesen TI, Benndorf G. Combined cone-beam CT imaging and microsurgical dissection of cadaver specimens to study cerebral venous anatomy: a technical note. Surg Radiol Anat 2023; 45:1177-1184. [PMID: 37542573 PMCID: PMC10514096 DOI: 10.1007/s00276-023-03195-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 06/28/2023] [Indexed: 08/07/2023]
Abstract
PURPOSE Cadaver dissections and X-ray based 3D angiography are considered gold standards for studying neurovascular anatomy. We sought to develop a model that utilize the combination of both these techniques to improve current tools for anatomical research, teaching and preoperative surgical planning, particularly addressing the venous system of the brain. MATERIALS AND METHODS Seven ethanol-fixed human cadaveric heads and one arm were injected with a latex-barium mixture into the internal jugular veins and the brachial artery. After the ethanol-based fixation, specimens were scanned by high-resolution cone-beam CT and images were post-processed on a 3D-workstation. Subsequent, microsurgical dissections were performed by an experienced neurosurgeon and venous anatomy was compared with relevant 3D venograms. RESULTS Latex-barium mixtures resulted in a homogenous cast with filling of the cerebral venous structures down to 150 μm in diameter. The ethanol-based preparation of the cadaveric brains allowed for near-realistic microsurgical maneuverability during dissection. The model improves assessment of the venous system for anatomical education and hands-on surgical training. CONCLUSION To our knowledge we describe the first preparation method which combines near-realistic microsurgical dissection of human heads with high-resolution 3D imaging of the cerebral venous system in the same specimens.
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Affiliation(s)
- Markus E Krogager
- Department of Neurosurgery, University Hospital of Copenhagen, Rigshospitalet, Copenhagen, Denmark.
| | - Rasmus H Dahl
- Department of Radiology, University Hospital of Copenhagen, Rigshospitalet, Copenhagen, Denmark
- Department of Radiology, Hvidovre Hospital, Copenhagen, Denmark
| | - Lars Poulsgaard
- Department of Neurosurgery, University Hospital of Copenhagen, Rigshospitalet, Copenhagen, Denmark
| | - Kåre Fugleholm
- Department of Neurosurgery, University Hospital of Copenhagen, Rigshospitalet, Copenhagen, Denmark
| | - Tom Sehested
- Department of Neurosurgery, Aarhus University Hospital, Aarhus, Denmark
| | - Ronni Mikkelsen
- Department of Neuroradiology, Aarhus University Hospital, Aarhus, Denmark
- Department of Biomedicine, Aarhus University, Aarhus, Denmark
| | - Jørgen Tranum-Jensen
- Department of Cellular and Molecular Medicine, The Panum Institute, University of Copenhagen, Copenhagen, Denmark
| | - Tiit I Mathiesen
- Department of Neurosurgery, University Hospital of Copenhagen, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - Goetz Benndorf
- Department of Radiology, University Hospital of Copenhagen, Rigshospitalet, Copenhagen, Denmark
- Department of Radiology, Baylor College of Medicine, Houston, TX, USA
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12
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Vasyltsiv R, Qian X, Xu Z, Ryu S, Zhao W, Howansky A. Feasibility of 4D HDR brachytherapy source tracking using x-ray tomosynthesis: Monte Carlo investigation. Med Phys 2023; 50:4695-4709. [PMID: 37402139 DOI: 10.1002/mp.16579] [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: 01/04/2023] [Revised: 05/16/2023] [Accepted: 06/11/2023] [Indexed: 07/05/2023] Open
Abstract
PURPOSE High dose rate (HDR) brachytherapy rapidly delivers dose to targets with steep dose gradients. This treatment method must adhere to prescribed treatment plans with high spatiotemporal accuracy and precision, as failure to do so may degrade clinical outcomes. One approach to achieving this goal is to develop imaging techniques to track HDR sources in vivo in reference to surrounding anatomy. This work investigates the feasibility of using an isocentric C-arm x-ray imager and tomosynthesis methods to track Ir-192 HDR brachytherapy sources in vivo over time (4D). METHODS A tomosynthesis imaging workflow was proposed and its achievable source detectability, localization accuracy, and spatiotemporal resolution were investigated in silico. An anthropomorphic female XCAT phantom was modified to include a vaginal cylinder applicator and Ir-192 HDR source (0.5 × 0.5 × 5.0 mm3 ), and the workflow was carried out using the MC-GPU Monte Carlo image simulation platform. Source detectability was characterized using the reconstructed source signal-difference-to-noise-ratio (SDNR), localization accuracy by the absolute 3D error in its measured centroid location, and spatiotemporal resolution by the full-width-at-half-maximum (FWHM) of line profiles through the source in each spatial dimension considering a maximum C-arm angular velocity of 30° per second. The dependence of these parameters on acquisition angular range (θtot = 0°-90°), number of views, angular increment between views (Δθ = 0°-15°), and volumetric constraints imposed in reconstruction was evaluated. Organ voxel doses were tallied to derive the workflow's attributable effective dose. RESULTS The HDR source was readily detected and its centroid was accurately localized with the proposed workflow and method (SDNR: 10-40, 3D error: 0-0.144 mm). Tradeoffs were demonstrated for various combinations of image acquisition parameters; namely, increasing the tomosynthesis acquisition angular range improved resolution in the depth-encoded direction, for example from 2.5 mm to 1.2 mm between θtot = 30o and θtot = 90o , at the cost of increasing acquisition time from 1 to 3 s. The best-performing acquisition parameters (θtot = 90o , Δθ = 1°) yielded no centroid localization error, and achieved submillimeter source resolution (0.57 × 1.21 × 5.04 mm3 apparent source dimensions, FWHM). The total effective dose for the workflow was 263 µSv for its required pre-treatment imaging component and 7.59 µSv per mid-treatment acquisition thereafter, which is comparable to common diagnostic radiology exams. CONCLUSIONS A system and method for tracking HDR brachytherapy sources in vivo using C-arm tomosynthesis was proposed and its performance investigated in silico. Tradeoffs in source conspicuity, localization accuracy, spatiotemporal resolution, and dose were determined. The results suggest this approach is feasible for localizing an Ir-192 HDR source in vivo with submillimeter spatial resolution, 1-3 second temporal resolution and minimal additional dose burden.
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Affiliation(s)
- Roman Vasyltsiv
- Department of Radiology, Stony Brook University, Health Sciences Center L4-120, Stony Brook, New York, USA
| | - Xin Qian
- Department of Radiation Oncology, Stony Brook University, Health Sciences Center L2, Stony Brook, New York, USA
| | - Zhigang Xu
- Department of Radiation Oncology, Stony Brook University, Health Sciences Center L2, Stony Brook, New York, USA
| | - Samuel Ryu
- Department of Radiation Oncology, Stony Brook University, Health Sciences Center L2, Stony Brook, New York, USA
| | - Wei Zhao
- Department of Radiology, Stony Brook University, Health Sciences Center L4-120, Stony Brook, New York, USA
| | - Adrian Howansky
- Department of Radiology, Stony Brook University, Health Sciences Center L4-120, Stony Brook, New York, USA
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13
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Chen KK, Lin CJ. Estimating Pulsatile Flow Velocity using Four-Dimensional Digital Subtraction Angiography . ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2023; 2023:1-4. [PMID: 38082691 DOI: 10.1109/embc40787.2023.10340843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
Digital subtraction angiography (DSA) is a X-ray based imaging modality for interventional procedures, and remains criterion standard for diagnosing vascular diseases. The imaging protocol of DSA involves administration of a foreign contrast medium into the blood vessel that opacifies the vasculature during the imaging. Using two-dimensional (2D) DSA with high temporal resolution, it was recently demonstrated that the pulsatile velocity can be estimated by evaluating the temporal and spatial variations of the contrast medium distributions in the blood vessel. In this paper, we evaluate the feasibility to estimate the pulsatile flow velocity using the four-dimensional (4D) DSA. To overcome the noise and artefacts of 4D-DSA data, a empirical mode decomposition plus autocorrelation based method is proposed to estimate the pulsatile velocities, and the pulsatile velocities estimated using 2D-DSA are used as reference for comparison.Clinical Relevance-4D-DSA encompasses both structural and temporal information; it theoretically reduces the need of multiple scans, hence reducing the radiation doses. The estimated pulsatile flow velocities open up a new parameter for hemodynamic studies and potential for real-time diagnostic and therapeutic monitoring during interventional procedures.
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14
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Malviya KK, Verma A. Importance of Anatomical Variation of the Hepatic Artery for Complicated Liver and Pancreatic Surgeries: A Review Emphasizing Origin and Branching. Diagnostics (Basel) 2023; 13:diagnostics13071233. [PMID: 37046451 PMCID: PMC10093498 DOI: 10.3390/diagnostics13071233] [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: 01/31/2023] [Revised: 03/21/2023] [Accepted: 03/22/2023] [Indexed: 04/14/2023] Open
Abstract
Knowledge of anatomical variations of the hepatic artery from its origin to intrahepatic segmentation is of utmost importance for planning upper abdominal surgeries including liver transplantation, pancreatoduodenectomy, and biliary reconstruction. The origin and branching pattern of the hepatic artery was thoroughly described by the classification of Michels and Hiatt. Some rare variations of the hepatic artery were classified by Kobayashi and Koops. By the use of the multidetector computed tomography (MDCT) technique, the branching pattern of the hepatic artery can be visualized quite accurately. Unawareness of these arterial variations may lead to intraoperative injuries such as necrosis, abscess, and failure of the liver and pancreas. The origin and course of the aberrant hepatic arteries are crucial in the surgical planning of carcinoma of the head of the pancreas and hepatobiliary surgeries. In liver transplant surgeries, to minimize intraoperative bleeding complications and postoperative thrombosis, exact anatomy of the branching of the hepatic artery, its variations and intrahepatic course is of utmost importance. This review discusses variations in the anatomy of the hepatic artery from its origin to branching by the use of advanced imaging techniques and its effect on the liver, pancreatic, biliary and gastric surgeries.
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Affiliation(s)
- Kapil Kumar Malviya
- Department of Anatomy, Institute of Medical Science, Banaras Hindu University, Varanasi 221005, Uttar Pradesh, India
| | - Ashish Verma
- Department of Radiodiagnosis and Imaging, Institute of Medical Science, Banaras Hindu University, Varanasi 221005, Uttar Pradesh, India
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15
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Cayron AF, Morel S, Allémann E, Bijlenga P, Kwak BR. Imaging of intracranial aneurysms in animals: a systematic review of modalities. Neurosurg Rev 2023; 46:56. [PMID: 36786880 PMCID: PMC9928939 DOI: 10.1007/s10143-023-01953-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 11/28/2022] [Accepted: 01/23/2023] [Indexed: 02/15/2023]
Abstract
Intracranial aneurysm (IA) animal models are paramount to study IA pathophysiology and to test new endovascular treatments. A number of in vivo imaging modalities are available to characterize IAs at different stages of development in these animal models. This review describes existing in vivo imaging techniques used so far to visualize IAs in animal models. We systematically searched for studies containing in vivo imaging of induced IAs in animal models in PubMed and SPIE Digital library databases between 1 January 1945 and 13 July 2022. A total of 170 studies were retrieved and reviewed in detail, and information on the IA animal model, the objective of the study, and the imaging modality used was collected. A variety of methods to surgically construct or endogenously induce IAs in animals were identified, and 88% of the reviewed studies used surgical methods. The large majority of IA imaging in animals was performed for 4 reasons: basic research for IA models, testing of new IA treatment modalities, research on IA in vivo imaging of IAs, and research on IA pathophysiology. Six different imaging techniques were identified: conventional catheter angiography, computed tomography angiography, magnetic resonance angiography, hemodynamic imaging, optical coherence tomography, and fluorescence imaging. This review presents and discusses the advantages and disadvantages of all in vivo IA imaging techniques used in animal models to help future IA studies finding the most appropriate IA imaging modality and animal model to answer their research question.
