Numerical Simulation of the Intra-Aneurysmal Flow Dynamics

Intra-aneurysmal flow dynamics is analyzed qualitatively and quantitatively with numerical simulation technique, and presented for the future clinical application in embolizing cerebral aneurysms. From the volumetric data obtained by three-dimensional computed tomographic angiography, patient-specific vessel models were created for 16 middle cerebral artery aneurysms. Intra-aneurysmal flow dynamics was visualized and analyzed qualitatively, and the geometrical parameters of vessels and aneurysms that affect the intra-aneurysmal flow dynamics were determined quantitatively by correlation analysis. The flow velocity was delayed in the aneurysm cavity, especially at its tip where the rupture usually occurs. The intra-aneurysmal flow dynamics was considerably influenced by the geometrical parameters that are related to the width of the neck and the branching angle of larger branch artery. The intra-aneurysmal flow dynamics is complex, and the numerical flow simulations with patient-specific vascular models seems effective in understanding the flow dynamics and planning the endovascular treatment of cerebral aneurysms.

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The Accuracy and Usefulness of 3D-DSA and 3D-CT Angiography for Cerebral Aneurysms

Interventional Neuroradiology ◽

10.1177/15910199010070s128 ◽

2001 ◽

Vol 7 (1_suppl) ◽

pp. 181-186 ◽

Cited By ~ 4

Author(s):

F. Ishida ◽

K. Kawaguchi ◽

M. Mizuno ◽

T. Hoshino ◽

K. Murao ◽

...

Keyword(s):

Intracranial Aneurysms ◽

Three Dimensional ◽

Cerebral Aneurysms ◽

Computed Tomographic Angiography ◽

Dissecting Aneurysm ◽

Digital Subtraction ◽

Computed Tomographic ◽

3D Ct Angiography ◽

The Difference ◽

Tomographic Angiography

For evaluation of intracranial cerebral aneurysms, three-dimensional (3D) digital subtraction angiography (DSA) and 3D-computed tomographic angiography (CTA) were demonstrated in fifteen patients. The diagnostic accuracy of preoperative 3DCTA is equal to that of 3D-DSA except for the case with a dissecting aneurysm. The virtual images of 3D-CTA were well correlated with surgical findings. In endovascular treatment of intracranial aneurysms, 3D-DSA had an obvious advantage in obtaining the best working angle of the C-arm. The major branches originating from the dome were depicted on 3D-DSA in two cases that could not be judged on 3D-CTA. The aim of the present study was to verify the difference between 3D-DSA and 3D-CTA for evaluation of intracranial aneurysms.

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Three-dimensional Computed Tomographic Angiography of Cerebral Aneurysms

Neurosurgery ◽

10.1227/00006123-199504000-00016 ◽

1995 ◽

Vol 36 (4) ◽

pp. 749-755 ◽

Cited By ~ 50

Author(s):

Donatella Tampieri ◽

Richard Leblanc ◽

Judy Oleszek ◽

Ronald Pokrupa ◽

Denis Melançon

Keyword(s):

Three Dimensional ◽

Cerebral Aneurysms ◽

Computed Tomographic Angiography ◽

Computed Tomographic ◽

Tomographic Angiography

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Three-dimensional Computed Tomographic Angiography in Detection of Cerebral Aneurysms in Acute Subarachnoid Hemorrhage

Neurosurgery ◽

10.1097/00006123-199707000-00026 ◽

1997 ◽

Vol 41 (1) ◽

pp. 125-130 ◽

Cited By ~ 99

Author(s):

Abderrezak Zouaoui ◽

Mokrane Sahel ◽

Beatrice Marro ◽

Stephane Clemenceau ◽

Nafissa Dargent ◽

...

Keyword(s):

Subarachnoid Hemorrhage ◽

Three Dimensional ◽

Cerebral Aneurysms ◽

Computed Tomographic Angiography ◽

Computed Tomographic ◽

Acute Subarachnoid Hemorrhage ◽

Tomographic Angiography

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Three-dimensional Computed Tomographic Angiography of Cerebral Aneurysms

Neurosurgery ◽

10.1097/00006123-199504000-00016 ◽

1995 ◽

Vol 36 (4) ◽

pp. 749???755 ◽

Cited By ~ 12

Author(s):

Donatella Tampieri ◽

Richard Leblanc ◽

Judy Oleszek ◽

Ronald Pokrupa ◽

Denis Melan??on

Keyword(s):

Three Dimensional ◽

Cerebral Aneurysms ◽

Computed Tomographic Angiography ◽

Computed Tomographic ◽

Tomographic Angiography

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Rebleeding of ruptured cerebral aneurysms during three-dimensional computed tomographic angiography: report of two cases and literature review

Neurosurgical Review ◽

10.1007/s10143-007-0068-6 ◽

2007 ◽

Vol 30 (2) ◽

pp. 151-154 ◽

Cited By ~ 19

Author(s):

Akihito Hashiguchi ◽

Chikara Mimata ◽

Homare Ichimura ◽

Motohiro Morioka ◽

Jun-ichi Kuratsu

Keyword(s):

Literature Review ◽

Three Dimensional ◽

Cerebral Aneurysms ◽

Computed Tomographic Angiography ◽

Computed Tomographic ◽

Tomographic Angiography

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Case series of 64 slice computed tomography-computed tomographic angiography with 3D reconstruction to diagnose symptomatic cerebral aneurysms: new standard of care?

