Abstract:The DSA TTs showed significant correlation with Hunt and Hess grades. TT delays appear to be independent of increased intracranial pressure and may be an indicator of decreased CBF in patients with a higher Hunt and Hess grade. This method may serve as an indirect technique to assess relative CBF in the angiography suite.
“…The advantage of using the AUC of the time density curve controlled with the adjacent proximal ICA in the analysis is the minimization of confounders related to the site of the contrast injection, vessel size, or volume of contrast administered. [13][14][15][16][17] Our study shows that the contrast stagnation can be quantified based on the AUC in the aneurysm controlled by the petrous ICA. Patients with incomplete aneurysm occlusion tended to have a paradoxical faster contrast clearance from the aneurysm sac post-FDS compared to baseline, while aneurysms that showed complete occlusion did have a prolonged contrast clearance in the AUC ratio after stent deployment.…”
Section: Discussionmentioning
confidence: 74%
“…With this DSA postprocessing analysis, blood flow is indirectly extrapolated through the computation of the curve obtained by plotting contrast density against time during the angiographic cycle. [13][14][15][16][17] In this study, we used a DSA-based post-processing software, SyngoiFlow TM (Siemens Healthineers, Forchheim, Germany) for a 2D parametric parenchymal blood flow analysis, to study the relative changes in contrast time-density in a cohort of patient with anterior circulation cerebral aneurysms proximal to the ICA terminus treated with FDS. We assess the software's capacity to detect any hemodynamic difference at baseline and immediately after FDS deployment between the aneurysm groups that showed complete vs. incomplete occlusion at six months' follow-up.…”
Objective Indications for the treatment of cerebral aneurysms with flow diversion stents are expanding. The current aneurysm occlusion rate at six months ranges between 60 and 80%. Predictability of complete vs. partial aneurysm occlusion is poorly defined. Here, we evaluate the angiographic contrast time-density as a predictor of aneurysm occlusion rate at six months’ post-flow diversion stents. Methods Patients with unruptured cerebral aneurysms proximal to the internal carotid artery terminus treated with single flow diversion stents were included. 2D parametric parenchymal blood flow software (Siemens-Healthineers, Forchheim, Germany) was used to calculate contrast time-density within the aneurysm and in the proximal adjacent internal carotid artery. The area under the curve ratio between the two regions of interests was assessed at baseline and after flow diversion stents deployment. The area under the curve ratio between completely vs. partially occluded aneurysms at six months’ follow-up was compared. Results Thirty patients with 31 aneurysms were included. Mean aneurysm diameter was 8 mm (range 2–28 mm). Complete occlusion was obtained in 19 aneurysms. Younger patients ( P = 0.006) and smaller aneurysms ( P = 0.046) presented higher chance of complete obliteration. Incomplete occlusion of the aneurysm was more likely if the area under the curve contrast time-density ratio showed absolute ( P = 0.001) and relative percentage ( P = 0.001) decrease after flow diversion stents deployment. Area under ROC curve was 0.85. Conclusion Negative change in the area under the curve ratio indicates less contrast stagnation in the aneurysm and lower chance of occlusion. These data provide a real-time analysis after aneurysm treatment. If validated in larger datasets, this can prompt input to the surgeon to place a second flow diversion stents.