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Affiliation(s)
- Anne F Cayron
- Department of Pathology and Immunology, Faculty of Medicine, University of Geneva, Rue Michel-Servet 1, CH-1211, Geneva, Switzerland
- Geneva Center for Inflammation Research, Faculty of Medicine, University of Geneva, Geneva, Switzerland
- School of Pharmaceutical Sciences, University of Geneva, Geneva, Switzerland
- Institute of Pharmaceutical Sciences of Western Switzerland, University of Geneva, Geneva, Switzerland
| | - Sandrine Morel
- Department of Pathology and Immunology, Faculty of Medicine, University of Geneva, Rue Michel-Servet 1, CH-1211, Geneva, Switzerland
- Geneva Center for Inflammation Research, Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Department of Clinical Neurosciences - Division of Neurosurgery, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Eric Allémann
- School of Pharmaceutical Sciences, University of Geneva, Geneva, Switzerland
- Institute of Pharmaceutical Sciences of Western Switzerland, University of Geneva, Geneva, Switzerland
| | - Philippe Bijlenga
- Department of Clinical Neurosciences - Division of Neurosurgery, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Brenda R Kwak
- Department of Pathology and Immunology, Faculty of Medicine, University of Geneva, Rue Michel-Servet 1, CH-1211, Geneva, Switzerland.
- Geneva Center for Inflammation Research, Faculty of Medicine, University of Geneva, Geneva, Switzerland.
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16
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Xiang W, Yan L, Zhao Y, Yang M, Bai S, Ma L, Pan L. Four-dimensional digital subtraction angiography to assess cerebral arteriovenous malformations. J Neuroimaging 2023; 33:67-72. [PMID: 36305629 DOI: 10.1111/jon.13065] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 10/13/2022] [Accepted: 10/13/2022] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND AND PURPOSE The performance of a novel prototype four-dimensional (4D) digital subtraction angiography (DSA) for cerebral arteriovenous malformation (AVM) diagnosis was evaluated and compared with that of two-dimensional (2D) and three-dimensional (3D) DSA. METHODS In this retrospective study, 37 consecutive cerebral AVM patients were included. The standard diagnostic results were concluded from the 2D and 3D DSA. Two 4D DSA volumes were reconstructed for each patient by a commercial and a prototype software, then evaluated by two independent experienced neurosurgeons, who were blinded to the diagnosis and treatment process. The evaluation results were compared with the diagnostic results on Spetzler-Martin (SM) Grading Scale, number of feeding arteries, number of draining veins, and intranidal aneurysms. RESULTS Complete agreement was achieved between 4D DSA and 2D and 3D DSA in SM Grading Scale and intracranial aneurysm identification (agreement coefficient: 1) for both reviewers. The agreement coefficients were .888 and .917 for both reviewers in feeding artery number determination using 4D DSA product and 4D DSA prototype, respectively. The agreement coefficients in draining vein number determination were all larger than .94 for both reviewers using both 4D DSA volumes. CONCLUSIONS The performance of this prototype 4D DSA in cerebral AVMs diagnosis was largely equivalent to that of 2D and 3D DSA combination. Four-dimensional DSA can be regarded as a very good complement for 2D DSA in cerebral AVM diagnosis.
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Affiliation(s)
- Weichu Xiang
- Department of Neurosurgery, General Hospital of Central Theater Command, Wuhan, China
| | - Linhai Yan
- Department of Neurosurgery, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Yueyuan Zhao
- Department of Neurosurgery, General Hospital of Central Theater Command, Wuhan, China
| | - Ming Yang
- Department of Neurosurgery, General Hospital of Central Theater Command, Wuhan, China
| | - Sanli Bai
- Department of Neurosurgery, General Hospital of Central Theater Command, Wuhan, China
| | - Lianting Ma
- Department of Neurosurgery, General Hospital of Central Theater Command, Wuhan, China
| | - Li Pan
- Department of Neurosurgery, General Hospital of Central Theater Command, Wuhan, China
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17
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El Hadji S, Bonilauri A, De Momi E, Castana L, Macera A, Berta L, Cardinale F, Baselli G. Validation of SART 3.5D algorithm for cerebrovascular dynamics and artery versus vein classification in presurgical 3D digital subtraction angiographies. Phys Med Biol 2022; 67. [DOI: 10.1088/1361-6560/ac8c7f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 08/24/2022] [Indexed: 11/12/2022]
Abstract
Abstract
Classification of arteries and veins in cerebral angiograms can increase the safety of neurosurgical procedures, such as StereoElectroEncephaloGraphy, and aid the diagnosis of vascular pathologies, as arterovenous malformations. We propose a new method for vessel classification using the contrast medium dynamics in rotational digital subtraction angiography (DSA). After 3D DSA and angiogram segmentation, contrast enhanced projections are processed to suppress soft tissue and bone structures attenuation effect and further enhance the CM flow. For each voxel labelled as vessel, a time intensity curve (TIC) is obtained as a linear combination of temporal basis functions whose weights are addressed by simultaneous algebraic reconstruction technique (SART 3.5D), expanded to include dynamics. Each TIC is classified by comparing the areas under the curve in the arterial and venous phases. Clustering is applied to optimize the classification thresholds. On a dataset of 60 patients, a median value of sensitivity (90%), specificity (91%), and accuracy (92%) were obtained with respect to annotated arterial and venous voxels up to branching order 4–5. Qualitative results are also presented about CM arrival time mapping and its distribution in arteries and veins respectively. In conclusion, this study shows a valuable impact, at no protocol extra-cost or invasiveness, concerning surgical planning related to the enhancement of arteries as major organs at risk. Also, it opens a new scope on the pathophysiology of cerebrovascular dynamics and its anatomical relationships.
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18
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Frisken S, Haouchine N, Du R, Golby AJ. Using temporal and structural data to reconstruct 3D cerebral vasculature from a pair of 2D digital subtraction angiography sequences. Comput Med Imaging Graph 2022; 99:102076. [PMID: 35636377 PMCID: PMC10801782 DOI: 10.1016/j.compmedimag.2022.102076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 02/28/2022] [Accepted: 05/05/2022] [Indexed: 11/24/2022]
Abstract
PURPOSE The purpose of this work is to present a new method for reconstructing patient-specific three-dimensional (3D) vasculature of the brain from a pair of digital subtraction angiography (DSA) image sequences from different viewpoints, e.g., from bi-plane angiography. Our long-term goal is to provide high resolution visualization of 3D vasculature with dynamic flow of contrast agent from limited data that is readily available during surgical procedures. The proposed method is the second of a three-stage process composed of 1) augmenting vessel segmentation with vessel radii and timing of the arrival of a bolus of contrast agent, 2) reconstructing a volumetric representation of the augmented vessel data from the augmented 2D segmentations, and 3) generating a 3D model of vessels and flow of contrast agent from the volumetric reconstruction. Unlike previous methods, which are either limited to relatively simple vessel structures or rely on multiple views and/or prior models of the vasculature, our method requires only a single pair of 2D DSA sequences taken from different view directions. METHODS We developed a new mathematical algorithm that augments vessel centerlines with vessel radii and bolus arrival times derived directly from the 2D DSA sequences to constrain the 3D reconstruction. We validated this method on digital phantoms derived from clinical data and from fractal models of branching tree structures. RESULTS In standard reconstruction methods, reconstruction by projection of two views into 3D space results in 'ghosting' artifacts, i.e., false 3D structure that occurs where vessels or vessel segments overlap in the 2D images. For the complex vascular of the brain, this ghosting is severe and is a major hurdle for methods that attempt to generate 3D structure from 2D images. We show that our approach reduces ghosting by up to 99% in digital phantoms derived from clinical data. CONCLUSION Our dramatic reduction in ghosting artifacts in 3D reconstructions from a pair of 2D image sequences is an important step towards generating high resolution 3D vasculature with dynamic flow information from a single DSA sequence acquired using bi-plane angiography.
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Affiliation(s)
- Sarah Frisken
- Department of Radiology, Brigham and Women's Hospital, United States; Harvard Medical School, United States.
| | - Nazim Haouchine
- Department of Radiology, Brigham and Women's Hospital, United States; Harvard Medical School, United States
| | - Rose Du
- Department of Radiology, Brigham and Women's Hospital, United States; Department of Neurosurgery, Brigham and Women's Hospital, United States; Harvard Medical School, United States
| | - Alexandra J Golby
- Department of Radiology, Brigham and Women's Hospital, United States; Department of Neurosurgery, Brigham and Women's Hospital, United States; Harvard Medical School, United States
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19
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Uchiyama Y, Fujimura S, Takao H, Ono H, Katayama K, Suzuki T, Ishibashi T, Otani K, Karagiozov K, Fukudome K, Murayama Y, Yamamoto M. Extraction of patient-specific boundary conditions from 4D-DSA and their influence on CFD simulations of cerebral aneurysms. Comput Methods Biomech Biomed Engin 2022; 25:1222-1234. [PMID: 35195493 DOI: 10.1080/10255842.2021.2005035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
We developed a new technique for extracting patient-specific inflow conditions, such as the pulse cycle duration and blood flow velocity, from four-dimensional digital subtraction angiography images and experimentally examined its validity. The maximum error between the values extracted by the technique and measured values was 14.3%. We performed blood flow simulations and calculated representative haemodynamic parameters. The maximum differences between the parameters obtained using general and patient-specific inflow conditions were approximately 400%, 150%, and 50% for the velocity, normalised wall shear stress, and pressure loss coefficient, respectively. These results indicate that patient-specific conditions are critical for accurately reproducing aneurysmal haemodynamics.
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Affiliation(s)
- Yuya Uchiyama
- Graduate School of Mechanical Engineering, Tokyo University of Science, Tokyo, Japan.,Department of Innovation for Medical Information Technology, The Jikei University School of Medicine, Tokyo, Japan
| | - Soichiro Fujimura
- Department of Innovation for Medical Information Technology, The Jikei University School of Medicine, Tokyo, Japan.,Department of Mechanical Engineering, Tokyo University of Science, Tokyo, Japan
| | - Hiroyuki Takao
- Graduate School of Mechanical Engineering, Tokyo University of Science, Tokyo, Japan.,Department of Innovation for Medical Information Technology, The Jikei University School of Medicine, Tokyo, Japan.,Department of Neurosurgery, The Jikei University School of Medicine, Tokyo, Japan
| | - Hiroshi Ono
- Department of Innovation for Medical Information Technology, The Jikei University School of Medicine, Tokyo, Japan
| | - Keigo Katayama
- Graduate School of Mechanical Engineering, Tokyo University of Science, Tokyo, Japan
| | - Takashi Suzuki
- Department of Innovation for Medical Information Technology, The Jikei University School of Medicine, Tokyo, Japan.,Siemens Healthcare Japan K.K., Tokyo, Japan
| | - Toshihiro Ishibashi
- Department of Neurosurgery, The Jikei University School of Medicine, Tokyo, Japan
| | - Katharina Otani
- Department of Neurosurgery, The Jikei University School of Medicine, Tokyo, Japan.,Siemens Healthcare Japan K.K., Tokyo, Japan
| | - Kostadin Karagiozov
- Department of Neurosurgery, The Jikei University School of Medicine, Tokyo, Japan
| | - Koji Fukudome
- Department of Mechanical Engineering, Tokyo University of Science, Tokyo, Japan
| | - Yuichi Murayama
- Department of Neurosurgery, The Jikei University School of Medicine, Tokyo, Japan
| | - Makoto Yamamoto
- Department of Mechanical Engineering, Tokyo University of Science, Tokyo, Japan
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Maupu C, Lebas H, Boulaftali Y. Imaging Modalities for Intracranial Aneurysm: More Than Meets the Eye. Front Cardiovasc Med 2022; 9:793072. [PMID: 35242823 PMCID: PMC8885801 DOI: 10.3389/fcvm.2022.793072] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 01/17/2022] [Indexed: 11/21/2022] Open
Abstract
Intracranial aneurysms (IA) are often asymptomatic and have a prevalence of 3 to 5% in the adult population. The risk of IA rupture is low, however when it occurs half of the patients dies from subarachnoid hemorrhage (SAH). To avoid this fatal evolution, the main treatment is an invasive surgical procedure, which is considered to be at high risk of rupture. This risk score of IA rupture is evaluated mainly according to its size and location. Therefore, angiography and anatomic imaging of the intracranial aneurysm are crucial for its diagnosis. Moreover, it has become obvious in recent years that several other factors are implied in this complication, such as the blood flow complexity or inflammation. These recent findings lead to the development of new IA imaging tools such as vessel wall imaging, 4D-MRI, or molecular MRI to visualize inflammation at the site of IA in human and animal models. In this review, we will summarize IA imaging techniques used for the patients and those currently in development.
