Radiation exposure in the endovascular therapy of cranial and spinal dural arteriovenous fistula in the last decade: a retrospective, single-center observational study

Opitz, Marcel; Zensen, Sebastian; Bos, Denise; Li, Yan; Styczen, Hanna; Wetter, Axel; Guberina, Nika; Jabbarli, Ramazan; Sure, Ulrich; Forsting, Michael; Wanke, Isabel; Deuschl, Cornelius

doi:10.1007/s00234-021-02816-6

Cited by 8 publications

(4 citation statements)

References 34 publications

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“…Recently, Opitz et al suggested a DRL for spinal angiographies performed in patients presenting with SDAVF. They presented dosimetric data for SDAVFs from 58 diagnostic spinal angiographies, revealing a DRL of 396.39 Gy cm 2 [18], which is in line with our calculated values. Furthermore, two multicenter studies from France done by Etard et al and Kien et al reported DRLs for spinal angiographies [19,20].…”

Section: Resultssupporting

confidence: 88%

Radiation Dose and Fluoroscopy Time of Diagnostic Angiography in Patients with Spinal Dural Arteriovenous Fistula

et al. 2022

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Purpose Spinal dural arteriovenous fistulas (SDAVFs) represent the most common indication for a spinal angiography. The diagnostic reference level (DRL) for this specific endovascular procedure is still to be determined. This single-center study provides detailed dosimetrics of diagnostic spinal angiography performed in patients with SDAVFs. Methods Retrospective analysis of all diagnostic spinal angiographies between December 2011 and January 2021. Only patients with an SDAVF who had baseline magnetic resonance angiography (MRA), diagnostic digital subtraction angiography (DSA), treatment and follow-up at this institution were included. Dose area product (DAP, Gy cm2) and fluoroscopy time were compared between preoperative and postoperative angiographies, according to SDAVF locations (common versus uncommon), MRA results at baseline (positive versus negative) and DSA protocols (low-dose, mixed-dose, normal-dose). The 75th percentile of the DAP distribution was used to define the local DRL. Results A total of 62 spinal angiographies were performed in 25 patients with SDAVF. Preoperative angiographies (30/62, 48%) yielded a significantly higher DAP and longer fluoroscopy time when compared to postoperative angiographies (32/62, 53%) (p < 0.01). The local DRL was 329.41 Gy cm2 for a nonspecific (n = 62), 395.59 Gy cm2 for a preoperative and 138.6 Gy cm2 for a postoperative spinal angiography. Preoperative angiography of uncommonly located SDAVFs yielded a significantly longer fluoroscopy time (p = 0.02). The MRA-based fistula detection had no significant impact on dosimetrics (p > 0.05). A low-dose protocol yielded a 61% reduction of DAP. Conclusion The results of the present study suggest novel DRLs for spinal angiography in patients with SDAVF. Dedicated low-dose protocols enable radiation dose optimization in these procedures.

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Section: Resultssupporting

confidence: 88%

Radiation Dose and Fluoroscopy Time of Diagnostic Angiography in Patients with Spinal Dural Arteriovenous Fistula

et al. 2022

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“…Only in a few dosimetry studies, have intracranial DAFVs been represented as a subcategory [ 14 , 21 , 22 ]. The reported results in terms of local DRLs were quite various (414 Gy cm 2 , 507.33 Gy cm 2 and 730 Gy cm 2 ).…”

Section: Discussionmentioning

confidence: 99%

“…The reported results in terms of local DRLs were quite various (414 Gy cm 2 , 507.33 Gy cm 2 and 730 Gy cm 2 ). However, Forbrig et al [ 14 ] and Opitz et al [ 21 ] excluded CCFs, and Kien et al [ 22 ] did not describe the inclusion criteria in detail. Regarding FT, Forbrig et al, proposed 142 min and Kien et al, 80 min.…”

