Virtual 2D angiography from four-dimensional digital subtraction angiography (4D-DSA): A feasibility study

Abstract

Background Digital subtraction angiography (DSA) remains the gold standard for angiographic evaluation of cerebrovascular pathology, however, multiple acquisitions requiring additional time and radiation are often needed. In contrast, 3D-DSA provides volumetric information from a single injection but neglects temporal information. Four-dimensional-DSA (4D-DSA) combines temporal information of 2D-DSA with volumetric information of 3D-DSA to provide time-resolved tomographic 3D reconstructions, potentially reducing procedure time and radiation. This work evaluates the diagnostic quality of virtual single-frame 4D-DSA relative to 2D-DSA images by assessing clinicians’ ability to evaluate cerebrovascular pathology. Methods Single-frame images of four projections from 4D-DSA and their corresponding 2D-DSA images (n = 15) were rated by two neurointerventional radiologists. Images were graded based on diagnostic quality (0 = non-diagnostic, 1 = poor, 2 = acceptable, 3 = good). Dose area product (DAP) for each case was recorded for all 2D-DSA, 4D-DSA acquisitions, and the overall procedure. Results The mean diagnostic quality of all four 4D-DSA projections from both raters was 1.75 while the mean of 2D-DSA projections was 2.8. Student’s t-test revealed significant difference in diagnostic quality between 4D-DSA and 2D-DSA at all four projections (p < 0.001). On average 4D-DSA acquisitions accounted for 30% dose compared to the overall average aggregated dose per procedure. Conclusions The difference in image quality between virtual single-frame 4D-DSA and their respective 2D-DSA images is statistically significant. Furthermore, 4D-DSA acquisitions require less radiation dose than conventional procedures with 2D-DSA acquisitions.

Four‐dimensional digital subtraction angiography to assess cerebral arteriovenous malformations

“…Previous study also attempted to use the virtual 2D angiography generated from 4D DSA as a substitution for conventional 2D DSA to reduce overall time, contrast, and radiation dose from multiple 2D acquisitions. 14 Their results showed that the spatial resolution of the virtual 2D DSA was not comparable to conventional 2D DSA, especially in small vessels. Combined with our results, we can conclude that 4D DSA cannot be used as a substitution for 2D…”

“…Furter increasing the spatial resolution in future prototype versions might allow to better resolve vessels, which are located very close to each other. Previous study also attempted to use the virtual 2D angiography generated from 4D DSA as a substitution for conventional 2D DSA to reduce overall time, contrast, and radiation dose from multiple 2D acquisitions 14 . Their results showed that the spatial resolution of the virtual 2D DSA was not comparable to conventional 2D DSA, especially in small vessels.…”

Double C-Arm Digital Subtraction Angiography Guidance During Transjugular Intrahepatic Portosystemic Shunt Placement

“…The most technically challenging step in TIPS procedure, and frequently the longest, is the puncture of the PV following HV access [16,17]. Double C-arm DSA has been widely used in clinical practice, especially in neurointerventional practice [18].…”

A Systematic Review Comparing Digital Subtraction Angiogram With Magnetic Resonance Angiogram Studies in Demonstrating the Angioarchitecture of Cerebral Arteriovenous Malformations

“…Computer-assisted radio monitoring (CARM) and cone-beam computed tomography systems are the methodologies used for developing and measuring volume in the vascular body and are the primary techniques encompassed in four-dimensional (4D) DSA (or time-resolved DSA) [ 8 , 9 ]. The only limitation of digital subtraction angiogram is the contrast-induced procedure and its risk of possessing ionizing radiation; however, the advantages outweigh the risk by a huge margin [ 10 ].…”