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Fahrig R, Jaffray DA, Sechopoulos I, Webster Stayman J. Flat-panel conebeam CT in the clinic: history and current state. J Med Imaging (Bellingham) 2021; 8:052115. [PMID: 34722795 DOI: 10.1117/1.jmi.8.5.052115] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 09/27/2021] [Indexed: 11/14/2022] Open
Abstract
Research into conebeam CT concepts began as soon as the first clinical single-slice CT scanner was conceived. Early implementations of conebeam CT in the 1980s focused on high-contrast applications where concurrent high resolution ( < 200 μ m ), for visualization of small contrast-filled vessels, bones, or teeth, was an imaging requirement that could not be met by the contemporaneous CT scanners. However, the use of nonlinear imagers, e.g., x-ray image intensifiers, limited the clinical utility of the earliest diagnostic conebeam CT systems. The development of consumer-electronics large-area displays provided a technical foundation that was leveraged in the 1990s to first produce large-area digital x-ray detectors for use in radiography and then compact flat panels suitable for high-resolution and high-frame-rate conebeam CT. In this review, we show the concurrent evolution of digital flat panel (DFP) technology and clinical conebeam CT. We give a brief summary of conebeam CT reconstruction, followed by a brief review of the correction approaches for DFP-specific artifacts. The historical development and current status of flat-panel conebeam CT in four clinical areas-breast, fixed C-arm, image-guided radiation therapy, and extremity/head-is presented. Advances in DFP technology over the past two decades have led to improved visualization of high-contrast, high-resolution clinical tasks, and image quality now approaches the soft-tissue contrast resolution that is the standard in clinical CT. Future technical developments in DFPs will enable an even broader range of clinical applications; research in the arena of flat-panel CT shows no signs of slowing down.
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Affiliation(s)
- Rebecca Fahrig
- Innovation, Advanced Therapies, Siemens Healthcare GmbH, Forchheim, Germany.,Friedrich-Alexander Universitat, Department of Computer Science 5, Erlangen, Germany
| | - David A Jaffray
- MD Anderson Cancer Center, Departments of Radiation Physics and Imaging Physics, Houston, Texas, United States
| | - Ioannis Sechopoulos
- Radboud University Medical Center, Department of Medical Imaging, Nijmegen, The Netherlands.,Dutch Expert Center for Screening (LRCB), Nijmegen, The Netherlands.,University of Twente, Technical Medical Center, Enschede, The Netherlands
| | - J Webster Stayman
- Johns Hopkins University, Department of Biomedical Engineering, Baltimore, Maryland, United States
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22
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Saatci I, Cekirge HS. 4D DSA: technical addition or big revolution? J Neurointerv Surg 2021; 13:977-978. [PMID: 34172485 DOI: 10.1136/neurintsurg-2021-017669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/14/2021] [Indexed: 11/04/2022]
Affiliation(s)
- Isil Saatci
- Radiology, Koru Health Group, Ankara, Turkey
| | - H Saruhan Cekirge
- Radiology, Koru Health Group, Ankara, Turkey.,Private Office, Saruhan Cekirge, Ankara, Turkey
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23
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Hoang VT, Van HAT, Trinh CT, Pham NTT, Huynh C, Ha TN, Huynh PH, Nguyen HQ, Vo UG, Nguyen TT. Uterine Arteriovenous Malformation: A Pictorial Review of Diagnosis and Management. J Endovasc Ther 2021; 28:659-675. [PMID: 34142901 DOI: 10.1177/15266028211025022] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Uterine arteriovenous malformation (UAVM) is a rare condition and is classified as either congenital or acquired UAVM. Patients with UAVMs usually experience miscarriages or recurrent menorrhagia. Ultrasound is used for the initial estimation of UAVMs. Computed tomography and magnetic resonance imaging are noninvasive and valuable methods that provide good compatibility with digital subtraction angiography to support the diagnosis and treatment of UAVM. Timely diagnosis is crucial to provide appropriate treatment for alleviating complications. This article presents a pictorial and literature review of the current evidence of the diagnosis and management of UAVM.
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Affiliation(s)
- Van Trung Hoang
- Department of Radiology, Thien Hanh Hospital, Buon Ma Thuot, Vietnam
| | - Hoang Anh Thi Van
- Department of Radiology, Thien Hanh Hospital, Buon Ma Thuot, Vietnam
| | | | | | - Chinh Huynh
- Department of Radiology, Tu Du Hospital, Ho Chi Minh City, Vietnam
| | - To Nguyen Ha
- Department of Radiology, Tu Du Hospital, Ho Chi Minh City, Vietnam
| | - Phuong Hai Huynh
- Department of Radiology, University Medical Center at Ho Chi Minh City, Vietnam
| | - Hoang Quan Nguyen
- Department of Radiology, Da Nang Oncology Hospital, Da Nang, Vietnam
| | - Uyen Giao Vo
- Department of Vascular Surgery, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
| | - Thanh Thao Nguyen
- Department of Radiology, Hue University of Medicine and Pharmacy, Hue University, Hue, Vietnam
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24
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Chen KK, Lin CJ, Guo WY, Chu WF, Wu YT. Estimating blood flow velocity using time-resolved 3D angiography and a derived physical law of contrast media. Physiol Meas 2021; 42:025007. [PMID: 33498022 DOI: 10.1088/1361-6579/abe022] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Four-dimensional (4D) digital subtraction angiography (DSA) offers a method for evaluating hemodynamics. It is, however, unclear how the delivered contrast medium interacts with the physiological blood flow, and how hemodynamic information may be inferred from the mixture of the contrast medium and blood. In this study, we present a theoretical explanation of contrast dynamics, and an accompanying algorithm for estimating blood flow velocity. APPROACH We retrospectively recruited 23 patients who underwent both 4D DSA and magnetic resonance (MR) phase-contrast imaging. The 4D DSA-reconstructed contrast dynamics were first studied for the internal carotid arteries. Using physical laws governing fluid motion within a curved tube, we showed that the reconstructed contrast dynamics obeyed a simple advection equation. We then proposed an algorithm for estimating the contrast dynamics using angiographic data, and subsequently estimated the axial blood flow velocity using an advection equation. MAIN RESULTS The estimated velocities were compared using three techniques: the Fourier technique, Lin's method, and MR phase contrast. Testing with noise-corrupted artificial data showed that the proposed algorithm was noise resistant. The velocities of 23 patients computed by 4D DSA using the proposed algorithm showed a moderate correlation with the MR phase contrast (r = 0.61), and good correlations with the other two techniques (r = 0.75 and r = 0.72). SIGNIFICANCE The proposed algorithm and has been applied to blood vessel segments with poor signal-to-noise ratios and axial lengths of less than 3 cm, and has a physical basis for computing axial flow velocities using an advection equation. The results of the proposed algorithm are consistent with existing methods.
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Affiliation(s)
- Ko-Kung Chen
- Taipei Veterans General Hospital, Department of Radiology, Taipei, Taiwan
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25
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Ishibashi T, Maruyama F, Kan I, Sano T, Murayama Y. Four-dimensional digital subtraction angiography for exploration of intraosseous arteriovenous fistula in the sphenoid bone. Surg Neurol Int 2021; 12:85. [PMID: 33767889 PMCID: PMC7982113 DOI: 10.25259/sni_858_2020] [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: 11/30/2020] [Accepted: 01/08/2021] [Indexed: 11/04/2022] Open
Abstract
Background Intraosseous arteriovenous fistula (AVF) is a rare clinical entity that typically presents with symptoms from their effect on surrounding structures. Here, we report a case of intraosseous AVF in the sphenoid bone that presented with bilateral abducens palsy. Case Description A previously healthy man presented with tinnitus for 1 month, and initial imaging suspected dural AVF of the cavernous sinus. Four-dimensional digital subtraction angiography (4D-DSA) imaging and a three-dimensional (3D) fused image from the bilateral external carotid arteries revealed that the shunt was in a large venous pouch within the sphenoid bone that was treated through transvenous coil embolization. His symptoms improved the day after surgery. Conclusion This is a case presentation of intraosseous AVF in the sphenoid bone and highlights the importance of 4D-DSA and 3D fused images for planning the treatment strategy.
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Affiliation(s)
- Toshihiro Ishibashi
- Department of Neurosurgery, The Jikei University School of Medicine, Minato-Ku, Tokyo, Japan
| | - Fumiaki Maruyama
- Department of Neurosurgery, The Jikei University School of Medicine, Minato-Ku, Tokyo, Japan
| | - Issei Kan
- Department of Neurosurgery, The Jikei University School of Medicine, Minato-Ku, Tokyo, Japan
| | - Tohru Sano
- Department of Neurosurgery, The Jikei University School of Medicine, Minato-Ku, Tokyo, Japan
| | - Yuichi Murayama
- Department of Neurosurgery, The Jikei University School of Medicine, Minato-Ku, Tokyo, Japan
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26
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Falk KL, Schafer S, Speidel MA, Strother CM. 4D-DSA: Development and Current Neurovascular Applications. AJNR Am J Neuroradiol 2021; 42:214-220. [PMID: 33243899 PMCID: PMC7872169 DOI: 10.3174/ajnr.a6860] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 07/30/2020] [Indexed: 11/07/2022]
Abstract
Originally described by Davis et al in 2013, 4D-Digital Subtraction Angiography (4D-DSA) has developed into a commercially available application of DSA in the angiography suite. 4D-DSA provides the user with 3D time-resolved images, allowing observation of a contrast bolus at any desired viewing angle through the vasculature and at any time point during the acquisition (any view at any time). 4D-DSA mitigates some limitations that are intrinsic to both 2D- and 3D-DSA images. The clinical applications for 4D-DSA include evaluations of AVMs and AVFs, intracranial aneurysms, and atherosclerotic occlusive disease. Recent advances in blood flow quantification using 4D-DSA indicate that these data provide both the velocity and geometric information necessary for the quantification of blood flow. In this review, we will discuss the development, acquisition, reconstruction, and current neurovascular applications of 4D-DSA volumes.
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Affiliation(s)
- K L Falk
- From the School of Medicine and Public Health (K.L.R.)
