Color-coded Digital Subtraction Angiography Research Articles

Overloaded transnidal pressure gradient as the hemodynamic mechanism leading to arteriovenous malformation rupture: a quantitative analysis using intravascular pressure monitoring and color-coded digital subtraction angiography

BackgroundThe hemodynamics of brain arteriovenous malformations (AVMs) may have implications for hemorrhage. This study aimed to explore the hemodynamics of ruptured AVMs by direct microcatheter intravascular pressure monitoring (MIPM) and...

Peri-therapeutic multi-modal hemodynamic assessment and detection of predictors for symptomatic in-stent restenosis after percutaneous transluminal angioplasty and stenting.

This study performed multi-modal hemodynamic analysis including quantitative color-coded digital subtraction angiography (QDSA) and computational fluid dynamics (CFD) to delineate peri-therapeutic hemodynamic changes and explore the risk factors for in-stent restenosis (ISR) and symptomatic ISR (sISR). Forty patients were retrospectively reviewed. Time to peak (TTP), full width at half maximum (FWHM), cerebral circulation time (CCT), angiographic mean transit time (aMTT), arterial stenosis index (ASI), wash-in gradient (WI), wash-out gradient (WO) and stasis index were calculated with QDSA and translesional pressure ratio (PR) and wall shear stress ratio (WSSR) were quantified from CFD analysis. These hemodynamic parameters were compared between before and after stent deployment and multivariate logistic regression model was established to detect predictors for ISR and sISR at follow-up. It was found that stenting generally reduced TTP, stasis index, CCT, aMTT and translesional WSSR while significantly increased translesional PR. ASI decreased after stenting, and during the mean follow-up time of 6.48 ± 2.86 months, lower ASI (<0.636) as well as larger stasis index were corroborated to be independently associated with sISR. aMTT showed a linear correlation with CCT before and after stenting. PTAS not only improved cerebral circulation and blood flow perfusion but also changed local hemodynamics significantly. ASI and stasis index derived from QDSA were proved to play a prominent role in risk stratification for sISR. Multi-modal hemodynamic analysis could facilitate intraoperative real-time hemodynamic monitoring and help the determination of the end point of intervention.

Indirect revascularization vs. non-surgical treatment for Moyamoya disease and Moyamoya syndrome: A comparative effectiveness study.

The efficacy of indirect revascularization vs. non-surgical treatment in adults with Moyamoya disease (MMD) and Moyamoya syndrome (MMS) remains controversial. To compare the clinical outcomes of indirect revascularization and non-surgical treatments in adult patients with MMD and MMS. We collected medical records and follow-up results of adult patients with MMD and MMS who received treatment in the China-Japan Union Hospital of Jilin University between January 2019 and December 2021. A Shapiro-Wilk test, independent sample t-test or Mann-Whitney U-test, and Pearson chi-square test were used to compare baseline variables. The propensity-score analysis was used to compare clinical outcomes of patients with MMD and MMS who underwent indirect revascularization and non-surgical treatments. The color-coded digital subtraction angiography (CC-DSA) was used to quantitatively analyzed the preoperative and postoperative (at 6-month follow-up) images of patients in the surgical group. A total of 144 patients were included in this study, of whom 37 received indirect revascularization treatment and 107 received non-surgical treatment. The average age of the patients was 58.3 ± 13.4 years. Perioperative complications were observed in eight of the operations. During the follow-up period, a total of 35 stroke events occurred, including two cases (5.4%) in the surgery group and 33 cases (30.8%) in the non-surgery group (p < 0.05). The preoperative mean transit time (MTT) of bypass vessel (superficial temporal artery, STA) was 0.26 ± 0.07, and the postoperative MTT of bypass vessel was 3.0 ± 0.25, and there was no statistical difference between the subgroups. Indirect revascularization surgery can significantly reduce the recurrent stroke incidence of MMD and MMS patients.

Evaluation of Tissue Perfusion by Wound Blush and 2D Color-Coded Digital Subtraction Angiography During Endovascular Intervention and Its Impact on Limb Salvage in Critical Limb Ischemia

