Cerebral Aneurysm Pulsation: Do Iterative Reconstruction Methods Improve Measurement Accuracy In Vivo?

Illies, Till; Säring, Dennis; Kinoshita, Manabu; Fujinaka, Toshiyuki; Bester, Maxim; Fiehler, Jens; Tomiyama, Noriyuki; Watanabe, Yoshiyuki

doi:10.3174/ajnr.a4000

Cited by 8 publications

(1 citation statement)

References 16 publications

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“…Increasingly, the use of static morphological parameters is questioned [ 33 ], with the adjunctive presence of UIA pulsation perhaps being critical to rupture risk decisions, particularly for small UIA [ 34 ]. However, while UIA pulsation is suggested to be important in the risk assessment of UIA, the requirements for CT imaging equipment capable of evaluating pulsation have been a practical clinical barrier [ 35 ]. While the development of 64-multi-slice spiral CT has found success in overcoming large-scale motions of the heart and the great vessels, requisite long scan time, small z-axis coverage, and low temporal resolution preclude capturing the needed CT scan data within a single cardiac cycle, which is required to observe the minute pulsation of UIAs [ 10 ].…”

Section: Discussionmentioning

confidence: 99%

Dynamic evaluation of unruptured intracranial aneurysms by 4D-CT angiography: comparison with digital subtraction angiography (DSA) and surgical findings

Yang,

Gao,

Gao

et al. 2023

BMC Med Imaging

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Background This study was to prospectively investigate the feasibility of four-dimensional computed tomography angiography (4D-CTA) with electrocardiogram-gated (ECG) reconstruction for preoperative evaluation of morphological parameters, and compared with digital subtraction angiography (DSA). We also aimed to detect pulsation in unruptured intracranial aneurysms (UIAs) by using 4D-CTA, as a potential predicting factor of growth or rupture. Materials 64 patients with 64 UIAs underwent ECG-gated dynamic 4D-CTA imaging before treatment, of which 46 patients additionally underwent DSA. Original scanning data were reconstructed to produce 20 data sets of cardiac cycles with 5%-time intervals. The extent of agreement on UIAs morphological features assessed with 4D-CTA and DSA was estimated using the k coefficient of the Kappa test. The radiation doses were also calculated and compared between 4D-CTA and DSA. In the aneurysmal surgically treated in our institution, we were able to compare the surgical findings of the aneurysm wall with 4D-CTA images. We performed long-term follow-up on untreated patients. Results The morphological characteristics detected by 4D-CTA and DSA were consistent in aneurysm location (k = 1.0), shape (k = 0.76), maximum diameter (k = 0.94), aneurysm neck (k = 0.79) and proximity to parent and branch vessels (k = 0.85). 4D-CTA required lower radiation doses (0.32 ± 0.11 mSv) than DSA (0.84 ± 0.37 mSv, P < 0.001). Pulsation was detected in 26 of the 64 unruptured aneurysms, and all underwent neurosurgical clipping or interventional embolization. In aneurysms surgically treated in our hospital, we observed a significant correlation between 4D-CTA findings and surgical evaluation of the aneurysmal wall, in particular the irregular pulsations detected on 4D-CTA have demonstrated to correspond to dark-reddish thinner wall at surgery. Conclusions In this proof-of-concept study, 4D-CTA provided real-time, non-invasive preoperative assessments of UIAs comparable to DSA. Moreover, optimal correlation between the irregular pulsation detected by 4D-CTA and the surgical findings support a possible role of this technique to identify aneurysms with a higher risk of rupture.

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Section: Discussionmentioning

confidence: 99%

Dynamic evaluation of unruptured intracranial aneurysms by 4D-CT angiography: comparison with digital subtraction angiography (DSA) and surgical findings

Yang,

Gao,

Gao

et al. 2023

BMC Med Imaging

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Feasibility of capturing vessel expansion with 4D‐CTA: Phantom study to determine reproducibility, spatial and temporal resolution

Linden,

Stam,

Aquarius

et al. 2024

Medical Physics

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BackgroundDynamic Computed Tomography Angiography (4D CTA) has the potential of providing insight into the biomechanical properties of the vessel wall, by capturing motion of the vessel wall. For vascular pathologies, like intracranial aneurysms, this could potentially refine diagnosis, prognosis, and treatment decision‐making.PurposeThe objective of this research is to determine the feasibility of a 4D CTA scanner for accurately measuring harmonic diameter changes in an in‐vitro simulated vessel.MethodsA silicon tube was exposed to a simulated heartbeat. Simulated heart rates between 40 and 100 beats‐per‐minute (bpm) were tested and the flow amplitude was varied, resulting in various changes of tube diameter. A 320‐detector row CT system with ECG‐gating captured three consecutive cycles of expansion. Image registration was used to calculate the diameter change. A vascular echography set‐up was used as a reference, using a 9 MHz linear array transducer. The reproducibility of 4D CTA was represented by the Pearson correlation (r) between the three consecutive diameter change patterns, captured by 4D CTA. The peak value similarity (pvs) was calculated between the 4D CTA and US measurements for increasing frequencies and was chosen as a measure of temporal resolution. Spatial resolution was represented by the Sum of the Relative Percentual Difference (SRPD) between 4D CTA and US diameter change patterns for increasing amplitudes.ResultsThe reproducibility of 4D CTA measurements was good (r ≥ 0.9) if the diameter change was larger than 0.3 mm, moderate (0.7 ≤ r < 0.9) if the diameter change was between 0.1 and 0.3 mm, and low (r < 0.7) if the diameter change was smaller than 0.1 mm. Regarding the temporal resolution, the amplitude of 4D CTA was similar to the US measurements (pvs ≥ 90%) for the frequencies of 40 and 50 bpm. Frequencies between 60 and 80 bpm result in a moderate similarity (70% ≤ pvs < 90%). A low similarity (pvs < 70%) is observed for 90 and 100 bpm. Regarding the spatial resolution, diameter changes above 0.30 mm result in SRPDs consistently below 50%.ConclusionIn a phantom setting, 4D CTA can be used to reliably capture reproducible tube diameter changes exceeding 0.30 mm. Low pulsation frequencies (40 or 50 bpm) provide an accurate measurement of the maximum tube diameter change.

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Reduction of misregistration on cerebral four-dimensional computed tomography angiography images using advanced patient motion correction reconstruction

et al. 2016

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Cerebral Aneurysm Pulsation: Do Iterative Reconstruction Methods Improve Measurement Accuracy In Vivo?

Cited by 8 publications

References 16 publications

Dynamic evaluation of unruptured intracranial aneurysms by 4D-CT angiography: comparison with digital subtraction angiography (DSA) and surgical findings

Dynamic evaluation of unruptured intracranial aneurysms by 4D-CT angiography: comparison with digital subtraction angiography (DSA) and surgical findings

Feasibility of capturing vessel expansion with 4D‐CTA: Phantom study to determine reproducibility, spatial and temporal resolution

Reduction of misregistration on cerebral four-dimensional computed tomography angiography images using advanced patient motion correction reconstruction

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