- Department of Biomedical Engineering (K.L.R.)
| | - S Schafer
- Siemens Healthineers (S.S.), Malvern, Pennsylvania
| | - M A Speidel
- Medical Physics (M.A.S.), University of Wisconsin-Madison, Madison, Wisconsin
| | - C M Strother
- Radiology (C.M.S.), University of Wisconsin-Madison, Madison, Wisconsin
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Settecase F, Rayz VL. Advanced vascular imaging techniques. HANDBOOK OF CLINICAL NEUROLOGY 2021; 176:81-105. [DOI: 10.1016/b978-0-444-64034-5.00016-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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28
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Kato N, Yuki I, Hataoka S, Dahmani C, Otani K, Abe Y, Kakizaki S, Nagayama G, Maruyama F, Ikemura A, Kan I, Kodama T, Ishibashi T, Murayama Y. 4D Digital Subtraction Angiography for the Temporal Flow Visualization of Intracranial Aneurysms and Vascular Malformations. J Stroke Cerebrovasc Dis 2020; 29:105327. [PMID: 32992207 DOI: 10.1016/j.jstrokecerebrovasdis.2020.105327] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 09/08/2020] [Accepted: 09/11/2020] [Indexed: 11/30/2022] Open
Abstract
PURPOSE To assess the benefit and radiation dose of four-dimensional (4D) digital subtraction angiography (DSA) - a time resolved three-dimensional (3D) DSA application - to evaluate the flow and architecture of aneurysms and vascular malformations. METHODS All patients with cerebrovascular disease were considered who underwent 4D-DSA at our institution between January 2015 and February 2016. For the aneurysm patients, we evaluated the image quality in terms of the visualization of contrast flow in the aneurysm on a 3-point scale (excellent, fair and poor). Interrater agreement between two raters was estimated using Cohen's Kappa statistics. For the shunt disease patients, the additional information obtained from the 4D-DSA was described for each disease. The median radiation dose and volume of contrast medium required for the acquisitions were estimated. RESULTS A total of 173 patients underwent 4D-DSA; 126 intracranial aneurysms, 10 arteriovenous malformations (AVM), 15 dural arteriovenous fistula (dAVF) and 22 other diseases. For aneurysm patients, excellent and fair visualization of the intra-aneurysmal flow was observed in 27.7%, 72.3%, and excellent (κ = 0.9) agreement between the raters was found. For AVM and dAVF patients, 4D-DSA clarified the complex vasculature by viewing the discrete time phase of contrast filling. Median radiation dose for intracranial lesions was 79.6 mGy for 6s 4D-DSA, and 175 mGy for 12s 4D-DSA. The median amount of contrast medium used was 18.0 ml for 6s 4D-DSA and 21.0 ml for 12s 4D-DSA. CONCLUSIONS 4D-DSA provided additional information regarding intra-aneurysmal flow and contributed to detect different component of nidus or shunt points.
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Affiliation(s)
- Naoki Kato
- Department of Neurosurgery, The Jikei University School of Medicine Tokyo, 3-25-8, Nishi-shinbashi, Minato-ku, Tokyo 105-8461, Japan.
| | - Ichiro Yuki
- Department of Neurosurgery, The Jikei University School of Medicine Tokyo, 3-25-8, Nishi-shinbashi, Minato-ku, Tokyo 105-8461, Japan; Department of Neurosurgery, University California Irvine School of Medicine, California, USA.
| | - Shunsuke Hataoka
- Department of Neurosurgery, The Jikei University School of Medicine Tokyo, 3-25-8, Nishi-shinbashi, Minato-ku, Tokyo 105-8461, Japan; Department of Neurosurgery, National Hospital Organization Yokohama Medical Center, Kanagawa, Japan.
| | - Chihebeddine Dahmani
- Technology Excellence, Mechatronic Products, Technology & Innovation, Siemens Healthcare GmbH, Allee am Röthelheimpark 15, Erlangen, Germany.
| | - Katharina Otani
- AT Innovation Department, Siemens Healthcare K.K., Gate City West Tower, 1-11-1 Osaki, Shinagawa-ku, Tokyo, Japan.
| | - Yukiko Abe
- Department of Radiology, The Jikei University Hospital, Tokyo, Japan.
| | - Shota Kakizaki
- Department of Neurosurgery, The Jikei University School of Medicine Tokyo, 3-25-8, Nishi-shinbashi, Minato-ku, Tokyo 105-8461, Japan.
| | - Gota Nagayama
- Department of Neurosurgery, The Jikei University School of Medicine Tokyo, 3-25-8, Nishi-shinbashi, Minato-ku, Tokyo 105-8461, Japan.
| | - Fumiaki Maruyama
- Department of Neurosurgery, The Jikei University School of Medicine Tokyo, 3-25-8, Nishi-shinbashi, Minato-ku, Tokyo 105-8461, Japan.
| | - Ayako Ikemura
- Department of Neurosurgery, The Jikei University School of Medicine Tokyo, 3-25-8, Nishi-shinbashi, Minato-ku, Tokyo 105-8461, Japan.
| | - Issei Kan
- Department of Neurosurgery, The Jikei University School of Medicine Tokyo, 3-25-8, Nishi-shinbashi, Minato-ku, Tokyo 105-8461, Japan.
| | - Tomonobu Kodama
- Department of Neurosurgery, The Jikei University School of Medicine Tokyo, 3-25-8, Nishi-shinbashi, Minato-ku, Tokyo 105-8461, Japan.
| | - Toshihiro Ishibashi
- Department of Neurosurgery, The Jikei University School of Medicine Tokyo, 3-25-8, Nishi-shinbashi, Minato-ku, Tokyo 105-8461, Japan.
| | - Yuichi Murayama
- Department of Neurosurgery, The Jikei University School of Medicine Tokyo, 3-25-8, Nishi-shinbashi, Minato-ku, Tokyo 105-8461, Japan.
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29
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Yu JF, Pung L, Minami H, Mueller K, Khangura R, Darflinger R, Hetts SW, Cooke DL. Virtual 2D angiography from four-dimensional digital subtraction angiography (4D-DSA): A feasibility study. Interv Neuroradiol 2020; 27:307-313. [PMID: 32985291 DOI: 10.1177/1591019920961604] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Digital subtraction angiography (DSA) remains the gold standard for angiographic evaluation of cerebrovascular pathology, however, multiple acquisitions requiring additional time and radiation are often needed. In contrast, 3D-DSA provides volumetric information from a single injection but neglects temporal information. Four-dimensional-DSA (4D-DSA) combines temporal information of 2D-DSA with volumetric information of 3D-DSA to provide time-resolved tomographic 3D reconstructions, potentially reducing procedure time and radiation. This work evaluates the diagnostic quality of virtual single-frame 4D-DSA relative to 2D-DSA images by assessing clinicians' ability to evaluate cerebrovascular pathology. METHODS Single-frame images of four projections from 4D-DSA and their corresponding 2D-DSA images (n = 15) were rated by two neurointerventional radiologists. Images were graded based on diagnostic quality (0 = non-diagnostic, 1 = poor, 2 = acceptable, 3 = good). Dose area product (DAP) for each case was recorded for all 2D-DSA, 4D-DSA acquisitions, and the overall procedure. RESULTS The mean diagnostic quality of all four 4D-DSA projections from both raters was 1.75 while the mean of 2D-DSA projections was 2.8. Student's t-test revealed significant difference in diagnostic quality between 4D-DSA and 2D-DSA at all four projections (p < 0.001). On average 4D-DSA acquisitions accounted for 30% dose compared to the overall average aggregated dose per procedure. CONCLUSIONS The difference in image quality between virtual single-frame 4D-DSA and their respective 2D-DSA images is statistically significant. Furthermore, 4D-DSA acquisitions require less radiation dose than conventional procedures with 2D-DSA acquisitions.
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Affiliation(s)
- Jay F Yu
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA
| | - Leland Pung
- Siemens Medical Solutions Inc., Malvern, PA, USA
| | | | | | - Rajkamal Khangura
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA
| | - Robert Darflinger
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA
| | - Steven W Hetts
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA
| | - Daniel L Cooke
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA
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Meram E, Shaughnessy G, Longhurst C, Hoffman C, Wagner M, Mistretta CA, Speidel MA, Laeseke PF. Optimization of quantitative time-resolved 3D (4D) digital subtraction angiography in a porcine liver model. Eur Radiol Exp 2020; 4:37. [PMID: 32613472 PMCID: PMC7329977 DOI: 10.1186/s41747-020-00164-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 04/30/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Time-resolved three-dimensional digital subtraction angiography (4D-DSA) can be used to quantify blood velocity. Contrast pulsatility, a major discriminant on 4D-DSA, is yet to be optimized. We investigated the effects of different imaging and injection parameters on sideband ratio (SBR), a measure of contrast pulsatile strength, within the hepatic vasculature of an in vivo porcine model. METHODS Fifty-nine hepatic 4D-DSA procedures were performed in three female domestic swine (mean weight 54 kg). Contrast injections were performed in the common hepatic artery with different combinations of imaging duration (6 s or 12 s), injection rates (from 1.0 to 2.5 mL/s), contrast concentration (50% or 100%), and catheter size (4 Fr or 5 Fr). Reflux was recorded. SBR and vessel cross-sectional areas were calculated in 289 arterial segments. Multiple linear mixed-effects models were estimated to determine the effects of parameters on SBR and cross-sectional vessel area. RESULTS Twelve-second acquisitions yielded a SBR higher than 6 s (p < 0.001). No significant differences in SBR were seen between different catheter sizes (p = 0.063) or contrast concentration (p = 0.907). For higher injection rates (2.5 mL/s), SBR was lower (p = 0.007) and cross-sectional area was higher (p < 0.001). Reflux of contrast does not significantly affect SBR (p = 0.087). CONCLUSIONS The strength of contrast pulsatility used for flow quantitation with 4D-DSA can be increased by adjusting injection rates and using longer acquisition times. Reduction of contrast concentration to 50% is feasible and reflux of contrast does not significantly hinder contrast pulsatility.
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Affiliation(s)
- Ece Meram
- Department of Radiology, University of Wisconsin-Madison, Madison, WI, USA.
| | - Gabe Shaughnessy
- Department of Medical Physics, University of Wisconsin-Madison, Madison, WI, USA
| | - Colin Longhurst
- Department of Biostatistics and Medical Informatics, University of Wisconsin-Madison, Madison, WI, USA
| | - Carson Hoffman
- Department of Medical Physics, University of Wisconsin-Madison, Madison, WI, USA
| | - Martin Wagner
- Department of Medical Physics, University of Wisconsin-Madison, Madison, WI, USA
| | - Charles A Mistretta
- Department of Radiology, University of Wisconsin-Madison, Madison, WI, USA.,Department of Medical Physics, University of Wisconsin-Madison, Madison, WI, USA
| | - Michael A Speidel
- Department of Medical Physics, University of Wisconsin-Madison, Madison, WI, USA
| | - Paul F Laeseke
- Department of Radiology, University of Wisconsin-Madison, Madison, WI, USA.,Section of Interventional Radiology, University of Wisconsin-Madison, Madison, WI, USA
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Clarençon F, Lenck S, Shotar E, Boch AL, Lefevre E, Premat K, Amador MDM, Sourour NA. Four-dimensional digital subtraction angiography for exploration of spinal cord vascular malformations: preliminary experience. J Neurointerv Surg 2020; 13:69-74. [PMID: 32586909 DOI: 10.1136/neurintsurg-2020-015909] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 05/07/2020] [Accepted: 05/12/2020] [Indexed: 11/03/2022]
Abstract
BACKGROUND The precise understanding of the angioarchitecture of spinal vascular malformations (SVMs) is often difficult to reach with conventional digital subtraction angiography (DSA). The purpose of our study was to evaluate the potential of four-dimensional DSA (4D-DSA) (Siemens Healthcare) in the exploration of SVMs. METHODS We retrospectively studied all patients who underwent spinal DSA, including 4D-DSA acquisition, from July 2018 to June 2019 at a single institution. All spinal DSA acquisitions were performed under general anesthesia. 4D-DSA acquisitions were acquired with the protocol '12 s DSA Dyna4D Neuro'. 12 mL of iodixanol 320 mg iodine/mL were injected via a 5 F catheter (1 mL/s during the 12 s 4D-DSA acquisition). Inter-rater (three independent reviewers) and intermodality agreements were assessed. RESULTS Nine consecutive patients (six men, three women, mean age 55.3±19.8 years) with 10 SVMs (spinal dural arteriovenous fistulas n=3, spinal epidural arteriovenous fistulas n=2, spinal pial arteriovenous fistulas n=2, and spinal arteriovenous malformations n=2; one patient had two synchronous pial fistulas) had spinal DSA, including 4D-DSA acquisition. Inter-rater agreement was good and moderate for the venous drainage pattern and the SVM subtype, respectively. In 9 of 10 cases, the quality of the acquisition was graded as good. Satisfactory concordance between 4D-DSA and the selective microcatheterization was observed in 90% of cases for the location of the shunt point. CONCLUSION 4D-DSA acquisition may be helpful for a better understanding of the angioarchitecture of SVMs. Larger series are warranted to confirm these preliminary results.