Neurology International ◽

10.4081/ni.2012.e2 ◽

2012 ◽

Vol 4 (1) ◽

pp. 2 ◽

Cited By ~ 2

Author(s):

Dietrich Jehle ◽

Floria Chae ◽

Jonathan Wai ◽

Sam Cloud ◽

David Pierce ◽

...

Keyword(s):

3D Reconstruction ◽

New Technology ◽

Cerebral Arteries ◽

Three Dimensional ◽

Case Series ◽

Cerebral Aneurysms ◽

Standard Of Care ◽

Computed Tomographic Angiography ◽

Computed Tomographic ◽

Tomographic Angiography

CT angiography (CTA) has improved significantly over the past few years such that the reconstructed images of the cerebral arteries may now be equivalent to conventional digital angiography. The new technology of 64 slice multi-detector CTA can reconstruct detailed images that can reliably identify small cerebral aneurysms, even those <3mm. In addition, it is estimated that CT followed by lumbar puncture (LP) misses up to 4% of symptomatic aneurysms. We present a series of cases that illustrates how CT followed by CTA may be replacing CT-LP as the standard of care in working up patients for symptomatic cerebral aneurysms and the importance of performing three dimensional (3D) reconstructions. A series of seven cases of symptomatic cerebral aneurysms were identified that illustrate the sensitivity of CT-CTA <em>versus</em> CT-LP and the importance of 3D reconstruction in identifying these aneurysms. Surgical treatment was recommended for 6 of the 7 patients with aneurysms and strict hypertension control was recommended for the seventh patient. Some of these patients demonstrated subarachnoid hemorrhage on presentation while others had negative LPs. A number of these patients with negative LPs were clearly symptomatic from their aneurysms. At least one of these cerebral aneurysms was not apparent on CTA without 3D reconstruction. 3D reconstruction of CTA is crucial to adequately identify cerebral aneurysms. This case series helps reinforce the importance of 3D reconstruction. There is some data to suggest that 64 slice CT-CTA may be equivalent or superior to CT-LP in the detection of symptomatic cerebral aneurysms.

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Application of Three-Dimensional Printed Vascular Modeling as a Perioperative Guide to Perforator Mapping and Pedicle Dissection during Abdominal Flap Harvest for Breast Reconstruction

Journal of Reconstructive Microsurgery ◽

10.1055/s-0039-1700991 ◽

2020 ◽

Vol 36 (05) ◽

pp. 325-338 ◽

Cited By ~ 1

Author(s):

Michael V. DeFazio ◽

Elsa M. Arribas ◽

Faisal I. Ahmad ◽

Huong T. Le-Petross ◽

Jun Liu ◽

...

Keyword(s):

Breast Reconstruction ◽

Three Dimensional ◽

Computed Tomographic Angiography ◽

Patient Specific ◽

Branching Pattern ◽

Computed Tomographic ◽

Deep Inferior Epigastric Artery ◽

3D Printed ◽

Operative Findings ◽

Tomographic Angiography

Abstract Background Advancements in three-dimensional (3D) printing have enabled production of patient-specific guides to aid perforator mapping and pedicle dissection during abdominal flap harvest. We present our early experience using this tool to navigate deep inferior epigastric artery (DIEA) topography and evaluate its impact on operative efficiency and clinical outcomes. Patients and Methods Between January 2013 and December 2018, a total of 50 women underwent computed tomographic angiography (CTA)-guided perforator mapping prior to abdominal flap breast reconstruction, with (n = 9) and without (n = 41) 3D-printed vascular modeling (3DVM). Models were assessed for their accuracy in identifying perforator location and source-vessel anatomy, as determined by operative findings from 18 hemi-abdomens. The margin of error (MOE) for perforator localization using 3DVM was calculated and compared with CTA-derived measurements for the same patients. Flap harvest times, outcomes, and complications for patients who were preoperatively mapped using 3DVM versus CTA alone were analyzed. Results Overall, complete concordance was observed between 3DVM and operative findings with regards to perforator number, source-vessel origin, and DIEA branching pattern. By comparison, CTA interpretation of these parameters inaccurately identified branching pattern and perforator source-vessel origin in 28 and 33% of hemi-abdomens, respectively (p = 0.045 and p = 0.02). Compared with operative measurements, the average MOE for perforator localization using 3DVM was significantly lower than that obtained from CTA alone (0.81 vs. 8.71 mm, p < 0.0001). Reference of 3D-printed models, intraoperatively, was associated with a mean reduction in flap harvest time by 21 minutes (60.7 vs. 81.7 minutes, p < 0.001). Although not statistically significant, rates of perforator-level injury, microvascular insufficiency, and fat necrosis were lower among patients mapped using 3DVM. Conclusion The results of this study support the accuracy of 3DVM for identifying DIEA topography and perforator location. Application of this technology may translate to enhanced operative efficiency and fewer perfusion-related complications for patients undergoing abdominal free flap breast reconstruction.

