scholarly journals The value of three-dimensional digital subtraction angiography for detection and classification of intracranial aneurysm remnants after clipping

2021 ◽  
Vol 1 ◽  
pp. 100328
Author(s):  
S. Marbacher ◽  
B. Grüter ◽  
M. Halter ◽  
D.R. Vogt ◽  
J. Kienzler ◽  
...  
Keyword(s):  
Intracranial Aneurysm ◽  
Digital Subtraction Angiography ◽  
Three Dimensional ◽  
Digital Subtraction

scholarly journals Value of Three-Dimensional Digital Subtraction Angiography for Detection and Classification of Intracranial Aneurysm Remnants After Clipping

2021 ◽  
Author(s):  
Serge Marbacher ◽  
Matthias Halter ◽  
Deborah R Vogt ◽  
Jenny C Kienzler ◽  
Christian T J Magyar ◽  
...  
Keyword(s):  
Intracranial Aneurysm ◽  
Digital Subtraction Angiography ◽  
Diagnostic Yield ◽  
Three Dimensional ◽  
P Value ◽  
Digital Subtraction ◽  
Patient Demographics ◽  
Included Patient ◽  
2D And 3D

Abstract BACKGROUND The current gold standard for evaluation of the surgical result after intracranial aneurysm (IA) clipping is two-dimensional (2D) digital subtraction angiography (DSA). While there is growing evidence that postoperative 3D-DSA is superior to 2D-DSA, there is a lack of data on intraoperative comparison. OBJECTIVE To compare the diagnostic yield of detection of IA remnants in intra- and postoperative 3D-DSA, categorize the remnants based on 3D-DSA findings, and examine associations between missed 2D-DSA remnants and IA characteristics. METHODS We evaluated 232 clipped IAs that were examined with intraoperative or postoperative 3D-DSA. Variables analyzed included patient demographics, IA and remnant distinguishing characteristics, and 2D- and 3D-DSA findings. Maximal IA remnant size detected by 3D-DSA was measured using a 3-point scale of 2-mm increments. RESULTS Although 3D-DSA detected all clipped IA remnants, 2D-DSA missed 30.4% (7 of 23) and 38.9% (14 of 36) clipped IA remnants in intraoperative and postoperative imaging, respectively (95% CI: 30 [ 12, 49] %; P-value .023 and 39 [23, 55] %; P-value = <.001), and more often missed grade 1 (< 2 mm) clipped remnants (odds ratio [95% CI]: 4.3 [1.6, 12.7], P-value .005). CONCLUSION Compared with 2D-DSA, 3D-DSA achieves a better diagnostic yield in the evaluation of clipped IA. Our proposed method to grade 3D-DSA remnants proved to be simple and practical. Especially small IA remnants have a high risk to be missed in 2D-DSA. We advocate routine use of either intraoperative or postoperative 3D-DSA as a baseline for lifelong follow-up of clipped IA.

Comparison of Intra- and Postoperative 3-Dimensional Digital Subtraction Angiography in Evaluation of the Surgical Result After Intracranial Aneurysm Treatment

Neurosurgery ◽  
2019 ◽  
Vol 87 (4) ◽  
pp. 689-696 ◽  
Author(s):  
Serge Marbacher ◽  
Jenny C Kienzler ◽  
Itai Mendelowitsch ◽  
Donato D’Alonzo ◽  
Lukas Andereggen ◽  
...  
Keyword(s):  
Image Quality ◽  
Intracranial Aneurysm ◽  
Digital Subtraction Angiography ◽  
Three Dimensional ◽  
Standard Of Care ◽  
Digital Subtraction ◽  
Factors Affecting ◽  
Imaging Quality ◽  
3 Dimensional ◽  
Surgical Result

Abstract BACKGROUND Postoperative three-dimensional digital subtraction angiography (3D-DSA) is the gold standard in evaluating intracranial aneurysm (IA) remnants after clipping. Should intraoperative 3D-DSA image quality be equally good as postoperative 3D-DSA, it could supplant the latter as standard of care for follow-up of clipped IA. OBJECTIVE To directly compare the quality of assessment of clipped IA by intraoperative and postoperative 3D-DSA. METHODS From a prospective cohort of 221 consecutive patients who underwent craniotomy for IA treatment in a hybrid operating room, we retrospectively studied 26 patients who had both intraoperative and postoperative 3D-DSA imaging of their clipped aneurysm. Comparison of intraoperative and postoperative 3D-DSA images (blinded for review) included parameters that affected image quality and differences between the 2 periods. RESULTS In the 26 patients with 32 clipped IAs, the mean interval was 11 ± 7 mo between intraoperative and postoperative imaging 3D-DSA examinations. Reconstruction with multiple clips was used in 14 (44%) cases. Of 15 remnants, 9 (60%) were small (<2 mm). In comparing intraoperative and postoperative 3D-DSA, no discordance or discrepancy in assessment of the surgical result was noted for any clipped IA, and overall imaging quality was excellent for both modalities. Factors affecting minor differences in image quality were not identified. CONCLUSION Compared with postoperative 3D-DSA, intraoperative 3D-DSA images achieved equally high quality and effective, immediate interpretation of the surgical clipping result. With comparable imaging quality and no discordant findings, intraoperative 3D-DSA could replace postoperative 3D-DSA to become the standard of care in IA surgery.