Section: Discussionmentioning

confidence: 99%

Radiation Dose and Fluoroscopy Time of Endovascular Coil Embolization in Patients with Carotid Cavernous Fistulas

et al. 2022

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Carotid cavernous fistulas (CCFs) are abnormal connections between the cavernous sinus and the internal and/or external carotid artery. Endovascular therapy is the gold standard treatment. In the current retrospective single-center study we report detailed dosimetrics of all patients with CCFs treated by endovascular coil embolization between January 2012 and August 2021. Procedural and dosimetric data were compared between direct and indirect fistulas according to Barrow et al., and different DSA protocol groups. The local diagnostic reference level (DRL) was defined as the 3rd quartile of the dose distribution. In total, thirty patients met the study criteria. The local DRL was 376.2 Gy cm2. The procedural dose area product (DAP) (p = 0.03) and the number of implanted coils (p = 0.02) were significantly lower in direct fistulas. The median values for fluoroscopy time (FT) (p = 0.08) and number of DSA acquisitions (p = 0.84) were not significantly different between groups. There was a significantly positive correlation between DAP and FT (p = 0.003). The application of a dedicated low-dose protocol yielded a 32.6% DAP reduction. In conclusion, this study provides novel DRLs for endovascular CCF treatment using detachable coils. The data presented in this work might be used to establish new specific DRLs.

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“…Several studies have reported on radiation exposure and FT during neurointerventional procedures with modern biplane angiography systems, e.g., mechanical thrombectomy [ 20 , 21 ] and endovascular treatment of intracranial dural arteriovenous fistulae [ 22 , 23 ] or carotid-cavernous fistula [ 24 ]. The aim is to raise awareness of the radiation dose and, in the long term, to optimize the modification of angiography systems and therapeutic techniques.…”

Section: Discussionmentioning

confidence: 99%

Radiation dose and fluoroscopy time of aneurysm coiling in patients with unruptured and ruptured intracranial aneurysms as a function of aneurysm size, location, and patient age

et al. 2022

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Purpose Endovascular treatment of unruptured intracranial aneurysms (UIAs) requires a risk–benefit analysis and adherence to diagnostic reference levels (DRLs). The national DRL (250 Gy·cm2) is only determined for intracranial aneurysm coiling in general, including ruptured intracranial aneurysms (RIAs). This study aims to investigate the dose in the treatment of UIAs and RIAs separately. Methods In a retrospective study design, dose area product (DAP) and fluoroscopy time (FT) were assessed for all patients undergoing intracranial aneurysm coiling between 2010 and 2021. DRL was set as the 75th percentile of the dose distribution. A multivariable linear regression analysis was performed to investigate DAP and FT for the two groups, UIA and RIA adjusted for patient age, aneurysm size, and location. Results 583 (414 females, mean age 56.5 years, 311 UIAs) are included. In the overall population, DAP (median (IQR)) is 157 Gy·cm2 (108–217) with a median FT of 32.7 min (IQR 24.0–47.0). Local DRL is 183 Gy·cm2 for UIAs and 246 Gy·cm2 for RIAs. After adjustment for the other variables, the UIA and RIA groups have a significant effect on both DAP (p < 0.001; 95% CI − 68.432 – − 38.040) and FT (p < 0.001; 95% CI − 628.279 – − 291.254). In general, both DAP and FT increase significantly with patient age and aneurysm size, whereas the location of the aneurysm did not significantly change neither DAP (p = 0.171; 95% CI − 5.537–31.065) nor FT (p = 0.136; 95% CI − 357.391–48.508). Conclusion Both aneurysm size and patient age were associated with increased DAP, whereas aneurysm location did not significantly change DAP or FT. The increased dose in patients with RIAs is likely equivalent to additional diagnostic cerebral four-vessel angiography performed in this group.

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Radiation exposure in the endovascular therapy of cranial and spinal dural arteriovenous fistula in the last decade: a retrospective, single-center observational study

Cited by 8 publications

References 34 publications

Radiation Dose and Fluoroscopy Time of Diagnostic Angiography in Patients with Spinal Dural Arteriovenous Fistula

Radiation Dose and Fluoroscopy Time of Diagnostic Angiography in Patients with Spinal Dural Arteriovenous Fistula

Radiation Dose and Fluoroscopy Time of Endovascular Coil Embolization in Patients with Carotid Cavernous Fistulas

Radiation dose and fluoroscopy time of aneurysm coiling in patients with unruptured and ruptured intracranial aneurysms as a function of aneurysm size, location, and patient age

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