Application of Time-Resolved 3D Digital Subtraction Angiography to Plan Cerebral Arteriovenous Malformation Radiosurgery

Chen, K.-K.; Guo, Wan‐Yuo; Yang, Huai Che; Lin, Chung Jung; Wu, Chen-Hao; Gehrisch, Sonja; Kowarschik, Markus; Wu, Yu‐Te; Chung, Wen‐Yuh

doi:10.3174/ajnr.a5074

Cited by 24 publications

(20 citation statements)

References 30 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…To date, few studies examining the efficacy of RA in GKS have been reported, and no detailed analyses of dosimetric variables like those performed herein have been performed previously. 6,30 Our findings support the use of RA in GKS planning; however, further research aimed at determining whether the use of RA improves the radiosurgical outcomes, including the rates of nidus obliteration and complications, is needed. The actual efficacy of RA seems to vary depending on the characteristics of the nidus.…”

Section: Discussionmentioning

confidence: 55%

“…27,28,37 Although it is likely that the integration of RA would improve GKS dose planning, few studies examining the efficacy of integrating RA into the GKS treatment planning process have been performed. 6,30 At our institution, we have routinely used RA for GKS planning since 2015. Therefore, the aim of the present study was to examine the efficacy of integrating RA into the dose planning process for AVM treatment.…”

mentioning

confidence: 99%

See 1 more Smart Citation

Integration of rotational angiography enables better dose planning in Gamma Knife radiosurgery for brain arteriovenous malformations

Hasegawa¹,

Hanakita²,

Shin³

et al. 2018

Journal of Neurosurgery

View full text Add to dashboard Cite

OBJECTIVEIn Gamma Knife radiosurgery (GKS) for arteriovenous malformations (AVMs), CT angiography (CTA), MRI, and digital subtraction angiography (DSA) are generally used to define the nidus. Although the AVM angioarchitecture can be visualized with superior resolution using rotational angiography (RA), the efficacy of integrating RA into the GKS treatment planning process has not been elucidated.METHODSUsing data collected from 25 consecutive patients with AVMs who were treated with GKS at the authors’ institution, two neurosurgeons independently created treatment plans for each patient before and after RA integration. For all patients, MR angiography, contrasted T1 imaging, CTA, DSA, and RA were performed before treatment. The prescription isodose volume before (PIVB) and after (PIVA) RA integration was measured. For reference purposes, a reference target volume (RTV) for each nidus was determined by two other physicians independent of the planning surgeons, and the RTV covered by the PIV (RTVPIV) was established. The undertreated volume ratio (UVR), overtreated volume ratio (OVR), and Paddick’s conformal index (CI), which were calculated as RTVPIV/RTV, RTVPIV/PIV, and (RTVPIV)2/(RTV × PIV), respectively, were measured by each neurosurgeon before and after RA integration, and the surgeons’ values at each point were averaged. Wilcoxon signed-rank tests were used to compare the values obtained before and after RA integration. The percentage change from before to after RA integration was calculated for the average UVR (%ΔUVRave), OVR (%ΔOVRave), and CI (%ΔCIave) in each patient, as ([value after RA integration]/[value before RA integration] − 1) × 100. The relationships between prior histories and these percentage change values were examined using Wilcoxon signed-rank tests.RESULTSThe average values obtained by the two surgeons for the median UVR, OVR, and CI were 0.854, 0.445, and 0.367 before RA integration and 0.882, 0.478, and 0.463 after RA integration, respectively. All variables significantly improved after compared with before RA integration (UVR, p = 0.009; OVR, p < 0.001; CI, p < 0.001). Prior hemorrhage was significantly associated with larger %ΔOVRave (median 20.8% vs 7.2%; p = 0.023) and %ΔCIave (median 33.9% vs 13.8%; p = 0.014), but not %ΔUVRave (median 4.7% vs 4.0%; p = 0.449).CONCLUSIONSIntegrating RA into GKS treatment planning may permit better dose planning owing to clearer visualization of the nidus and, as such, may reduce undertreatment and waste irradiation. Further studies examining whether the observed RA-related improvement in dose planning also improves the radiosurgical outcome are needed.

show abstract

Section: Discussionmentioning

confidence: 55%

mentioning

confidence: 99%

Integration of rotational angiography enables better dose planning in Gamma Knife radiosurgery for brain arteriovenous malformations

Hasegawa¹,

Hanakita²,

Shin³

et al. 2018

Journal of Neurosurgery

View full text Add to dashboard Cite

show abstract

“…Moreover, very few studies have described the effectiveness of 3DRA on GKRS planning, though they do not state a detailed integration method. [19][20][21] Thus, most physicians still cannot benefit from 3DRA. Here, we show a very simple method to integrate 3DRA into GKRS planning.…”

Section: -9mentioning

confidence: 99%

Integrating 3D Rotational Angiography into Gamma Knife Planning

Hasegawa

Hanakita

Shin

et al. 2018

AJNR Am J Neuroradiol

View full text Add to dashboard Cite

SUMMARY: 3D rotational angiography provides remarkable spatial resolution for cerebrovascular disorders; however, it cannot be integrated directly into gamma knife planning due to the discrepancy of DICOM "tag" information, and most physicians still cannot benefit from 3D rotational angiography. Here, we describe a simple and easy technique to enable the integration of 3D rotational angiography. ABBREVIATIONS:GKRS ϭ gamma knife stereotactic radiosurgery; 3DRA ‫؍‬ 3D rotational angiography

show abstract

“…Recent reports have demonstrated the usefulness of 4D‐DSA both in analyzing the details of complex vascular lesions and in treatment planning . The high frame rate of the acquisitions (30 fps) combined with the high spatial resolution of the x‐ray detector combine to provide images that allow visualization of minute changes in flow patterns and angio‐architecture …”

Section: Introductionmentioning

confidence: 99%

“…10,11 The high frame rate of the acquisitions (30 fps) combined with the high spatial resolution of the x-ray detector combine to provide images that allow visualization of minute changes in flow patterns and angio-architecture. 10,11,12 In preliminary studies, we have shown that, through use of a Fourier Phase technique, it is possible to obtain values of blood velocity using 4D-DSA data that are in agreement with data obtained using a doppler flow wire. 13 In this report we describe and illustrate further development and testing of this approach.…”

Section: Introductionmentioning

confidence: 99%

Measuring blood velocity using 4D‐DSA: A feasibility study

et al. 2018

View full text Add to dashboard Cite

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.

show abstract

Application of Time-Resolved 3D Digital Subtraction Angiography to Plan Cerebral Arteriovenous Malformation Radiosurgery

Cited by 24 publications

References 30 publications

Integration of rotational angiography enables better dose planning in Gamma Knife radiosurgery for brain arteriovenous malformations

Integration of rotational angiography enables better dose planning in Gamma Knife radiosurgery for brain arteriovenous malformations

Integrating 3D Rotational Angiography into Gamma Knife Planning

Measuring blood velocity using 4D‐DSA: A feasibility study

Contact Info

Product

Resources

About