Radiation Dosimetry of 3D Rotational Neuroangiography and 2D-DSA in Children

Shkumat, Nicholas; Shroff, Manohar; Muthusami, Prakash

doi:10.3174/ajnr.a5568

Cited by 14 publications

(9 citation statements)

References 25 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Regarding radiation exposure, evidence suggests that the radiation exposure is lower for 3DRA than it is for a series of DSA or CTA images; the mean effective doses are roughly 0.9 mSv for a single DSA acquisition, 2.1-3.4 mSv for a series of DSA acquisitions, 3-29 mSv for suspected-stroke CTA, and 0.2-1.3 mSv for 3DRA. 5,8,[31][32][33]35 As for HiRes-XperCT or cone-beam CTA, the speculated radiation exposure is roughly three times greater than that for 3DRA and two times greater than that for a single acquisition of biplane DSA. 28 Our current angiography protocol entails a single acquisition of biplane DSA followed by RA, which mainly includes 3DRA, with the occasional use of HiRes-XperCT for cases with small, faint niduses; thus, it could be speculated that our protocol delivers an equivalent or a lower radiation dose than multiple magnified DSA acquisitions to obtain the appropriate images.…”

Section: Figmentioning

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

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: Figmentioning

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

“…In 2010, Cone Beam CT became available and provided satisfactory image guidance for the procedure. It eventually replaced CT fluoroscopy in 2016 due to its adequate performance, ease of use and recognized radiation dose reduction, as has been demonstrated in the literature [19,20]. The corticosteroid currently used is triamcinolone hexacetonide as studies have shown that it is more effective than hydrocortisone succinate and triamcinolone acetonide in reducing pain and joint inflammation [21,22].…”

Section: Discussionmentioning

confidence: 99%

Image guided sacroiliac joint corticosteroid injections in children: an 18-year single-center retrospective study

et al. 2020

View full text Add to dashboard Cite

Background: Sacroiliitis is commonly seen in enthesitis-related arthritis (ERA), a subtype of juvenile idiopathic arthritis (JIA). Sacroiliitis is characterized by the inflammation of the sacroiliac (SI) joints (+/− adjacent tissues). The treatment options include systemic therapy with or without corticosteroid SI joint injections. Image guided SI joint injections are frequently requested in pediatric patients with sacroiliitis. The purpose of this study was to evaluate the feasibility and efficacy of SI joint injections in children with sacroiliitis. Methods: A retrospective study of patients referred to Interventional Radiology (IR) for SI joint corticosteroid injections (2000-2018). Clinical information was collected from Electronic Patient Charts and procedural details from PACS. Efficacy was determined clinically, by MRI, or both when available. Results: 50 patients (13.8 years; M:F = 35:15) underwent image-guided SI joint corticosteroid injections. Most common indications were JIA (84%) and inflammatory bowel disease (14%). 80% had bilateral injections. 80% were performed under general anesthesia and 20% under sedation. The corticosteroid of choice was triamcinolone hexacetonide in 98% of patients. Needle guidance and confirmation was performed using CT and fluoroscopy (54%), Cone Beam CT (CBCT, 46%), with initial ultrasound assistance in 34%. All procedures were technically successful without any complications. 32/50 patients had long-term follow-up (2 years); 21/32 (66%) had clinical improvement within 3-months. Of 15 patients who had both pre-and post-procedure MRIs, 93% showed shortterm improvement. At 2 years, 6% of patients were in remission, 44% continued the same treatment and 47% escalated treatment. Conclusion: Image-guided SI joint injections are safe and technically feasible in children. Imaging modalities for guidance have evolved, with CBCT being the current first choice. Most patients showed short-term clinical and imaging improvement, requiring long-term maintenance or escalation of medical treatment.

show abstract

“…The ability to perform 3DRA with low radiation doses while maintaining high spatial and contrast resolution reconstructions has also been demonstrated. 32 This allows the use of 3DRA-MR imaging fusion to confidently identify or exclude small vascular nidi or dysplastic structures that are characteristic of bAVM recurrence in children. This is especially relevant for false-positive MR imaging studies because MR imaging enhancement, though highly sensitive for vascular structures, is of questionable significance in the posttreatment setting, as described above.…”

Section: Discussionmentioning

confidence: 99%

Predictive Value of MRI in Diagnosing Brain AVM Recurrence after Angiographically Documented Exclusion in Children

Jhaveri

Amirabadi

Dirks

et al. 2019

AJNR Am J Neuroradiol

Self Cite

View full text Add to dashboard Cite

BACKGROUND AND PURPOSE: MRI is routinely performed following brain AVM after treatment in children. Our aim was to determine the predictive values of contrast-enhanced MR imaging and TOF-MRA for brain AVM recurrence in children, compared with conventional angiography and the role of 3D rotational angiography-MR imaging fusion in these cases. MATERIALS AND METHODS: We included all pediatric patients with brain AVMs during an 18-year period with angiographically documented obliteration after treatment. Patients underwent 3T MR imaging, including contrast-enhanced MR imaging, TOF-MRA, and conventional angiography, with a subset undergoing 3D rotational angiography. The predictive values of contrast-enhanced MR imaging and TOF-MRA for brain AVM recurrence were determined. CTA sections reconstructed from 3D rotational angiography were coregistered with and fused to 3D-T1WI for analysis.

show abstract

Radiation Dosimetry of 3D Rotational Neuroangiography and 2D-DSA in Children

Cited by 14 publications

References 25 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

Image guided sacroiliac joint corticosteroid injections in children: an 18-year single-center retrospective study

Predictive Value of MRI in Diagnosing Brain AVM Recurrence after Angiographically Documented Exclusion in Children

Contact Info

Product

Resources

About