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Imaging in Propeller Flap Surgery

Seminars in Plastic Surgery ◽

10.1055/s-0040-1715159 ◽

2020 ◽

Vol 34 (03) ◽

pp. 145-151

Author(s):

Shimpei Ono ◽

Hiroyuki Ohi ◽

Rei Ogawa

Keyword(s):

Low Cost ◽

Three Dimensional ◽

Duplex Sonography ◽

Computed Tomographic Angiography ◽

Ease Of Use ◽

Computed Tomographic ◽

Imaging Tool ◽

Preoperative Mapping ◽

Flap Design ◽

Tomographic Angiography

AbstractSince propeller flaps are elevated as island flaps and most often nourished by a single perforator nearby the defect, it is challenging to change the flap design intraoperatively when a reliable perforator cannot be found where expected to exist. Thus, accurate preoperative mapping of perforators is essential in the safe planning of propeller flaps. Various methods have been reported so far: (1) handheld acoustic Doppler sonography (ADS), (2) color duplex sonography (CDS), (3) perforator computed tomographic angiography (P-CTA), and (4) magnetic resonance angiography (MRA). To facilitate the preoperative perforator assessment, P-CTA is currently considered as the gold standard imaging tool in revealing the three-dimensional anatomical details of perforators precisely. Nevertheless, ADS remains the most widely used tool due to its low cost, faster learning, and ease of use despite an undesirable number of false-positive results. CDS can provide hemodynamic characteristics of the perforator and is a valid and safer alternative particularly in patients in whom ionizing radiation and/or contrast exposure should be limited. Although MRA is less accurate in detecting smaller perforators of caliber less than 1.0 mm and the intramuscular course of perforators at the present time, MRA is expected to improve in the future due to the recent developments in technology, making it as accurate as P-CTA. Moreover, it provides the advantage of being radiation-free with fewer contrast reactions.

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Preoperative Use of CT Angiography in Infants With Coarctation of the Aorta

World Journal for Pediatric and Congenital Heart Surgery ◽

10.1177/2150135116683929 ◽

2017 ◽

Vol 8 (2) ◽

pp. 196-202 ◽

Cited By ~ 8

Author(s):

Kirsten Rose-Felker ◽

Joshua D. Robinson ◽

Carl L. Backer ◽

Cynthia K. Rigsby ◽

Osama M. Eltayeb ◽

...

Keyword(s):

Radiation Dose ◽

Surgical Approach ◽

New Technology ◽

Three Dimensional ◽

Coarctation Of The Aorta ◽

Computed Tomographic Angiography ◽

Great Vessel ◽

Z Score ◽

Computed Tomographic ◽

Tomographic Angiography

Background: Computed tomographic angiography (CTA) and echocardiography (echo) are used preoperatively in coarctation of the aorta to define arch hypoplasia and great vessel branching. We sought to determine differences in quantitative measurements, as well as surgical utility, between modalities. Methods: Infants (less than six months) with both CTA and echo prior to coarctation repair from 2004 to 2013 were included. Measurements were compared and correlated with surgical approach. Three surgeons reviewed de-identified images to predict approach and characterize utility. Computed tomographic angiography radiation dose was calculated. Results: Thirty-three patients were included. No differences existed in arch measurements between echo and CTA ( z-score: −2.59 vs −2.43; P = .47). No differences between modalities were seen for thoracotomy ( z-score: −2.48 [echo] vs −2.31 [CTA]; P = .48) or sternotomy ( z-score: −3.13 [echo] vs −3.08 [CTA]; P = .84). Computed tomographic angiography delineated great vessel branching pattern in two patients with equivocal echo findings ( P = .60). Surgeons rated CTA as far more useful than echo in understanding arch hypoplasia and great vessel branching in cases where CTA was done to resolve anatomical questions that remain after echo evaluation. Two of three surgeons were more likely to choose the surgical approach taken based on CTA (surgeon A, P = .02; surgeon B, P = .01). Radiation dose averaged 2.5 (1.6) mSv and trended down from 2.9 mSv (1.8 mSv; n = 20) to 1.6 mSv (0.5 mSv; n = 7) ( P = .06) with new technology. Conclusion: Although CTA and echo measurements of the aorta do not differ, CTA better delineates branching and surgeons strongly prefer it for three-dimensional arch anatomy. We recommend CTA for patients with anomalous arch branching patterns, diffuse or complex hypoplasia, or unusual arch morphology not fully elucidated by echo.

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