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Affiliation(s)
- Frédéric Clarençon
- Sorbonne Université, Paris, Île-de-France, France .,Neuroradiology, Hôpital Universitaire Pitié Salpêtrière, Paris, Île-de-France, France
| | - Stéphanie Lenck
- Neuroradiology, Hôpital Universitaire Pitié Salpêtrière, Paris, Île-de-France, France
| | - Eimad Shotar
- Neuroradiology, Hôpital Universitaire Pitié Salpêtrière, Paris, Île-de-France, France
| | - Anne-Laure Boch
- Neurosurgery, Hôpital Universitaire Pitié-Salpêtrière, Paris, Île-de-France, France
| | - Etienne Lefevre
- Sorbonne Université, Paris, Île-de-France, France.,Neurosurgery, Hôpital Universitaire Pitié-Salpêtrière, Paris, Île-de-France, France
| | - Kevin Premat
- Sorbonne Université, Paris, Île-de-France, France.,Neuroradiology, Hôpital Universitaire Pitié Salpêtrière, Paris, Île-de-France, France
| | - Maria Del Mar Amador
- Neurology, Hôpital Universitaire Pitié-Salpêtrière, Paris, Île-de-France, France
| | - Nader-Antoine Sourour
- Neuroradiology, Hôpital Universitaire Pitié Salpêtrière, Paris, Île-de-France, France
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Falk KL, Harvey EC, Schafer S, Speidel MA, Strother CM. Optimizing the Quality of 4D-DSA Temporal Information. AJNR Am J Neuroradiol 2019; 40:2124-2129. [PMID: 31672837 PMCID: PMC6975361 DOI: 10.3174/ajnr.a6290] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2019] [Accepted: 09/03/2019] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Quantification of blood flow using a 4D-DSA would be useful in the diagnosis and treatment of cerebrovascular diseases. A protocol optimizing identification of density variations in the time-density curves of a 4D-DSA has not been defined. Our purpose was to determine the contrast injection protocol most likely to result in the optimal pulsatility signal strength. MATERIALS AND METHODS Two 3D-printed patient-specific models were used and connected to a pulsatile pump and flow system, which delivered 250-260 mL/min to the model. Contrast medium (Isovue, 370 mg I/mL, 75% dilution) was injected through a 6F catheter positioned upstream from the inlet of the model. 4D-DSA acquisitions were performed for the following injection rates: 1.5, 2.0, 2.5, 3.0 and 3.5 mL/s for 8 seconds. To determine pulsatility, we analyzed the time-density curve at the inlets using the oscillation amplitude and a previously described numeric metric, the sideband ratio. Vascular geometry from 4D-DSA reconstructions was compared with ground truth and micro-CT measurements of the model. Dimensionless numbers that characterize hemodynamics, Reynolds and Craya-Curtet, were calculated for each injection rate. RESULTS The strongest pulsatility signal occurred with the 2.5 mL/s injections. The largest oscillation amplitudes were found with 2.0- and 2.5-mL/s injections. Geometric accuracy was best preserved with injection rates of >1.5 mL/s. CONCLUSIONS An injection rate of 2.5 mL/s provided the strongest pulsatility signal in the 4D-DSA time-density curve. Geometric accuracy was best preserved with injection rates above 1.5 mL/s. These results may be useful in future in vivo studies of blood flow quantification.
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Affiliation(s)
- K L Falk
- From the Department of Biomedical Engineering (K.L.R.)
| | - E C Harvey
- Department of Medical Physics (E.H., M.A.S.)
| | - S Schafer
- Siemens Healthineers Forchheim Germany (S.S.), Hoffman Estates, Illinois
| | - M A Speidel
- Department of Medical Physics (E.H., M.A.S.)
| | - C M Strother
- Department of Radiology (C.M.S.), University of Wisconsin-Madison, Madison, Wisconsin
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Hoelter P, Goelitz P, Lang S, Luecking H, Kalmuenzer B, Struffert T, Doerfler A. Visualization of large vessel occlusion, clot extent, and collateral supply using volume perfusion flat detector computed tomography in acute stroke patients. Acta Radiol 2019; 60:1504-1511. [PMID: 30862169 DOI: 10.1177/0284185119836220] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Philip Hoelter
- Department of Neuroradiology, University Hospital Erlangen, Erlangen, Germany
| | - Philipp Goelitz
- Department of Neuroradiology, University Hospital Erlangen, Erlangen, Germany
| | - Stefan Lang
- Department of Neuroradiology, University Hospital Erlangen, Erlangen, Germany
| | - Hannes Luecking
- Department of Neuroradiology, University Hospital Erlangen, Erlangen, Germany
| | - Bernd Kalmuenzer
- Department of Neurology, University Hospital Erlangen, Erlangen, Germany
| | - Tobias Struffert
- Department of Neuroradiology, University Hospital Erlangen, Erlangen, Germany
| | - Arnd Doerfler
- Department of Neuroradiology, University Hospital Erlangen, Erlangen, Germany
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Change in Perfusion Angiography During Transcatheter Arterial Chemoembolization for Hepatocellular Carcinoma Predicts Short-Term Outcomes. AJR Am J Roentgenol 2019; 213:746-754. [DOI: 10.2214/ajr.18.20499] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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Lang S, Hoelter P, Birkhold AI, Schmidt M, Endres J, Strother C, Doerfler A, Luecking H. Quantitative and Qualitative Comparison of 4D-DSA with 3D-DSA Using Computational Fluid Dynamics Simulations in Cerebral Aneurysms. AJNR Am J Neuroradiol 2019; 40:1505-1510. [PMID: 31467234 DOI: 10.3174/ajnr.a6172] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Accepted: 07/01/2019] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE 4D-DSA allows time-resolved 3D imaging of the cerebral vasculature. The aim of our study was to evaluate this method in comparison with the current criterion standard 3D-DSA by qualitative and quantitative means using computational fluid dynamics. MATERIALS AND METHODS 3D- and 4D-DSA datasets were acquired in patients with cerebral aneurysms. Computational fluid dynamics analysis was performed for all datasets. Using computational fluid dynamics, we compared 4D-DSA with 3D-DSA in terms of both aneurysmal geometry (quantitative: maximum diameter, ostium size [OZ1/2], volume) and hemodynamic parameters (qualitative: flow stability, flow complexity, inflow concentration; quantitative: average/maximum wall shear stress, impingement zone, low-stress zone, intra-aneurysmal pressure, and flow velocity). Qualitative parameters were descriptively analyzed. Correlation coefficients (r, P value) were calculated for quantitative parameters. RESULTS 3D- and 4D-DSA datasets of 10 cerebral aneurysms in 10 patients were postprocessed. Evaluation of aneurysmal geometry with 4D-DSA (r maximum diameter = 0.98, P maximum diameter <.001; r OZ1/OZ2 = 0.98/0.86, P OZ1/OZ2 < .001/.002; r volume = 0.98, P volume <.001) correlated highly with 3D-DSA. Evaluation of qualitative hemodynamic parameters (flow stability, flow complexity, inflow concentration) did show complete accordance, and evaluation of quantitative hemodynamic parameters (r average/maximum wall shear stress diastole = 0.92/0.88, P average/maximum wall shear stress diastole < .001/.001; r average/maximum wall shear stress systole = 0.94/0.93, P average/maximum wall shear stress systole < .001/.001; r impingement zone = 0.96, P impingement zone < .001; r low-stress zone = 1.00, P low-stress zone = .01; r pressure diastole = 0.84, P pressure diastole = .002; r pressure systole = 0.9, P pressure systole < .001; r flow velocity diastole = 0.95, P flow velocity diastole < .001; r flow velocity systole = 0.93, P flow velocity systole < .001) did show nearly complete accordance between 4D- and 3D-DSA. CONCLUSIONS Despite a different injection protocol, 4D-DSA is a reliable basis for computational fluid dynamics analysis of the intracranial vasculature and provides equivalent visualization of aneurysm geometry compared with 3D-DSA.
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Affiliation(s)
- S Lang
- From the Department of Neuroradiology (S.L., P.H., M.S., J.E., A.D., H.L.), University of Erlangen-Nuremberg, Erlangen, Germany
| | - P Hoelter
- From the Department of Neuroradiology (S.L., P.H., M.S., J.E., A.D., H.L.), University of Erlangen-Nuremberg, Erlangen, Germany
| | - A I Birkhold
- Siemens Healthcare GmbH (A.I.B.), Erlangen, Germany
| | - M Schmidt
- From the Department of Neuroradiology (S.L., P.H., M.S., J.E., A.D., H.L.), University of Erlangen-Nuremberg, Erlangen, Germany
| | - J Endres
- From the Department of Neuroradiology (S.L., P.H., M.S., J.E., A.D., H.L.), University of Erlangen-Nuremberg, Erlangen, Germany
| | - C Strother
- Department of Radiology (C.S.), Clinical Sciences Center, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - A Doerfler
- From the Department of Neuroradiology (S.L., P.H., M.S., J.E., A.D., H.L.), University of Erlangen-Nuremberg, Erlangen, Germany
| | - H Luecking
- From the Department of Neuroradiology (S.L., P.H., M.S., J.E., A.D., H.L.), University of Erlangen-Nuremberg, Erlangen, Germany
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Quantitative 4D-Digital Subtraction Angiography to Assess Changes in Hepatic Arterial Flow during Transarterial Embolization: A Feasibility Study in a Swine Model. J Vasc Interv Radiol 2019; 30:1286-1292. [PMID: 31160194 DOI: 10.1016/j.jvir.2019.01.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Revised: 01/10/2019] [Accepted: 01/12/2019] [Indexed: 11/22/2022] Open
Abstract
PURPOSE To determine the feasibility of using time-resolved 3D-digital subtraction angiography (4D-DSA) for quantifying changes in hepatic arterial blood flow and velocity during transarterial embolization. MATERIALS AND METHODS Hepatic arteriography and selective transarterial embolization were performed in 4 female domestic swine (mean weight, 54 kg) using 100-300-μm microspheres. Conventional 2D and 4D-DSA were performed before, during, and after each embolization. From the 4D-DSA reconstructions, blood flow and velocity values were calculated for hepatic arterial branches using a pulsatility-based algorithm. 4D-DSA velocity values were compared to those measured using an intravascular Doppler wire with a linear regression analysis. Paired t-tests were used to compare data before and after embolization. RESULTS There was a weak-to-moderate but statistically significant correlation of flow velocities measured with 4D-DSA and the Doppler wire (r = 0.35, n = 39, P = .012). For vessels with high pulsatility, the correlation was higher (r = 0.64, n = 11, P = .034), and the relationship between 4D-DSA and the Doppler wire fit a linear model with a positive bias toward the Doppler wire (failed to reject at 95% confidence level, P = .208). 4D-DSA performed after partial embolization showed a reduction in velocity in the embolized hepatic arteries compared to pre-embolization (mean, 3.96 ± 0.74 vs 11.8 2± 2.15 cm/s, P = .006). CONCLUSION Quantitative 4D-DSA can depict changes in hepatic arterial blood velocity during transarterial embolization in a swine model. Further work is needed to optimize 4D-DSA acquisitions and to investigate its applicability in humans.
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Wu Y, Shaughnessy G, Hoffman CA, Oberstar EL, Schafer S, Schubert T, Ruedinger KL, Davis BJ, Mistretta CA, Strother CM, Speidel MA. Quantification of Blood Velocity with 4D Digital Subtraction Angiography Using the Shifted Least-Squares Method. AJNR Am J Neuroradiol 2018; 39:1871-1877. [PMID: 30213811 PMCID: PMC6177311 DOI: 10.3174/ajnr.a5793] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Accepted: 06/11/2018] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE 4D-DSA provides time-resolved 3D-DSA volumes with high temporal and spatial resolutions. The purpose of this study is to investigate a shifted least squares method to estimate the blood velocity from the 4D DSA images. Quantitative validation was performed using a flow phantom with an ultrasonic flow probe as ground truth. Quantification of blood velocity in human internal carotid arteries was compared with measurements generated from 3D phase-contrast MR imaging. MATERIALS AND METHODS The centerlines of selected vascular segments and the time concentration curves of each voxel along the centerlines were determined from the 4D-DSA dataset. The temporal shift required to achieve a minimum difference between any point and other points along the centerline of a segment was calculated. The temporal shift as a function of centerline point position was fit to a straight line to generate the velocity. The proposed shifted least-squares method was first validated using a flow phantom study. Blood velocities were also estimated in the 14 ICAs of human subjects who had both 4D-DSA and phase-contrast MR imaging studies. Linear regression and correlation analysis were performed on both the phantom study and clinical study, respectively. RESULTS Mean velocities of the flow phantom calculated from 4D-DSA matched very well with ultrasonic flow probe measurements with 11% relative root mean square error. Mean blood velocities of ICAs calculated from 4D-DSA correlated well with phase-contrast MR imaging measurements with Pearson correlation coefficient r = 0.835. CONCLUSIONS The availability of 4D-DSA provides the opportunity to use the shifted least-squares method to estimate velocity in vessels within a 3D volume.
