Image-guided vascular neurosurgery based on three-dimensional rotational angiography

✓Three-dimensional rotational angiography is capable of exquisite visualization of cerebral blood vessels and their pathophysiology. Unfortunately, images obtained using this modality typically show a small region of interest without exterior landmarks to allow patient-to-image registration, precluding their use for neuronavigation purposes. The aim of this study was to find an alternative technique to enable 3D rotational angiography–guided vascular neurosurgery. Three-dimensional rotational angiograms were obtained in an angiographic suite with direct navigation capabilities. After image acquisition, a navigated pointer was used to touch fiducial positions on the patient's head. These positions were located outside the image volume but could nevertheless be transformed into image coordinates and stored in the navigation system. Prior to surgery, the data set was transferred to the navigation system in the operating room, and the same fiducial positions were touched again to complete the patient-to-image registration. This technique was tested on a Perspex phantom representing the cerebral vascular tree and on two patients with an intracranial aneurysm. In both the phantom and patients, the neuronavigation system provided 3D images representing the vascular tree in its correct orientation, that is, the orientation seen by the neurosurgeon through the microscope. In one patient, tissue shift was clearly observed without significant changes in the orientation of the structures. Results in this study demonstrate the feasibility of using 3D rotational angiography data sets for neuronavigation purposes. Determining the benefit of this type of navigation should be the subject of future studies.

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Low-Dose 3D Rotational Angiography in Measuring the Size of Intracranial Aneurysm: In Vitro Feasibility Study Using Aneurysm Phantom

Neurointervention ◽

10.5469/neuroint.2020.00437 ◽

2021 ◽

Vol 16 (1) ◽

pp. 59-63

Author(s):

Hee Jong Ki ◽

Bum-soo Kim ◽

Jun-Ki Kim ◽

Jai Ho Choi ◽

Yong Sam Shin ◽

...

Keyword(s):

Intracranial Aneurysm ◽

Endovascular Treatment ◽

Low Dose ◽

Three Dimensional ◽

3D Measurement ◽

Rotational Angiography ◽

3D Rotational Angiography ◽

Conventional Dose ◽

Noninferiority Margin

Purpose: Three-dimensional (3D) measurement of intracranial aneurysms is important in planning endovascular treatment, and 3D rotational angiography (RA) is effective in accurate measurement. The purpose of this study was to evaluate the feasibility of low dose 3D RA (5 seconds 0.10 μGy/frame) in measuring an intracranial aneurysm using an in vitro phantom.Materials and Methods: We investigated an <I>in vitro</i> 3D phantom of an intracranial aneurysm with 10 acquisitions of 3D RA with a conventional dose (5 seconds 0.36 μGy/frame) and 10 acquisitions with a low-dose (5 seconds 0.10 μGy/frame). 3D size and neck diameters of the aneurysm were measured and compared between the 2 groups (conventional and low-dose) using noninferiority statistics.Results: The aneurysm measurements were well-correlated between the 2 readers, and noninferiority in the measurement of aneurysmal size of low-dose 3D RA was demonstrated, as the upper margin of the 1-sided 97.5% confidence interval did not cross the pre-defined noninferiority margin of 0.2 mm by the 2 readers.Conclusion: Low-dose (5 seconds 0.10 μGy/frame) cerebral 3D RA is technically feasible and not inferior in in vitro 3D measurement of an intracranial aneurysm. Thus, low-dose 3D RA is promising and needs further evaluation for its clinical utility in the planning of endovascular treatment of an intracranial aneurysm.

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3D Rotational Angiography: Recent Experience in the Evaluation of Cerebral Aneurysms for Treatment

Interventional Neuroradiology ◽

10.1177/159101990000600202 ◽

2000 ◽

Vol 6 (2) ◽

pp. 85-94 ◽

Cited By ~ 13

Author(s):

S. Ishihara ◽

I.B. Ross ◽

M. Piotin ◽

A. Weill ◽

H. Aerts ◽

...

Keyword(s):

Decision Making ◽

Surgical Treatment ◽

Endovascular Treatment ◽

Three Dimensional ◽

Cerebral Aneurysms ◽

Early Experience ◽

Recent Experience ◽

Rotational Angiography ◽

3D Images ◽

3D Rotational Angiography

Three dimensional (3D) reconstruction techniques providing volume rendered 3D images from rotational angiography data now exist. We report the design and early experience with one such system. 237 aneurysms were studied. Information was obtained on the morphology of the aneurysm itself and the vascular architecture in and around the aneurysm. 218 (92%) aneurysms went on to have endovascular treatment. The 3D images provided valuable information on aneurysmal anatomy, including relationships with the parent and adjacent vessels. This technique allowed fast and safe decision-making regarding the feasibility of endovascular or surgical treatment and provided useful information for performing the chosen treatment.

