Benefits of 3D Rotational DSA Compared with 2D DSA in the Evaluation of Intracranial Aneurysm

Wong, S.; Nawawi, Ouzreiah; Ramli, Norlisah; Kadir, Khairul Azmi Abd

doi:10.1016/j.acra.2012.02.012

Cited by 67 publications

(42 citation statements)

References 15 publications

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“…3 Rotational 3D DSA provides more information about complex cerebrovascular anatomical detail than conventional DSA. 1,5,17,19,22 The 3D DSA images are reconstructed from 2 separate rotational angiography acquisitions: a mask run and a contrast run. These rotational angiography acquisitions are volume data sets analogous to flat-panel detector CT (FDCT) scans that contain bony and softtissue information similar to conventional multidetector CT.…”

Section: Discussionmentioning

confidence: 99%

Frameless neuronavigation based only on 3D digital subtraction angiography using surface-based facial registration

Stidd¹,

Wewel²,

Ghods³

et al. 2014

JNS

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Paralleling the rapid development of neuroimaging technology, the introduction of neuronavigation in the 1980s has revolutionized the surgery of intracranial diseases.2,11 Neuronavigation based on CT or MRI studies has tailored surgical interventions to individual anatomy and pathology, with minimal disruption to the physical and functional architecture of the brain. Vascular anatomy is best appreciated with digital subtraction angiography (DSA), which remains the gold standard for imaging of cerebrovascular pathology. Both CT angiography (CTA) and MR angiography (MRA) have lower detection sensitivity and inferior spatial resolution relative to DSA for aneurysms smaller than 3 mm. 1,19,20 The use of DS angiograms as source images for neuronavigation, however, has been limited because DSA studies typically lack the soft-tissue information necessary to register the radiographic image space to the head in the physical space. Images from DSA typically require fusion with CT or MR images for coregistration.Frameless neuronavigation based only on 3D digital subtraction angiography using surface-based facial registration Object. Cerebrovascular lesions can have complicated abnormal anatomy that is not completely characterized by CT or MR angiography. Although 3D rotational angiography provides superior spatial and temporal resolution, catheter angiograms are not easily registered to the patient, limiting the use of these images as a source for neuronavigation. However, 3D digital subtraction angiography (DSA) contains not only vascular anatomy but also facial surface anatomy data. The authors report a novel technique to register 3D DSA images by using only the surface anatomy contained within the data set without having to fuse the DSA image set to other imaging modalities or use fiducial markers.Methods. A cadaver model was first created to assess the accuracy of neuronavigation based on 3D DSA images registered by facial surface anatomy. A 3D DSA scan was obtained of a formalin-fixed cadaver head, with acquisitions of mask and contrast runs. The right common carotid artery was injected prior to the contrast run with a 45% contrast solution diluted with water-soluble red liquid latex. One week later, the head was registered to a neuronavigation system loaded with the 3D DSA images acquired earlier using facial surface anatomy. A right pterional craniotomy was performed and 10 different vascular landmarks were identified and measured for accuracy using the neuronavigation system. Neuronavigation based only on 3D DSA was then used to guide an open clipping procedure for a patient who presented with a ruptured distal lenticulostriate aneurysm.Results. The accuracy of the measurements for the cadaver model was 0.71 ± 0.25 mm (mean ± SE), which is superior to the 1.8-5 mm reported for neuronavigation. The 3D DSA-based navigation-assisted surgery for the distal lenticulostriate aneurysm aided in localization, resulting in a small craniotomy and minimal brain dissection.Conclusions. This is the first example of frameless neu...