“…The advantage of using the AUC of the time density curve controlled with the adjacent proximal ICA in the analysis is the minimization of confounders related to the site of the contrast injection, vessel size, or volume of contrast administered. [13][14][15][16][17] Our study shows that the contrast stagnation can be quantified based on the AUC in the aneurysm controlled by the petrous ICA. Patients with incomplete aneurysm occlusion tended to have a paradoxical faster contrast clearance from the aneurysm sac post-FDS compared to baseline, while aneurysms that showed complete occlusion did have a prolonged contrast clearance in the AUC ratio after stent deployment.…”
Section: Discussionmentioning
confidence: 74%
“…With this DSA postprocessing analysis, blood flow is indirectly extrapolated through the computation of the curve obtained by plotting contrast density against time during the angiographic cycle. [13][14][15][16][17] In this study, we used a DSA-based post-processing software, SyngoiFlow TM (Siemens Healthineers, Forchheim, Germany) for a 2D parametric parenchymal blood flow analysis, to study the relative changes in contrast time-density in a cohort of patient with anterior circulation cerebral aneurysms proximal to the ICA terminus treated with FDS. We assess the software's capacity to detect any hemodynamic difference at baseline and immediately after FDS deployment between the aneurysm groups that showed complete vs. incomplete occlusion at six months' follow-up.…”
Objective Indications for the treatment of cerebral aneurysms with flow diversion stents are expanding. The current aneurysm occlusion rate at six months ranges between 60 and 80%. Predictability of complete vs. partial aneurysm occlusion is poorly defined. Here, we evaluate the angiographic contrast time-density as a predictor of aneurysm occlusion rate at six months’ post-flow diversion stents. Methods Patients with unruptured cerebral aneurysms proximal to the internal carotid artery terminus treated with single flow diversion stents were included. 2D parametric parenchymal blood flow software (Siemens-Healthineers, Forchheim, Germany) was used to calculate contrast time-density within the aneurysm and in the proximal adjacent internal carotid artery. The area under the curve ratio between the two regions of interests was assessed at baseline and after flow diversion stents deployment. The area under the curve ratio between completely vs. partially occluded aneurysms at six months’ follow-up was compared. Results Thirty patients with 31 aneurysms were included. Mean aneurysm diameter was 8 mm (range 2–28 mm). Complete occlusion was obtained in 19 aneurysms. Younger patients ( P = 0.006) and smaller aneurysms ( P = 0.046) presented higher chance of complete obliteration. Incomplete occlusion of the aneurysm was more likely if the area under the curve contrast time-density ratio showed absolute ( P = 0.001) and relative percentage ( P = 0.001) decrease after flow diversion stents deployment. Area under ROC curve was 0.85. Conclusion Negative change in the area under the curve ratio indicates less contrast stagnation in the aneurysm and lower chance of occlusion. These data provide a real-time analysis after aneurysm treatment. If validated in larger datasets, this can prompt input to the surgeon to place a second flow diversion stents.
“…DSA determination of AVM hemodynamics also generally relies on a time to peak analysis that can be affected by vessel size, amount of contrast injected, and frame rate 12 29. Consequently, mainstay techniques are dependent on the location of the catheter during the contrast injection, vessel diameter, and volume of contrast injected, which may lead to variable and imprecise results.…”
Section: Discussionmentioning
confidence: 99%
“…Individual DSA runs were analyzed for contrast image intensity throughout the angiogram cycle with a custom-made software code (MATLAB, Mathworks, Natick, Massachusetts, USA). This technique identifies various intensity plots, including the maximum gray intensity in consecutive DICOM images 12 13. Region of interest (ROI) was selected over the cavernous ICA ipsilateral to the AVM and over each of the AVM draining veins at their closest point to the nidus.…”
A-Vt and iFlow transit times on DSA correlate with cerebral AVM flow measured using QMRA. Thus, these parameters may be used to indirectly estimate AVM flow before and after embolization during angiography in real time.
“…This technique identified various intensity plots, including the maximum gray intensity in consecutive DICOM images. 6 Region of interest (ROI) was selected over the middle segment of the middle cerebral artery (MCA) M1 segment at baseline and compared to post intervention for the same ROI. The time-intensity plot was divided into three components as shown in Figure 1, and estimated TTs were defined as follows:TT 10%–100% (time needed for the contrast to change from 10% image intensity to 100%) Figure 1.(a) TT 10%–100% at baseline for a patient with a paraophthalmic ICA aneurysm treated with PED.…”
It is postulated that hemodynamic changes occur in the distal vascular bed post-deployment of Pipeline Embolization Devices (PEDs). In this paper, we evaluate changes in the contrast transit times (TTs) on digital subtraction angiography (DSA) post-PED interventions. DSA films were analyzed using custom-made software for the time-density relationship at baseline and compared to post-PED deployment. All analyses were performed within the middle cerebral artery (MCA) M1 segment. Analyses included TT10%–100% (time needed for the contrast to change from 10% image intensity to 100%), TT100%–10%, and TT25%–25%. Forty-four patients were included. We found a significant decrease in TT10%–100% (2.79 to 2.24 seconds, p < 0.001) post-PED. There was a significant correlation between the percentage change in TT100%–10% and aneurysm size ( p = 0.02). There was also a significant decrease in TT25%–25% (7.07 to 6.41 seconds, p = 0.02) post-PED. Moreover, there was a significant correlation between the absolute or percentage changes in TT25%–25% and aneurysm size (rho = 0.54, p = 0.05 and rho = 0.29, p = 0.05, respectively). Statistically significant distal intracranial hemodynamic changes occur post-PED deployment. These hemodynamic changes appear to be more pronounced with large and giant aneurysms.
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