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Three-dimensional angiography for radiosurgical treatment planning for arteriovenous malformations

Journal of Neurosurgery ◽

10.3171/jns.2003.98.3.0536 ◽

2003 ◽

Vol 98 (3) ◽

pp. 536-543 ◽

Cited By ~ 33

Author(s):

Federico Colombo ◽

Carlo Cavedon ◽

Paolo Francescon ◽

Leopoldo Casentini ◽

Umberto Fornezza ◽

...

Keyword(s):

Treatment Planning ◽

Imaging Modality ◽

Treatment Plan ◽

Three Dimensional ◽

Ct Scanning ◽

New Method ◽

Rotational Angiography ◽

Content Type ◽

3D Rotational Angiography ◽

Fine Print

Object. Radiosurgical treatment of a cerebral arteriovenous malformation (AVM) requires the precise definition of the nidus of the lesion in stereotactic space. This cannot be accomplished using simple stereotactic angiography, but requires a combination of stereotactic biplanar angiographic images and stereotactic contrast-enhanced computerized tomography (CT) scans. In the present study the authors describe a method in which three-dimensional (3D) rotational angiography is integrated into stereotactic space to aid treatment planning for radiosurgery. Methods. Twenty patients harboring AVMs underwent treatment planning prior to linear accelerator radiosurgery. Planning involved the acquisition of two different data sets, one of which was obtained using the standard method (a combination of biplanar stereotactic angiography with stereotactic CT scanning), and the other, which was procured using a new technique (nonstereotactic 3D rotational angiography combined with stereotactic CT scanning by a procedure of image fusion). The treatment plan that was developed using the new method was compared with that developed using the standard one. For each patient the number of isocenters and the dimension of selected collimators were the same, based on the information supplied in both methods. Target coordinates were modified in only five cases and by a limited amount (mean 0.7 mm, range 0.3–1 mm). Conclusions. The new imaging modality offers an easier and more immediate interpretation of 3D data, while maintaining the same accuracy in target definition as that provided by the standard technique. Moreover, the new method has the advantage of using nonstereotactic 3D angiography, which can be performed at a different site and a different time with respect to the irradiation procedure.

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Three-Dimensional Rotational Angiography in Peripheral Endovascular Interventions

Journal of Endovascular Therapy ◽

10.1177/152660280301000328 ◽

2003 ◽

Vol 10 (3) ◽

pp. 595-600 ◽

Cited By ~ 3

Author(s):

Jos C. van den Berg ◽

Frans L. Moll

Keyword(s):

Three Dimensional ◽

Region Of Interest ◽

Arterial Disease ◽

Anatomical Location ◽

Rotational Angiography ◽

Endovascular Interventions ◽

Area Of Interest ◽

Continuous Rotation ◽

Peripheral Arterial Diseases ◽

Peripheral Arterial

Purpose: To demonstrate the feasibility and applicability of 3-dimensional rotational angiography (3D-RA) in the assessment of candidates for endovascular treatment of occlusive or aneurysmal arterial disease. Technique: In 3D-RA, a continuous rotation of the fluoroscopic tube around the region of interest is made while intra-arterial contrast is continuously infused. The area of interest is placed in the isocenter in both frontal and lateral planes. Images are acquired at a rate of 12.5 frames per second at a rotation speed of 30° per second. Injection protocols are adjusted according to the anatomical location. The acquisition takes 8 seconds and yields 100 contrast-enhanced cinefluoroscopic images that are automatically reconstructed within 5 minutes to yield a 3D volume that can be rotated and viewed in any direction. Measuring the diameter of the target vessel and length of the lesion can be performed in the same session. An initial evaluation of this technique in 101 patients with known peripheral vascular disease yielded diagnostically adequate images preprocedurally while adding a maximum of only 10 minutes to the endovascular procedure: 5 minutes for reconstruction and another 2 to 5 minutes for measurements, which were made without difficulty in all cases. 3D-RA aided in selection of the optimal fluoroscopic tube angulation for the endovascular procedures and provided assessment of the interventional results comparable to angiography. Conclusions: Our preliminary experience suggests that 3D-RA appears to be a valid tool in the pre- and periprocedural assessment of patients treated endovascularly for both aneurysmal and occlusive peripheral arterial diseases.

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Machine Learning Application for Rupture Risk Assessment in Small-Sized Intracranial Aneurysm

Journal of Clinical Medicine ◽

10.3390/jcm8050683 ◽

2019 ◽

Vol 8 (5) ◽

pp. 683 ◽

Cited By ~ 12

Author(s):

Heung Cheol Kim ◽

Jong Kook Rhim ◽

Jun Hyong Ahn ◽

Jeong Jin Park ◽

Jong Un Moon ◽

...