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Affiliation(s)
- Y Wu
- From the Departments of Medical Physics (Y.W., G.S., C.A.H., C.A.M., M.A.S.)
| | - G Shaughnessy
- From the Departments of Medical Physics (Y.W., G.S., C.A.H., C.A.M., M.A.S.)
| | - C A Hoffman
- From the Departments of Medical Physics (Y.W., G.S., C.A.H., C.A.M., M.A.S.)
| | | | | | - T Schubert
- Radiology (C.A.M., C.M.S., T.S.).,Department of Radiology and Nuclear Medicine (T.S.), Basel University Hospital, Basel, Switzerland
| | | | - B J Davis
- Biomedical Engineering (E.L.O., K.L.R., B.J.D.)
| | - C A Mistretta
- From the Departments of Medical Physics (Y.W., G.S., C.A.H., C.A.M., M.A.S.).,Radiology (C.A.M., C.M.S., T.S.)
| | | | - M A Speidel
- From the Departments of Medical Physics (Y.W., G.S., C.A.H., C.A.M., M.A.S.).,Medicine (M.A.S.), University of Wisconsin, Madison, Wisconsin
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Shaughnessy G, Schafer S, Speidel MA, Strother CM, Mistretta CA. Measuring blood velocity using 4D-DSA: A feasibility study. Med Phys 2018; 45:4510-4518. [PMID: 30102773 DOI: 10.1002/mp.13120] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Revised: 07/11/2018] [Accepted: 07/11/2018] [Indexed: 11/08/2022] Open
Abstract
PURPOSE Four-dimensional (4D) DSA reconstruction provides three-dimensional (3D) time-resolved visualization of contrast bolus passage through arterial vasculature in the interventional setting. The purpose of this study was to evaluate the feasibility of using these data in measuring blood velocity and flow. METHODS The pulsatile signals in the time concentration curves (TCCs) measured at different points along a vessel are markers of the movement of a contrast bolus and thus of blood flow. When combined with the spatial content, that is, geometry of the vasculature, this information then provides the data required to determine blood velocity. A Fourier-based algorithm was used to identify and follow the pulsatility signal. A Side Band Ratio (SBR) metric was used to reduce uncertainty in identifying the pulsatility in regions where the signal was weak. We tested this method using 4D-DSA reconstructions from vascular phantoms as well as from human studies. RESULTS In five studies using 3D printed patient-specific cerebrovascular phantoms, velocities calculated from the 4D-DSAs were found to be within 10% of velocities measured with a flow meter. Calculated velocity and flow values from three human studies were within the range of those reported in the literature. CONCLUSIONS 4D-DSA provides temporal and spatial information about blood flow and vascular geometry. This information is obtained using conventional rotational angiographic systems. In this small feasibility study, these data allowed calculations of velocity values that correlated well with measured values. The availability of velocity and blood flow information in the interventional setting would support a more quantitative approach to diagnosis, treatment planning and post-treatment evaluations of a variety of cerebrovascular diseases.
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Affiliation(s)
- Gabe Shaughnessy
- Department of Medical Physics, University of Wisconsin, Madison, WI, USA
| | | | - Michael A Speidel
- Department of Medical Physics, University of Wisconsin, Madison, WI, USA
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Xu J, Shaughnessy G, Schafer S, Jiang J, Mistretta C, Strother CM. Assessing the reliability of pulsatility in four-dimensional digital subtraction angiography time concentration curves. Biomed Phys Eng Express 2018. [DOI: 10.1088/2057-1976/aab5e4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Ognard J, Magro E, Caroff J, Ben Salem D, Andouard S, Nonent M, Gentric JC. A new time-resolved 3D angiographic technique (4D DSA): Description, and assessment of its reliability in Spetzler-Martin grading of cerebral arteriovenous malformations. J Neuroradiol 2017; 45:177-185. [PMID: 29274362 DOI: 10.1016/j.neurad.2017.11.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Revised: 10/23/2017] [Accepted: 11/19/2017] [Indexed: 01/18/2023]
Abstract
BACKGROUND AND PURPOSE The Spetzler and Martin (SM) cerebral arteriovenous malformation (AVM) classification is a widely used 5-tier classification. This common language allows specialists to exchange about AVMs and must be reliably characterized by the imaging methods. We presented an agreement study on a new method of digital subtracted 3D rotational angiography resolved in time (four-dimensional DSA: 4D DSA) compared to the gold standard (two-dimensional DSA: 2D DSA) in AVM grading using the SM classification. METHODS Ten patients with AVMs were included during one year, they had an angiographic exploration with both 4D DSA and 2D DSA. Three readers assessed the SM classification. One reader conducted a second reading. The inter-, intra-observer and intermodality agreements were calculated by Kappas. Dose to patient was reported. RESULTS Considering the SM grade, the inter-observer agreement between 4D DSA and 2D DSA was equivalent (κ=0.45 and 0.46), and calculated as substantial κ=0.76 between the 2 methods. The agreement between 4D DSA and 2D DSA was calculated as moderate κ=0.46 assessing the size of the nidus, slight κ=0.18 analyzing the drainage and almost perfect κ=0.95 depicting the localization. 4D DSA performed during a standard initial angiographic assessment of AVM represented approximately 6% of the total dose. CONCLUSION The addition of this new technique 4D DSA could be performed regularly in addition to the 2D DSA if available, to assess SM grading, with an acceptable exposure to ionizing radiation.
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Affiliation(s)
- Julien Ognard
- Service d'imagerie médicale, CHU de la Cavale-Blanche, boulevard Tanguy-Prigent, 29609 Brest, France; Inserm UMR 1101, laboratoire de traitement de l'information médicale (LaTIM), 5, avenue Foch, 29200 Brest cedex, France.
| | - Elsa Magro
- Inserm UMR 1101, laboratoire de traitement de l'information médicale (LaTIM), 5, avenue Foch, 29200 Brest cedex, France; Service de neurochirurgie, CHU de la Cavale-Blanche, boulevard Tanguy-Prigent, 29609 Brest, France
| | - Jildaz Caroff
- Service de neuroradiologie interventionnelle, hôpital Bicêtre, AP-HP, 78, rue du Général-Leclerc, 94270 Le Kremlin-Bicêtre, France
| | - Douraied Ben Salem
- Service d'imagerie médicale, CHU de la Cavale-Blanche, boulevard Tanguy-Prigent, 29609 Brest, France; Inserm UMR 1101, laboratoire de traitement de l'information médicale (LaTIM), 5, avenue Foch, 29200 Brest cedex, France
| | - Sebastien Andouard
- SIEMENS S.A.S. Division Healthcare, service application, 40, avenue des Fruitiers, 93200 Saint-Denis, France
| | - Michel Nonent
- Service d'imagerie médicale, CHU de la Cavale-Blanche, boulevard Tanguy-Prigent, 29609 Brest, France; Groupe d'étude de la thrombose occidentale, CHU de la Cavale-Blanche, boulevard Tanguy-Prigent, 29609 Brest, France
| | - Jean-Christophe Gentric
- Service d'imagerie médicale, CHU de la Cavale-Blanche, boulevard Tanguy-Prigent, 29609 Brest, France; Groupe d'étude de la thrombose occidentale, CHU de la Cavale-Blanche, boulevard Tanguy-Prigent, 29609 Brest, France
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Lang S, Gölitz P, Struffert T, Rösch J, Rössler K, Kowarschik M, Strother C, Doerfler A. 4D DSA for Dynamic Visualization of Cerebral Vasculature: A Single-Center Experience in 26 Cases. AJNR Am J Neuroradiol 2017; 38:1169-1176. [PMID: 28408632 DOI: 10.3174/ajnr.a5161] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Accepted: 01/23/2017] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE 4D DSA allows acquisition of time-resolved 3D reconstructions of cerebral vessels by using C-arm conebeam CT systems. The aim of our study was to evaluate this new method by qualitative and quantitative means. MATERIALS AND METHODS 2D and 4D DSA datasets were acquired in patients presenting with AVMs, dural arteriovenous fistulas, and cerebral aneurysms. 4D DSA was compared with 2D DSA in a consensus reading of qualitative and quantitative parameters of AVMs (eg, location, feeder, associated aneurysms, nidus size, drainage, Martin-Spetzler Score), dural arteriovenous fistulas (eg, fistulous point, main feeder, diameter of the main feeder, drainage), and cerebral aneurysms (location, neck configuration, aneurysmal size). Identifiability of perforators and diameters of the injection vessel (ICA, vertebral artery) were analyzed in 2D and 4D DSA. Correlation coefficients and a paired t test were calculated for quantitative parameters. The effective patient dose of the 4D DSA protocol was evaluated with an anthropomorphic phantom. RESULTS In 26 patients, datasets were acquired successfully (AVM = 10, cerebral aneurysm = 10, dural arteriovenous fistula = 6). Qualitative and quantitative evaluations of 4D DSA in AVMs (nidus size: r = 0.99, P = .001), dural arteriovenous fistulas (diameter of the main feeder: r = 0.954, P = .03), and cerebral aneurysms (aneurysmal size: r = 1, P = .001) revealed nearly complete accordance with 2D DSA. Perforators were comparably visualized with 4D DSA. Measurement of the diameter of the injection vessel in 4D DSA was equivalent to that in 2D DSA (P = .039). The effective patient dose of 4D DSA was 1.2 mSv. CONCLUSIONS 4D DSA is feasible for imaging of AVMs, dural arteriovenous fistulas, and cerebral aneurysms. 4D DSA offers reliable visualization of the cerebral vasculature and may improve the understanding and treatment of AVMs and dural arteriovenous fistulas. The number of 2D DSA acquisitions required for an examination may be reduced through 4D DSA.
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Affiliation(s)
- S Lang
- From the Departments of Neuroradiology (S.L., P.G., T.S., J.R., A.D.)
| | - P Gölitz
- From the Departments of Neuroradiology (S.L., P.G., T.S., J.R., A.D.)
| | - T Struffert
- From the Departments of Neuroradiology (S.L., P.G., T.S., J.R., A.D.)
| | - J Rösch
- From the Departments of Neuroradiology (S.L., P.G., T.S., J.R., A.D.)
| | - K Rössler
- Neurosurgery (K.R.), University of Erlangen-Nuremberg, Erlangen, Germany
| | - M Kowarschik
- Angiography & Interventional X-Ray Systems (M.K.), Siemens Healthcare GmbH, Forchheim, Germany
| | - C Strother
- Department of Radiology (C.S.), University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - A Doerfler
- From the Departments of Neuroradiology (S.L., P.G., T.S., J.R., A.D.)