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Section: Discussionmentioning

confidence: 99%

Frameless neuronavigation based only on 3D digital subtraction angiography using surface-based facial registration

Stidd¹,

Wewel²,

Ghods³

et al. 2014

JNS

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“…[135][136][137][138] In addition, the resolution provided by DSA is greater for the smallest of vessels, such as perforators. [139][140][141][142][143][144] Although DSA remains the gold standard, it should be recognized that catheter arteriography does have risks, albeit small. Possible complications include contrast-related events, cerebral infarction, aneurysmal rupture, arterial injury, and others.…”

Section: -134mentioning

confidence: 99%

Guidelines for the Management of Patients With Unruptured Intracranial Aneurysms

Thompson¹,

Brown²,

Amin‐Hanjani³

et al. 2015

Stroke

833

352

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Purpose— The aim of this updated statement is to provide comprehensive and evidence-based recommendations for management of patients with unruptured intracranial aneurysms. Methods— Writing group members used systematic literature reviews from January 1977 up to June 2014. They also reviewed contemporary published evidence-based guidelines, personal files, and published expert opinion to summarize existing evidence, indicate gaps in current knowledge, and when appropriate, formulated recommendations using standard American Heart Association criteria. The guideline underwent extensive peer review, including review by the Stroke Council Leadership and Stroke Scientific Statement Oversight Committees, before consideration and approval by the American Heart Association Science Advisory and Coordinating Committee. Results— Evidence-based guidelines are presented for the care of patients presenting with unruptured intracranial aneurysms. The guidelines address presentation, natural history, epidemiology, risk factors, screening, diagnosis, imaging and outcomes from surgical and endovascular treatment.

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“…It may therefore be expected that the use of 3DRA can contribute to lowering radiation exposure and contrast injections. Patient studies in neuroradiology have shown that the use of 3DRA for 3D roadmapping and pretreatment selection of optimal working projections can lead to radiation dose reduction for cases requiring multiple oblique 2D DSA runs (20)(21)(22). Similarly, a recent multicenter comparison has shown that the use of 3DRA for carotid artery treatment involves a cumulative radiation dose three times lower than that for procedures based on 2D angiography only, mainly due to quicker selection of working projections and consequent reduction in fluoroscopy time and number of 2D DSA series (23).…”

Section: Discussionmentioning

confidence: 99%

Three-dimensional rotational angiography is preferable to conventional two-dimensional techniques for uterine artery embolization

Gupta¹,

Zuurmond²,

Grünhagen³

et al. 2013

Diagn Interv Radiol

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ORIGINAL ARTICLE PURPOSE We aimed to investigate the potential benefits of three-dimensional rotational angiography (3DRA) compared to two-dimensional (2D) roadmapping to visualize the uterine artery (UA) origins during uterine artery embolization (UAE) procedures. MATERIALS AND METHODSSixty-three UAE cases performed under 3DRA guidance were reviewed retrospectively to determine if there was an optimal angiographic projection angle for identifying UA origin. Digital subtraction angiogram (DAS)-like images of the pelvic vessels were generated from the 3DRA scans at six different angles: left anterior oblique (LAO) 25°, 35°, 45°; and right anterior oblique (RAO) 25°, 35°, 45°. Two experienced interventional radiologists assessed if these angles could effectively serve as a roadmap to guide catheterization of the UA. Assessment was validated against original 3DRA scans to determine the percentage of true and false positives. RESULTSNo single projection angle was found that could consistently be utilized for UA catheterization. The projection angles used during 3D roadmapping for both the left and right UA showed two clusters with both a wide spread: RAO 20° to 50° and LAO 20° to 50°. More than 50% of the DSA-like images at RAO and LAO 45° appeared to be adequate for UA catheterization, but validation against the 3DRA revealed 28% of these images were suboptimal and deceptive, due to unappreciated overlapping vessels. CONCLUSIONNo standard projection angles can be recommended with 2D roadmapping to consistently visualize UA origin. The 3DRA can be as a useful tool for UAE to achieve reliable and consistent visibility of the UA origin.

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Benefits of 3D Rotational DSA Compared with 2D DSA in the Evaluation of Intracranial Aneurysm

Cited by 67 publications

References 15 publications

Frameless neuronavigation based only on 3D digital subtraction angiography using surface-based facial registration

Frameless neuronavigation based only on 3D digital subtraction angiography using surface-based facial registration

Guidelines for the Management of Patients With Unruptured Intracranial Aneurysms

Three-dimensional rotational angiography is preferable to conventional two-dimensional techniques for uterine artery embolization

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