Abstract
PurposeTo evaluate the potential benefits of digital variance angiography (DVA) in selective lower limb angiography and to compare the performance of 2 DVA algorithms (conventional DVA1 and the recently developed DVA2) to that of digital subtraction angiography (DSA). Materials and MethodsFrom November 2019 to May 2020, 112 iodinated contrast media (ICM) and 40 carbon dioxide (CO2) angiograms were collected from 15 and 13 peripheral artery disease patients, respectively. The DVA files were retrospectively generated from the same unsubtracted source file as DSA. The objectively calculated contrast-to-noise ratio (CNR) and the subjective visual image quality of DSA, DVA1, and DVA2 images were statistically compared using the Wilcoxon signed-rank test. The images were evaluated by 6 radiologists (R.P.T., S.V., A.M.K., S.S.A., O.E., and J.S.) from 2 centers using a 5-grade Likert scale. ResultsBoth DVA algorithms produced similar increase (at least 2-fold) in CNR values (P < .001) and significantly higher image quality scores than DSA, independent of the contrast agent used. The overall scores with ICM were 3.61 ± 0.05 for DSA, 4.30 ± 0.04 for DVA1, and 4.33 ± 0.04 for DVA2 (each P < .001 vs DSA). The scores for CO2 were 3.10 ± 0.14 for DSA, 3.63 ± 0.13 for DVA1 (P < .001 vs DSA), and 3.38 ± 0.13 for DVA2 (P < .05 vs DSA). ConclusionsDVA provides higher CNR and significantly better image quality in selective lower limb interventions irrespective of the contrast agent used. Between DVA algorithms, DVA1 is preferred because of its identical or better image quality than DVA2. DVA can potentially help the interventional decision process and its quality reserve might allow dose management (radiation/ICM reduction) in the future.
Highlights
The blood vessels are made visible during angiography with the injection of contrast agents and applied X-ray radiation
The acquired image data are subsequently processed with the technique of digital subtraction angiography (DSA) [1,2,3]
iodinated contrast media (ICM) and CO2 are the standard contrast agents used for angiographic guidance
Summary
Based on the reported noise reduction and improved image quality of DVA in nonselective lower limb angiography, the aim of the current study was to investigate whether the quality advantages of this new image processing technology could be observed in selective lower limb interventions, where the image quality of DSA is usually higher due to the administration of contrast agents closer to the location of lesions. The secondary aim of the study was to compare the performance of 2 different DVA algorithms in such a clinical setting. The main aim of this study was to investigate whether this quality advantage can be observed with different DVA algorithms (DVA1 and DVA2) in selective lower limb interventions
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