Multimodal angiographic assessment of cerebral arteriovenous malformations: a pilot study

Blanc, Raphaël; Seiler, Aude; Robert, Thomas; Baharvahdat, Humain; Lafarge, Maxime W.; Savatovsky, Julien; Hodel, Jérôme; Cicciò, Gabriele; Chauvet, Dorian; Pistocchi, Silvia; Bartolini, Bruno; Redjem, Hocine; Piotin, Michel

doi:10.1136/neurintsurg-2014-011402

Cited by 20 publications

(13 citation statements)

References 33 publications

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“…Three Points Of Interest (POIs) were identified and exported as 3D models (a). The virtual catherization trace was then reviewed for each POI on cross sectional views to assess its accuracy, as shown in coronal and sagittal reconstruction for POI 1 (b-c), and sagittal reconstructions for POI 2 (b) and POI 3 (c) (Blanc et al 2015).…”

Section: Discussionmentioning

confidence: 99%

Simulation of superselective catheterization for cerebrovascular lesions using a virtual injection software

Sundararajan

Ranganathan

Kishore³

et al. 2021

CVIR Endovasc

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Background This report addresses the feasibility of virtual injection software based on contrast-enhanced cone-beam CTs (CBCTs) in the context of cerebrovascular lesion embolization. Intracranial arteriovenous malformation (AVM), dural arteriovenous fistula (AVF) and mycotic aneurysm embolization cases with CBCTs performed between 2013 and 2020 were retrospectively reviewed. Cerebrovascular lesions were reviewed by 2 neurointerventionalists using a dedicated virtual injection software (EmboASSIST, GE Healthcare; Chicago, IL). Points of Interest (POIs) surrounding the vascular lesions were first identified. The software then automatically displayed POI-associated vascular traces from vessel roots to selected POIs. Vascular segments and reason for POI identification were recorded. Using 2D multiplanar reconstructions from CBCTs, the accuracy of vascular traces was assessed. Clinical utility metrics were recorded on a 3-point Likert scale from 1 (no benefit) to 3 (very beneficial). Results Nine cases (7 AVM, 1 AVF, 1 mycotic aneurysm) were reviewed, with 26 POIs selected. Three POIs were in 2nd order segments, 8 POIs in 3rd order segments and 15 POIs in 4th order segments of their respective arteries. The reviewers rated all 26 POI traces – involving a total of 90 vascular segments – as accurate. The average utility score across the 8 questions were 2.7 and 2.8 respectively from each reviewer, acknowledging the software’s potential benefit in cerebrovascular embolization procedural planning. Conclusion The operators considered CBCT-based virtual injection software clinically useful and accurate in guiding and planning cerebrovascular lesion embolization in this retrospective review. Future prospective studies in larger cohorts are warranted for validation of this modality.

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Section: Discussionmentioning

confidence: 99%

Simulation of superselective catheterization for cerebrovascular lesions using a virtual injection software

Sundararajan

Ranganathan

Kishore³

et al. 2021

CVIR Endovasc

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“… 4 , 5 Moreover, the evolution of computerized tomographic angiography as well as magnetic resonance tomographic angiography enabled almost noninvasive visualization of the angioarchitecture of cerebral aneurysms, arteriovenous malformations and fistulas without exposing patients to the risks related to trans-catheter angiography. 6 – 8 The preoperative, 3D visualization of cerebral vascular structures is the first and very important step in the planning of the treatment of these conditions. Since the consequences of complications that sometimes occur during endovascular intervention are often disastrous, an adequate visualization of the vascular target during treatment is essential for the appropriate choice of devices and techniques.…”

Section: Discussionmentioning

confidence: 99%

Flexible lateral isocenter: A novel mechanical functionality contributing to dose reduction in neurointerventional procedures