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Chen KK, Guo WY, Yang HC, Lin CJ, Wu CHF, Gehrisch S, Kowarschik M, Wu YT, Chung WY. Application of Time-Resolved 3D Digital Subtraction Angiography to Plan Cerebral Arteriovenous Malformation Radiosurgery. AJNR Am J Neuroradiol 2017; 38:740-746. [PMID: 28126751 DOI: 10.3174/ajnr.a5074] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Accepted: 11/18/2016] [Indexed: 01/14/2023]
Abstract
BACKGROUND AND PURPOSE Time-resolved 3D-DSA (4D-DSA) enables viewing vasculature from any desired angle and time frame. We investigated whether these advantages may facilitate treatment planning and the feasibility of using 4D-DSA as a single imaging technique in AVM/dural arteriovenous fistula radiosurgery. MATERIALS AND METHODS Twenty consecutive patients (8 dural arteriovenous fistulas and 12 AVMs; 13 men and 7 women; mean age, 45 years; range, 18-64 years) who were scheduled for gamma knife radiosurgery were recruited (November 2014 to October 2015). An optimal volume of reconstructed time-resolved 3D volumes that defines the AVM nidus/dural arteriovenous fistula was sliced into 2D-CT-like images. The original radiosurgery treatment plan was overlaid retrospectively. The registration errors of stereotactic 4D-DSA were compared with those of integrated stereotactic imaging. AVM/dural arteriovenous fistula volumes were contoured, and disjoint and conjoint components were identified. The Wilcoxon signed rank test and the Wilcoxon rank sum test were adopted to evaluate registration errors and contoured volumes of stereotactic 4D-DSA and integration of stereotactic MR imaging and stereotactic 2D-DSA. RESULTS Sixteen of 20 patients were successfully registered in Advanced Leksell GammaPlan Program. The registration error of stereotactic 4D-DSA was smaller than that of integrated stereotactic imaging (P = .0009). The contoured AVM volume of 4D-DSA was smaller than that contoured on the integration of MR imaging and 2D-DSA, while major inconsistencies existed in cases of dural arteriovenous fistula (P = .042 and 0.039, respectively, for measurements conducted by 2 authors). CONCLUSIONS Implementation of stereotactic 4D-DSA data for gamma knife radiosurgery for brain AVM/dural arteriovenous fistula is feasible. The ability of 4D-DSA to demonstrate vascular morphology and hemodynamics in 4 dimensions potentially reduces the target volumes of irradiation in vascular radiosurgery.
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Affiliation(s)
- K-K Chen
- From the Department of Biomedical Imaging and Radiological Sciences (K.-K.C., Y.-T.W.), National Yang-Ming University, Taipei, Taiwan
| | - W-Y Guo
- Departments of Radiology (W.-Y.G., C.-J.L.)
- School of Medicine (W.-Y.G., C.-J.L.), National Yang-Ming University, Taipei, Taiwan
| | - H-C Yang
- Neurosurgery (H.-C.Y., W.-Y.C.), Taipei Veterans General Hospital, Taipei, Taiwan
| | - C-J Lin
- Departments of Radiology (W.-Y.G., C.-J.L.)
- School of Medicine (W.-Y.G., C.-J.L.), National Yang-Ming University, Taipei, Taiwan
| | - C-H F Wu
- Siemens Healthcare Ltd, Advanced Therapies (C.-H.F.W.), Taipei, Taiwan
| | - S Gehrisch
- Siemens, Advanced Therapies (S.G., M.K.), Forchheim, Germany
| | - M Kowarschik
- Siemens, Advanced Therapies (S.G., M.K.), Forchheim, Germany
| | - Y-T Wu
- From the Department of Biomedical Imaging and Radiological Sciences (K.-K.C., Y.-T.W.), National Yang-Ming University, Taipei, Taiwan
| | - W-Y Chung
- Neurosurgery (H.-C.Y., W.-Y.C.), Taipei Veterans General Hospital, Taipei, Taiwan
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Kammerer S, Mueller-Eschner M, Berkefeld J, Tritt S. Time-resolved 3D Rotational Angiography (4D DSA) of the Lenticulostriate Arteries: Display of Normal Anatomic Variants and Collaterals in Cases with Chronic Obstruction of the MCA. Clin Neuroradiol 2017; 27:451-457. [PMID: 28352979 DOI: 10.1007/s00062-017-0578-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2016] [Accepted: 03/10/2017] [Indexed: 11/26/2022]
Abstract
PURPOSE The lenticulostriate arteries (LSA) and other perforators may play a role for collateral supply in cases with ischemia due to stenosis or occlusions of the middle cerebral artery (MCA). Purpose of this case series was to evaluate the potential of time-resolved 3D rotational angiography data sets (4D DSA) for detailed visualization of anatomic variants of LSA feeders and for display of local collaterals involving the LSA in cases with chronic MCA obstruction. METHODS Multiplanar and volume rendering reconstructions of 4D DSA data were computed in addition to standard postprocessing in 24 patients who had indications for 3D rotational angiography (3DRA) of the internal carotid artery (ICA) without pathologies of the ICA, middle cerebral artery (MCA) and anterior cerebral artery (ACA) main stems (n = 18) or with stenosis or chronic occlusion of the MCA (n = 6). For acquisition of 3DRA, we used a modified digital subtraction angiography (DSA) image acquisition protocol with an extended rotation angle of 260° and a prolonged scan time of 12 s on a Siemens Axiom Artis Zee biplane neuroangiography equipment. The 4D reconstructions of existing 3DRA data were computed on a dedicated workstation. Origin and course of LSA and other perforators were analyzed according to coronal multiplanar reconstructions (MPRs) with slice thicknesses between 6 and 28 mm. RESULTS In all cases 4D reconstructions of the LSA were technically feasible and evaluable. As expected, origin and course of LSA showed a wide range of variations: The most common pattern was a common trunk dividing into multiple ascending branches originating from the proximal M1 (n = 5) or the proximal A1 segment (n = 4). Alternatively, 8 patients showed several individual branches that directly originated from the proximal M1 segment of the MCA and occasionally from the A1 segment of the ACA. In patients with M1 stenosis or occlusion, 4 out of 6 cases had local collaterals with involvement of proximal LSA trunks and a network parallel to the obstructed vessel segment. The 4D reconstructions were found to be equivalent (n = 16) or superior to 3D reconstructions (n = 8). CONCLUSION The 4D DSA reconstructions provide a reliable display of normal LSA variants and connections to local collateral networks in cases with chronic MCA obstruction. The possibility to select a correct angiographic phase is advantageous compared to 3D DSA.
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Affiliation(s)
- S Kammerer
- Institute of Neuroradiology, University Hospital Frankfurt, Goethe University Frankfurt, Schleusenweg 2-16, 60528, Frankfurt, Germany.
| | - M Mueller-Eschner
- Institute of Neuroradiology, University Hospital Frankfurt, Goethe University Frankfurt, Schleusenweg 2-16, 60528, Frankfurt, Germany
| | - J Berkefeld
- Institute of Neuroradiology, University Hospital Frankfurt, Goethe University Frankfurt, Schleusenweg 2-16, 60528, Frankfurt, Germany
| | - S Tritt
- Institute of Neuroradiology, University Hospital Frankfurt, Goethe University Frankfurt, Schleusenweg 2-16, 60528, Frankfurt, Germany
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Sandoval-Garcia C, Yang P, Schubert T, Schafer S, Hetzel S, Ahmed A, Strother C. Comparison of the Diagnostic Utility of 4D-DSA with Conventional 2D- and 3D-DSA in the Diagnosis of Cerebrovascular Abnormalities. AJNR Am J Neuroradiol 2017; 38:729-734. [PMID: 28279986 DOI: 10.3174/ajnr.a5137] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Accepted: 11/15/2016] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE 4D-DSA is a time-resolved technique that allows viewing of a contrast bolus at any time and from any desired viewing angle. Our hypothesis was that the information content in a 4D-DSA reconstruction was essentially equivalent to that in a combination of 2D acquisitions and a 3D-DSA reconstruction. MATERIALS AND METHODS Twenty-six consecutive patients who had both 2D- and 3D-DSA acquisitions were included in the study. The angiography report was used to obtain diagnoses and characteristics of abnormalities. Diagnoses included AVM/AVFs, aneurysms, stenosis, and healthy individuals. 4D-DSA reconstructions were independently reviewed by 3 experienced observers who had no part in the clinical care. Using an electronic evaluation form, these observers recorded their assessments based only on the 4D reconstructions. The clinical evaluations were then compared with the 4D evaluations for diagnosis and lesion characteristics. RESULTS Results showed both interrater and interclass agreements (κ = 0.813 and 0.858). Comparing the 4D diagnosis with the clinical diagnosis for the 3 observers yielded κ values of 0.906, 0.912, and 0.906. The κ values for agreement among the 3 observers for the type of abnormality were 0.949, 0.845, and 0.895. There was complete agreement on the presence of an abnormality between the clinical and 4D-DSA in 23/26 cases. In 2 cases, there were conflicting opinions. CONCLUSIONS In this study, the information content of 4D-DSA reconstructions was largely equivalent to that of the combined 2D/3D studies. The availability of 4D-DSA should reduce the requirement for 2D-DSA acquisitions.
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Affiliation(s)
| | - P Yang
- Department of Neurosurgery (P.Y.), Changhai Hospital, Second Military Medical University, Shanghai, China
| | | | - S Schafer
- Siemens Healthineers, USA (S.S.), Hoffman Estates, Illinois
| | - S Hetzel
- Biostatistics and Medical Informatics (S.H.), University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - A Ahmed
- From the Departments of Neurological Surgery (C.S.-G., A.A.)
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Buehler M, Slagowski JM, Mistretta CA, Strother CM, Speidel MA. 4D DSA reconstruction using tomosynthesis projections. PROCEEDINGS OF SPIE--THE INTERNATIONAL SOCIETY FOR OPTICAL ENGINEERING 2017; 10132:101322C. [PMID: 28943698 PMCID: PMC5606252 DOI: 10.1117/12.2255197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
We investigate the use of tomosynthesis in 4D DSA to improve the accuracy of reconstructed vessel time-attenuation curves (TACs). It is hypothesized that a narrow-angle tomosynthesis dataset for each time point can be exploited to reduce artifacts caused by vessel overlap in individual projections. 4D DSA reconstructs time-resolved 3D angiographic volumes from a typical 3D DSA scan consisting of mask and iodine-enhanced C-arm rotations. Tomosynthesis projections are obtained either from a conventional C-arm rotation, or from an inverse geometry scanning-beam digital x-ray (SBDX) system. In the proposed method, rays of the tomosynthesis dataset which pass through multiple vessels can be ignored, allowing the non-overlapped rays to impart temporal information to the 4D DSA. The technique was tested in simulated scans of 2 mm diameter vessels separated by 2 to 5 cm, with TACs following either early or late enhancement. In standard 4D DSA, overlap artifacts were clearly present. Use of tomosynthesis projections in 4D DSA reduced TAC artifacts caused by vessel overlap, when a sufficient fraction of non-overlapped rays was available in each time frame. In cases where full overlap between vessels occurred, information could be recovered via a proposed image space interpolation technique. SBDX provides a tomosynthesis scan for each frame period in a rotational acquisition, whereas a standard C-arm geometry requires the grouping of multiple frames.
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Affiliation(s)
- Marc Buehler
- Dept. of Medical Physics, University of Wisconsin, Madison, WI, USA
| | | | - Charles A Mistretta
- Dept. of Medical Physics, University of Wisconsin, Madison, WI, USA
- Dept. of Radiology, University of Wisconsin, Madison, WI, USA
| | | | - Michael A Speidel
- Dept. of Medical Physics, University of Wisconsin, Madison, WI, USA
- Dept. of Medicine, University of Wisconsin, Madison, WI, USA
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Oberstar EL, Speidel MA, Davis BJ, Strother CM, Mistretta CA. Feasibility of reduced-dose three-dimensional/four-dimensional-digital subtraction angiogram using a weighted edge preserving filter. J Med Imaging (Bellingham) 2017; 4:013501. [PMID: 28097212 DOI: 10.1117/1.jmi.4.1.013501] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Accepted: 12/12/2016] [Indexed: 11/14/2022] Open
Abstract
A conventional three-dimensional/four-dimensional (3D/4D) digital subtraction angiogram (DSA) requires two rotational acquisitions (mask and fill) to compute the log-subtracted projections that are used to reconstruct a 3D/4D volume. Since all of the vascular information is contained in the fill acquisition, it is hypothesized that it is possible to reduce the x-ray dose of the mask acquisition substantially and still obtain subtracted projections adequate to reconstruct a 3D/4D volume with noise level comparable to a full-dose acquisition. A full-dose mask and fill acquisition were acquired from a clinical study to provide a known full-dose reference reconstruction. Gaussian noise was added to the mask acquisition to simulate a mask acquisition acquired at 10% relative dose. Noise in the low-dose mask projections was reduced with a weighted edge preserving filter designed to preserve bony edges while suppressing noise. Two-dimensional (2D) log-subtracted projections were computed from the filtered low-dose mask and full-dose fill projections, and then 3D/4D-DSA reconstruction algorithms were applied. Additional bilateral filtering was applied to the 3D volumes. The signal-to-noise ratio measured in the filtered 3D/4D-DSA volumes was compared to the full-dose case. The average ratio of filtered low-dose SNR to full-dose SNR was 0.856 for the 3D-DSA and 0.849 for the 4D-DSA, indicating that the method is a feasible approach to restoring SNR in DSA scans acquired with a low-dose mask. The method was also tested in a phantom study with full-dose fill and 22%-dose mask.