Keyword(s):

Diagnostic Accuracy ◽

Detection System ◽

Three Dimensional ◽

Region Of Interest ◽

Large Data ◽

Aneurysm Rupture ◽

Computer Assisted ◽

Rupture Risk ◽

Operating Characteristics ◽

Data Set

The assessment of rupture probability is crucial to identifying at risk intracranial aneurysms (IA) in patients harboring multiple aneurysms. We aimed to develop a computer-assisted detection system for small-sized aneurysm ruptures using a convolutional neural network (CNN) based on images of three-dimensional digital subtraction angiography. A retrospective data set, including 368 patients, was used as a training cohort for the CNN using the TensorFlow platform. Aneurysm images in six directions were obtained from each patient and the region-of-interest in each image was extracted. The resulting CNN was prospectively tested in 272 patients and the sensitivity, specificity, overall accuracy, and receiver operating characteristics (ROC) were compared to a human evaluator. Our system showed a sensitivity of 78.76% (95% CI: 72.30%–84.30%), a specificity of 72.15% (95% CI: 60.93%–81.65%), and an overall diagnostic accuracy of 76.84% (95% CI: 71.36%–81.72%) in aneurysm rupture predictions. The area under the ROC (AUROC) in the CNN was 0.755 (95% CI: 0.699%–0.805%), better than that obtained from a human evaluator (AUROC: 0.537; p < 0.001). The CNN-based prediction system was feasible to assess rupture risk in small-sized aneurysms with diagnostic accuracy superior to human evaluators. Additional studies based on a large data set are necessary to enhance diagnostic accuracy and to facilitate clinical application.

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Technique of Three-Dimensional (3D) Rotational Angiography

3D Angiographic Atlas of Neurovascular Anatomy and Pathology ◽

10.1017/cbo9780511547324.003 ◽

2009 ◽

pp. 5-10

Author(s):

Neil M. Borden

Keyword(s):

Three Dimensional ◽

Rotational Angiography ◽

3D Rotational Angiography

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Three-dimensional image analysis and visualization in confocal light microscopy

Proceedings, annual meeting, Electron Microscopy Society of America ◽

10.1017/s0424820100146631 ◽

1993 ◽

Vol 51 ◽

pp. 158-159

Author(s):

J. K. Samarabandu ◽

R. Acharya ◽

D. R. Pareddy ◽

P. C. Cheng

Keyword(s):

Depth Perception ◽

Computer Graphic ◽

Three Dimensional ◽

Cellular Organization ◽

Data Set ◽

Computational Burden ◽

Interactive Operation ◽

Cell Organization ◽

Confocal Images ◽

3D Digitization

In the study of cell organization in a maize meristem, direct viewing of confocal optical sections in 3D (by means of 3D projection of the volumetric data set, Figure 1) becomes very difficult and confusing because of the large number of nucleus involved. Numerical description of the cellular organization (e.g. position, size and orientation of each structure) and computer graphic presentation are some of the solutions to effectively study the structure of such a complex system. An attempt at data-reduction by means of manually contouring cell nucleus in 3D was reported (Summers et al., 1990). Apart from being labour intensive, this 3D digitization technique suffers from the inaccuracies of manual 3D tracing related to the depth perception of the operator. However, it does demonstrate that reducing stack of confocal images to a 3D graphic representation helps to visualize and analyze complex tissues (Figure 2). This procedure also significantly reduce computational burden in an interactive operation.

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EMCAT: An automatic image-processing system for electron-microscopic tomography

Proceedings, annual meeting, Electron Microscopy Society of America ◽

10.1017/s0424820100169821 ◽

1994 ◽

Vol 52 ◽

pp. 418-419

Author(s):

Weiping Liu ◽

John W. Sedat ◽

David A. Agard

Keyword(s):

Image Processing ◽

Structural Information ◽

Imaging Technique ◽

Three Dimensional ◽

Processing System ◽

Electron Microscopic ◽

Data Set ◽

Ordered Structures ◽

Automatic Image Processing ◽

Em Tomography

Any real world object is three-dimensional. The principle of tomography, which reconstructs the 3-D structure of an object from its 2-D projections of different view angles has found application in many disciplines. Electron Microscopic (EM) tomography on non-ordered structures (e.g., subcellular structures in biology and non-crystalline structures in material science) has been exercised sporadically in the last twenty years or so. As vital as is the 3-D structural information and with no existing alternative 3-D imaging technique to compete in its high resolution range, the technique to date remains the kingdom of a brave few. Its tedious tasks have been preventing it from being a routine tool. One keyword in promoting its popularity is automation: The data collection has been automated in our lab, which can routinely yield a data set of over 100 projections in the matter of a few hours. Now the image processing part is also automated. Such automations finish the job easier, faster and better.

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