Abstract
Quality of visualization of treatment devices during critical stages of endovascular interventions, can directly impact their safety and efficacy. Our aim was to compare the visualization of neurointerventional procedures and treatment devices using a 194-μm pixel flat panel detector mode and a 76-μm pixel complementary metal oxide semiconductor detector mode (high definition) of a new-generation x-ray detector system using a blinded-rater study. Deployment of flow-diversion devices for the treatment of internal carotid artery aneurysms was performed under flat panel detector and high-definition-mode image guidance in a neurointerventional phantom simulating patient cranium and tissue attenuation, embedded with 3D-printed intracranial vascular models, each with an aneurysm in the ICA segment. Image-sequence pairs of device deployments for each detector mode, under similar exposure and FOV conditions, were evaluated by 2 blinded experienced neurointerventionalists who independently selected their preferred image on the basis of visualization of anatomic features, image noise, and treatment device. They rated their selection as either similar, better, much better, or substantially better than the other choice. Inter- and intrarater agreement was calculated and categorized as poor, moderate, and good. Both raters demonstrating good inter- and intrarater agreement selected high-definition-mode images with a frequency of at least 95% each and, on average, rated the high-definition images as much better than flat panel detector images with a frequency of 73% from a total of 60 image pairs. Due to their higher resolution, high-definition-mode images are sharper and visually preferred compared with the flat panel detector images. The improved imaging provided by the high-definition mode can potentially provide an advantage during neurointerventional procedures.
Highlights
BACKGROUND AND PURPOSEQuality of visualization of treatment devices during critical stages of endovascular interventions, can directly impact their safety and efficacy
The technologic advances in neuroendovascular devices have led to fluoroscopically guided endovascular treatment of intracranial aneurysms becoming the preferred treatment
The flat panel detector (FPD) used in most angiographic and fluoroscopy suites consists of an array of square pixels based on thin-film transistor technology, with sizes varying from 140 to 200 m
Summary
Our aim was to compare the visualization of neurointerventional procedures and treatment devices using a 194-m pixel flat panel detector mode and a 76-m pixel complementary metal oxide semiconductor detector mode of a new-generation x-ray detector system using a blinded-rater study. Image Acquisition and Display Setup The main purpose of the study was to qualitatively evaluate the simulated clinical image sequences of PED deployment acquired using both FPD and HiDef modes of the new detector system. The aim of our study was to determine whether this added advantage provided by the HiDef mode can improve imaging of a treatment device such as a PED, a flow-diverter stent used for the treatment of intracranial aneurysms. The purpose of the study was to evaluate x-ray image quality of the new detector system during neurointerventional treatment
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