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Affiliation(s)
- Erick L Oberstar
- University of Wisconsin-Madison , Department of Biomedical Engineering, 1415 Engineering Drive, Madison, Wisconsin 53706, United States
| | - Michael A Speidel
- University of Wisconsin-Madison, Department of Medical Physics, 1111 Highland Avenue #1005, Madison, Wisconsin 53705, United States; University of Wisconsin-Madison, Department of Medicine, 1685 Highland Avenue, Madison, Wisconsin 53792, United States
| | - Brian J Davis
- University of Wisconsin-Madison , Department of Biomedical Engineering, 1415 Engineering Drive, Madison, Wisconsin 53706, United States
| | - Charles M Strother
- University of Wisconsin-Madison , Department of Radiology, 600 Highland Avenue, Madison, Wisconsin 53792, United States
| | - Charles A Mistretta
- University of Wisconsin-Madison, Department of Biomedical Engineering, 1415 Engineering Drive, Madison, Wisconsin 53706, United States; University of Wisconsin-Madison, Department of Medical Physics, 1111 Highland Avenue #1005, Madison, Wisconsin 53705, United States; University of Wisconsin-Madison, Department of Radiology, 600 Highland Avenue, Madison, Wisconsin 53792, United States
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Laviña B. Brain Vascular Imaging Techniques. Int J Mol Sci 2016; 18:ijms18010070. [PMID: 28042833 PMCID: PMC5297705 DOI: 10.3390/ijms18010070] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Revised: 12/13/2016] [Accepted: 12/26/2016] [Indexed: 12/13/2022] Open
Abstract
Recent major improvements in a number of imaging techniques now allow for the study of the brain in ways that could not be considered previously. Researchers today have well-developed tools to specifically examine the dynamic nature of the blood vessels in the brain during development and adulthood; as well as to observe the vascular responses in disease situations in vivo. This review offers a concise summary and brief historical reference of different imaging techniques and how these tools can be applied to study the brain vasculature and the blood-brain barrier integrity in both healthy and disease states. Moreover, it offers an overview on available transgenic animal models to study vascular biology and a description of useful online brain atlases.
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Affiliation(s)
- Bàrbara Laviña
- Department of Immunology, Genetics and Pathology, Rudbeck Laboratory, Uppsala University, 75185 Uppsala, Sweden.
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Lescher S, Gehrisch S, Klein S, Berkefeld J. Time-resolved 3D rotational angiography: display of detailed neurovascular anatomy in patients with intracranial vascular malformations. J Neurointerv Surg 2016; 9:887-894. [PMID: 27492375 DOI: 10.1136/neurintsurg-2016-012462] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Revised: 07/05/2016] [Accepted: 07/15/2016] [Indexed: 11/03/2022]
Abstract
PURPOSE The purpose of this pilot study was to demonstrate the applicability of time-resolved three-dimensional (3D) reconstructions from 3D digital subtraction angiography (DSA) rotational angiography (RA) datasets (four-dimensional (4D) DSA) to provide a more detailed display of the architecture of intracranial vascular malformations. METHODS The experimental reconstruction software was applied to the existing 3D DSA datasets obtained with Siemens Artis zee biplane neuroangiography equipment. We included 27 patients with clinical indications for 3DRA for preinterventional or preoperative evaluation of intracranial dural arteriovenous fistulas (dAVFs, n=8) or arteriovenous malformations (AVMs, n=19). A modified DSA acquisition protocol covering an extended rotation angle of the C-arm of 260° during a scan time of 12 s was used. 4D volumes were displayed with up to 30 frames/s in a transparent volume rendering (VRT) mode and time-resolved multiplanar reconstructions (MPRs). Arterial feeders, fistulous points, or the shunt zone within the AVM nidus and venous drainage patterns as well as associated aneurysms were assessed after definition of a standardized evaluation procedure by consensus of two reviewers in comparison with 2D DSA and conventional 3D reconstructions. RESULTS In all cases calculation of 4D reconstructions were technically feasible and evaluable. In two cases image quality was slightly compromised by movement artifacts. Compared with standard DSA projection images and 3D reconstructions, 4D VRTs and MPRs were rated significantly superior to define a proper projection and display of the shunt zone. In 12 out of 27 cases 4D reconstructions showed details of the angioarchitecture at the fistulous point or the nidus better than the other modalities and came close to the quality of superselective angiography. The efficacy of 3D and 4D applications was equal in the detection of pre- and intranidal aneurysms. The course of long arterial feeders and draining veins was difficult to assess on VRTs and MPRs. Especially for dAVFs, 2D DSA was clearly superior in identifying meningeal feeders. For detecting smaller vessels and for distinction between angiographic phases, 2D DSA is still considered to be superior to 4D imaging. Venous drainage was slightly better displayed in 4D reconstructions. CONCLUSIONS Time-resolved 3DRA with 4D VRTs and MPRs is technically feasible and provides a detailed display of the angioarchitecture at the fistulous point or the nidus. Visualization of all angiographic features demands additional post-processing. Further standardization of evaluation tools and studies with blinded independent reviewers are necessary before the new technique can replace conventional neuroangiographic approaches.
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Affiliation(s)
- Stephanie Lescher
- Institute of Neuroradiology, Hospital of Goethe University, Frankfurt am Main, Germany
| | - Sonja Gehrisch
- Siemens Healthcare GmbH, Advanced Therapies, Forchheim, Germany
| | - Sigrun Klein
- Siemens Healthcare GmbH, Advanced Therapies, Forchheim, Germany
| | - Joachim Berkefeld
- Institute of Neuroradiology, Hospital of Goethe University, Frankfurt am Main, Germany
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Srinivasan VM, Chintalapani G, Duckworth EAM, Kan P. Application of 4-Dimensional Digital Subtraction Angiography for Dural Arteriovenous Fistulas. World Neurosurg 2016; 96:24-30. [PMID: 27188639 DOI: 10.1016/j.wneu.2016.05.021] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Revised: 05/08/2016] [Accepted: 05/09/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Three-dimensional reconstruction of digital subtraction angiography (3D-DSA) is a useful imaging modality for assessing complex cerebrovascular lesions. However, due to the importance of flow over time in certain vascular lesions, 3D-DSA is of less value as it lacks the temporal resolution. Dural arteriovenous fistulas (AVFs) are complex lesions in which an arteriovenous shunt exists between meningeal arteries and a dural venous sinus or cortical vein. Traditional 2D-DSA, especially with superselective injections of feeding arteries, is currently the gold standard for assessment, but overlapping of opacified vessels can complicate interpretation. A novel imaging technique, 4D-DSA, merges 3D reconstructions of multiple temporal series. It offers a unique perspective on complex cerebrovascular lesions and may offer several advantages in the assessment of dural AVF. METHODS 4D-DSA images were acquired in 5 patients who presented with dural AVFs. All relevant clinical data, imaging, and procedural/operative reports were reviewed retrospectively. 4D-DSA images were reconstructed on a separate 3D workstation and compared to 2D and 3D-DSA images in an offline fashion. RESULTS In all 5 cases, 4D-DSA proved to be useful in lesion assessment and treatment planning. This included observation (n = 2), microsurgery (n = 1), and endovascular embolization (n = 2). CONCLUSIONS In the small series of patients in which it has been evaluated, 4D-DSA offers several advantages in assessing dural AVFs. The ability to see and manipulate feeding arteries in 3D combined with temporal resolution was useful in assessment and treatment planning. Continued experience with this imaging technique will be needed to identify its optimal use.
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Affiliation(s)
| | | | | | - Peter Kan
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA.
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Lin CJ, Hung SC, Chang FC, Guo WY, Luo CB, Kowarschik M, Chu WF, Liou AJYK. Finding the optimal deconvolution algorithm for MR perfusion in carotid stenosis: Correlations with angiographic cerebral circulation time. J Neuroradiol 2016; 43:290-6. [PMID: 27038737 DOI: 10.1016/j.neurad.2016.02.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Accepted: 02/08/2016] [Indexed: 11/28/2022]
Abstract
PURPOSE The aim of our study is to explore the impacts of different deconvolution algorithms on correlations between CBF, MTT, CBV, TTP, Tmax from MR perfusion (MRP) and angiography cerebral circulation time (CCT). METHODS Retrospectively, 30 patients with unilateral carotid stenosis, and available pre-stenting MRP and angiography were included for analysis. All MRPs were conducted in a 1.5-T MR scanner. Standard singular value decomposition, block-circulant, and two delay-corrected algorithms were used as the deconvolution methods. All angiographies were obtained in the same bi-plane flat-detector angiographic machine. A contrast bolus of 12mL was administrated via angiocatheter at a rate of 8mL/s. The acquisition protocols were the same for all cases. CCT was defined as the difference between time to peak from the cavernous ICA and the parietal vein in lateral view. Pearson correlations were calculated for CCT and CBF, MTT, CBV, TTP, Tmax. RESULTS The correlation between CCT and MTT was highest with Tmax (r=0.65), followed by MTT (r=0.60), CBF (r=-0.57), and TTP (r=0.33) when standard singular value decomposition was used. No correlation with CBV was noted. CONCLUSIONS MRP using a singular value decomposition algorithm confirmed the feasibility of quantifying cerebral blood flow deficit in steno-occlusive disease within the angio-room. This approach might further improve patient safety by providing immediate cerebral hemodynamics without extraradiation and iodine contrast.
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Affiliation(s)
- Chung-Jung Lin
- Department of radiology, Taipei Veterans general hospital, 201, Shipai Road, Section 2, 11217 Taipei, Taiwan; School of medicine, National Yang Ming university, Taipei, Taiwan
| | - Sheng-Che Hung
- Department of radiology, Taipei Veterans general hospital, 201, Shipai Road, Section 2, 11217 Taipei, Taiwan; School of medicine, National Yang Ming university, Taipei, Taiwan
| | - Feng-Chi Chang
- Department of radiology, Taipei Veterans general hospital, 201, Shipai Road, Section 2, 11217 Taipei, Taiwan; School of medicine, National Yang Ming university, Taipei, Taiwan
| | - Wan-Yuo Guo
- Department of radiology, Taipei Veterans general hospital, 201, Shipai Road, Section 2, 11217 Taipei, Taiwan; School of medicine, National Yang Ming university, Taipei, Taiwan.
| | - Chao-Bao Luo
- Department of radiology, Taipei Veterans general hospital, 201, Shipai Road, Section 2, 11217 Taipei, Taiwan; School of medicine, National Yang Ming university, Taipei, Taiwan
| | - Markus Kowarschik
- Siemens AG, healthcare sector, angiography and interventional X-Ray systems, Forchheim, Germany
| | - Wei-Fa Chu
- Department of radiology, Taipei Veterans general hospital, 201, Shipai Road, Section 2, 11217 Taipei, Taiwan; School of medicine, National Yang Ming university, Taipei, Taiwan
| | - Adrian J Y Kang Liou
- Department of radiology, Taipei Veterans general hospital, 201, Shipai Road, Section 2, 11217 Taipei, Taiwan; School of medicine, National Yang Ming university, Taipei, Taiwan
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