Abstract
PurposeIn previous clinical studies Digital Variance Angiography (DVA) provided higher signal-to-noise ratio (SNR) and better image quality than Digital Subtraction Angiography (DSA). Our aim was to investigate whether this quality reserve of DVA provides an opportunity for the reduction of iodinated contrast media (ICM) in carotid X-ray angiography (CXA). MethodOur prospective study enrolled 26 patients (67.0 ± 8.1 years) undergoing carotid percutaneous transluminal angioplasty. The SNR of DSA and DVA image pairs obtained by a standard (100 %, 6 mL ICM) or a low-dose (50 %, 3 mL ICM) protocol were compared. Visual evaluation of all images was performed by five specialists using a 5-grade rating scale. The quality of DSA100 and DVA50 videos was also compared. ResultsDVA provided more than two-fold SNR, the median SNRDVA/SNRDSA ratio was 2.06 (100 %) and 2.25 (50 %). In the visual evaluation, the DVA100 score (3.73 ± 0.06) was significantly higher than the DSA100 score (3.52 ± 0.07, Wilcoxon p < 0.001), and the DVA50 score (3.64 ± 0.13) was also significantly higher than the DSA50 score (3.01 ± 0.17, Wilcoxon p < 0.001). While the low-dose protocol significantly decreased the DSA score (Mann-Whitney p < 0.01, DSA100 vs DSA50), it had no effect on the DVA score (DVA100 vs DVA50). There was no statistical difference between the DSA100 and DVA50 scores. Evaluators preferred the diagnostic value of DVA50 to DSA100 videos in 61% of comparisons, the interrater agreement was 69 % (Fleiss’ kappa 0.35, p < 0.001) ConclusionsOur data show that DVA allows a substantial (50 %) ICM reduction in CXA without affecting the quality and diagnostic value of angiograms.
Highlights
Atherosclerosis, the accumulation of sclerotic plaques in the wall of blood vessels, and the concomitant stenosis of arteries is the major etiological factor of cardiovascular disorders, the leading cause of death and disabilities worldwide [1]
The aim of the current study was to investigate whether the signifi cant quality reserve of Digital Variance Angiography (DVA) could be converted to iodinated contrast media (ICM) reduction, we compared the signal-to-noise ratio (SNR) and image quality of Digital Subtraction Angiography (DSA) and DVA images and videos obtained during carotid percutaneous transluminal angioplasty (PTA) intervention, using both standard (100 %, 6 mL) and low-dose (50 %, 3 mL) ICM protocol
SNRs of DVA and DSA images were calculated in a total of 3074
Summary
Atherosclerosis, the accumulation of sclerotic plaques in the wall of blood vessels, and the concomitant stenosis of arteries is the major etiological factor of cardiovascular disorders, the leading cause of death and disabilities worldwide [1]. The incidence of carotid artery (CA) stenosis, a major risk factor of ischemic stroke is strikingly high in the elderly population (> 65 years), it is estimated in the range of 5–10 % in the US [2]. For decades Digital Subtraction Angiography (DSA) was the refer ence standard for examining carotid vessels and neurovascular pathol ogy. DSA records a native image mask that is subtracted from the subse quent contrast-enhanced image series, thereby blood vessels filled with The appearance of non-invasive imaging techniques, like computed tomography angiography, magnetic resonance angiography [3] or color Doppler ultrasound examination gradually replaced intra-arterial angiography in the diagnostic practice [4,5], DSA remains the method of choice in endovascular CA interventions or when the results of non-invasive methods are not conclusive [6].
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