Borota

Patz²

2017

Interv Neuroradiol

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Aim of the study A new functionality that enables vertical mobility of the lateral arm of a biplane angiographic machine is referred to as the flexible lateral isocenter. The aim of this study was to analyze the impact of the flexible lateral isocenter on the air-kerma rate under experimental conditions. Material and methods An anthropomorphic head-and-chest phantom with anteroposterior (AP) diameter of the chest varying from 22 cm to 30 cm simulated human bodies of different body constitutions. The angulation of the AP arm in the sagittal plane varied from 35 degrees to 55 degrees for each AP diameter. The air-kerma rate (mGy/min) values were read from the system dose display in two settings for each angle: flexible lateral isocenter and fixed lateral isocenter. Results The air-kerma rate was significantly lower for all AP diameters of the chest of the phantom when the flexible lateral isocenter was used: (a) For 22 cm, the p value was 0.028; (b) For 25 cm, the p value was 0.0169; (c) For 28 cm, the p value was 0.01005 and (d) For 30 cm, the p value was 0.01703. Conclusion Our results show that the flexible lateral isocenter contributes significantly to the reduction of the air-kerma rate, and thus to a safer environment in terms of dose lowering both for patients and staff.

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“…Three-dimensional (3D) digital subtraction angiography (DSA), which combines two-dimensional (2D) DSA and gantry rotation, is becoming a common technique for the assessment and the treatment of the cerebral arteries [ 1 2 3 4 5 6 7 8 9 10 ].…”

Section: Introductionmentioning

confidence: 99%

“…In most studies of 3D DSA, the injection rate and the volume of contrast medium have been determined based on the arteries involved and the position of the catheter tip [ 1 2 4 5 6 7 8 9 ]. However, the injection parameters for each artery vary among institutions and are not standardized.…”

Section: Introductionmentioning

confidence: 99%

Relationship between Injection Rate and Contrast Enhancement on Three-dimensional Digital Subtraction Angiography of the Cerebral Arteries

Takagi

Hanasaki

2018

Journal of the Belgian Society of Radiology

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Objective:Three-dimensional (3D) digital subtraction angiography (DSA) is becoming a common technique for the assessment of the cerebral arteries. Nevertheless, the injection parameters for each artery are not standardized among institutions. The objective of this study was to analyze the relationship between injection rate and contrast enhancement on 3D DSA of the common carotid artery.Materials and methods:Twenty-four patients who underwent 3D DSA of the common carotid artery from June 2013 to March 2015 were included in this retrospective study. Contrast enhancement of each patient was analyzed for four cerebral arteries segments (A1, A2, M1 and M2) by measuring the average pixel value on the source rotational two-dimensional DSA images. Linear regression analysis was used to investigate the correlation between injection rate and contrast enhancement.Results:All four regression lines showed that a higher injection rate led to higher contrast enhancement. There was a significant relationship for the A1, A2 and M1 segments (P = 0.008, 0.03 and < 0.001) but not for the M2 segment (P = 0.13). The goodness-of-fit of the regression lines was high for the M1 segment (R2 = 0.63). However, as the size of the vascular lumen became narrower, the value for the A1 (R2 = 0.28) and A2 (R2 = 0.19) segments became lower.Conclusion:In 3D DSA of the common carotid artery, contrast enhancement of a relatively wide lumen could be optimized by adjusting the injection rate. However, it is difficult to optimize the contrast enhancement of a relatively narrow lumen only by adjusting the injection rate.

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Multimodal angiographic assessment of cerebral arteriovenous malformations: a pilot study

Cited by 20 publications

References 33 publications

Simulation of superselective catheterization for cerebrovascular lesions using a virtual injection software

Simulation of superselective catheterization for cerebrovascular lesions using a virtual injection software

Flexible lateral isocenter: A novel mechanical functionality contributing to dose reduction in neurointerventional procedures

Relationship between Injection Rate and Contrast Enhancement on Three-dimensional Digital Subtraction Angiography of the Cerebral Arteries

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