scholarly journals Application of low injection rate and low contrast agent dose in three-dimensional rotational digital subtraction angiography of the intracranial aneurysm

2016 ◽  
Vol 22 (3) ◽  
pp. 287-292 ◽  
Author(s):  
Zhimei Gao ◽  
Yongming Zeng ◽  
Jingkun Sun ◽  
Jingjie Yang ◽  
Yang Zhou ◽  
...  
Keyword(s):  
Intracranial Aneurysm ◽  
Contrast Agent ◽  
Digital Subtraction Angiography ◽  
Three Dimensional ◽  
Noise Signal ◽  
Injection Rate ◽  
Digital Subtraction ◽  
Low Contrast ◽  
Noise Ratio ◽  
Rotational Digital Subtraction Angiography

Objective The objective of this article is to explore the feasibility of low injection rate and low contrast agent dose in three-dimensional rotational digital subtraction angiography (3D DSA) of the intracranial aneurysm. Materials and methods Fifty-one patients with suspected intracranial aneurysms were included. The catheter tip was kept within the internal carotid artery at the epistropheus level. Patients were divided into three groups randomly according to injection rate: group A (1.5 ml/s, n = 18), group B (2.0 ml/s, n = 18), and group C (3.0 ml/s, n = 15). The noise, signal-to-noise ratio (SNR), and carrier-to-noise ratio (CNR) of C2, C6, M1, and A1 segments were calculated. The continuous subtraction images and reconstructed images were evaluated by two technicians. Results No significant differences were found in noise between groups A and B, and groups A and C. Significant differences were found in the SNR and CNR of M1 and A1 segments between groups A and B, and groups B and C, but for C2 and C6 segments, they were not significant. Significant differences were found in the SNR and CNR of all segments between groups A and C. Significant differences were found in the contrast agent dose between all three groups. No significant differences were found in scores evaluated by two physicians between the three groups. Conclusion The personalized injection protocol of low injection rate and low contrast agent dose in 3D DSA of the intracranial aneurysm is feasible. The application of this protocol can reduce the dose of iodine and obtain satisfactory images.

scholarly journals Estimation of the number of feeding arteries of spinal arteriovenous malformations by using three-dimensional digital subtraction angiography

2018 ◽  
Vol 28 (4) ◽  
pp. 842-848 ◽  
Author(s):  
Soichiro Takamiya ◽  
Toshiya Osanai ◽  
Toshitaka Seki ◽  
Noriyuki Fujima ◽  
Kazutoshi Hida ◽  
...  
Keyword(s):  
Digital Subtraction Angiography ◽  
Arteriovenous Malformations ◽  
Three Dimensional ◽  
Digital Subtraction ◽  
Spinal Arteriovenous Malformations

scholarly journals Four-dimensional digital subtraction angiography for exploration of intraosseous arteriovenous fistula in the sphenoid bone

2021 ◽  
Vol 12 ◽  
pp. 85
Author(s):  
Toshihiro Ishibashi ◽  
Fumiaki Maruyama ◽  
Issei Kan ◽  
Tohru sano ◽  
Yuichi Murayama
Keyword(s):  
Arteriovenous Fistula ◽  
Digital Subtraction Angiography ◽  
Three Dimensional ◽  
Sphenoid Bone ◽  
External Carotid ◽  
Digital Subtraction ◽  
Fused Image ◽  
Initial Imaging ◽  
Bilateral Abducens Palsy ◽  
Bilateral Abducens

Background: Intraosseous arteriovenous fistula (AVF) is a rare clinical entity that typically presents with symptoms from their effect on surrounding structures. Here, we report a case of intraosseous AVF in the sphenoid bone that presented with bilateral abducens palsy. Case Description: A previously healthy man presented with tinnitus for 1 month, and initial imaging suspected dural AVF of the cavernous sinus. Four-dimensional digital subtraction angiography (4D-DSA) imaging and a three-dimensional (3D) fused image from the bilateral external carotid arteries revealed that the shunt was in a large venous pouch within the sphenoid bone that was treated through transvenous coil embolization. His symptoms improved the day after surgery. Conclusion: This is a case presentation of intraosseous AVF in the sphenoid bone and highlights the importance of 4D-DSA and 3D fused images for planning the treatment strategy.

Fusion Technique Using Three-Dimensional Digital Subtraction Angiography in the Evaluation of Complex Cerebral and Spinal Vascular Malformations

2016 ◽  
Vol 85 ◽  
pp. 353-358 ◽  
Author(s):  
Kenji Fukuda ◽  
Toshio Higashi ◽  
Masakazu Okawa ◽  
Mitsutoshi Iwaasa ◽  
Hiroshi Abe ◽  
...  
Keyword(s):  
Digital Subtraction Angiography ◽  
Vascular Malformations ◽  
Three Dimensional ◽  
Digital Subtraction ◽  
Fusion Technique ◽  
Spinal Vascular Malformations
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