Purpose: Critical limb ischemia (CLI) is an entity with high mortality if not properly treated. The primary aim of CLI revascularization is to enhance wound healing, which greatly depends on microvascular circulation. The available tools for assessment of revascularization success are deficient in the evaluation of local microvascular tissue perfusion, that wound blush (WB) reflects. A reliable technique that assesses capillary flow to foot lesions is needed. This study aims to assess WB angiographically at sites of interest in the foot after revascularization and its impact on limb salvage in CLI. Materials and Methods: 198 CLI patients (Rutherford category 5/6) with infrainguinal atherosclerotic lesions amenable for endovascular revascularization (EVR) were included. Limbs were directly or indirectly revascularized by EVR. Direct revascularization meant that successful revascularization of the area of interest according to the angiosome concept was achieved. A completion angiographic run was taken to assess WB. Patients were divided into 2 groups; positive and negative WB groups. In the event of a disagreement between the observational investigators, the digital subtraction angiography (DSA) series was analyzed for hemodynamic changes with a computerized 2D color-coded DSA (Syngo iFlow). Results: 176 limbs had successful revascularization in 157 patients. The successful revascularization rate was 88.9% (176/198), with technical failure encountered in 22 limbs. 121 patients had positive WB and 55 patients had negative WB. Direct revascularization of target areas was obtained in 98 limbs (55.7%). There was a significant difference in the rate of achieving direct flow to the lesion between the positive WB and negative WB groups (36.4% vs 19.3%, p≤0.001). We noticed a nonsignificant difference between patients who had direct revascularization of the foot lesion(s) and those who had indirect revascularization as regards limb salvage. Patients were followed up for 25.2 ± 12.7 months. By the end of the first year, limb salvage rate was significantly higher in patients who had positive WB (98% vs 63%, p<0.001, after 2 years (97% vs 58%, p<0.001) and after 3 years (94% vs 51.5%, p<0.001). Conclusions: WB is an important predictor and a prognostic factor for wound healing in CLI patients with soft tissue lesions.

Evaluation of superficial femoral artery-lesions after percutaneous transluminal angioplasty: color-coded summation images vs. monochromatic digital subtraction angiography

BackgroundPercutaneous transluminal angioplasty (PTA) is increasingly requested in the therapy of peripheral arterial occlusive disease. The evaluation of the technical result after balloon angioplasty with regard to bailout stenting is highly dependent on the operators´ subjective assessment and mainly based on the monochromatic digital subtraction angiography (DSA) images. The aim of this study was to compare color-coded single image as a novel diagnostic tool with monochromatic DSA for the analysis of flow limitation and need for stent implantation after PTA of superficial femoral artery (SFA) stenoses.MethodsDuring a period of 18 months, 213 SFA lesions were treated by PTA with a standard balloon in 170 patients, resulting in a total of 193 endovascular procedures. The median age of the patients was 77 years (range, 35–96 years). Median length of the treated lesions was 10.5 cm (range, 1.0–50 cm). Three interventional radiologists retrospectively evaluated the results of balloon angioplasty with monochromatic as well as post-processed color-coded DSA images for flow limitations to decide if subsequent stent implantation was necessary. Consensus reading of two experienced interventional radiologists 2 months after the initial review served as reference standard to perform a receiver operating characteristics (ROC) analysis.ResultsROC analysis for readers A, B and C showed area under the curve (AUC) values of 0.797, 0.865 and 0.804 for color-coded DSA and AUC values of 0.792, 0.843 and 0.872 for monochromatic DSA: a significant advantage of color-coded over conventional monochromatic DSA was not found for readers A and B (p > 0.05). Results of reader C were significantly better in the assessment of monochromatic images (p = 0.023). Diagnostic confidence using color-coded images was slightly higher than in monochromatic images (κ = 0.486 vs. κ = 0.459).ConclusionsIn this study, color coded DSA did not reveal to be superior to conventional monochromatic DSA when evaluating results of PTA and when deciding whether stent implantation is necessary or not. This technology, however, requires further experiences with special regard to homogeneously trained radiologists and to the time requirement.

Perfusion imaging with 320-slice spiral computed tomography and color-coded digital subtraction angiography for assessing acute skeletal muscle ischemia-reperfusion injury in a rabbit model

BackgroundIn recent years, skeletal muscle-related ischemia-reperfusion injury (IRI) has become more common. IRI can lead to severe limb injuries, multiple organ failure, and even death in some cases. However, there is still a lack of rapid and sensitive detection methods for IRI in skeletal muscle. This study aims to explore the value of computed tomography perfusion imaging (CTPI) and color-coded digital subtraction angiography (DSA) in assessing acute IRI of skeletal muscle in a rabbit model.MethodsFifty New Zealand white rabbits were randomly assigned to the ischemia-reperfusion (IR) group (n = 40) or sham group (n = 10). After 3 h of surgically-induced hindlimb ischemia, the IR group underwent reperfusion and CTPI and color-coded DSA were taken to assess the skeletal muscle at 0, 6, 12, or 24 h post-reperfusion. The data from CTPI and DSA in the right and left hindlimbs, blood flow (AF-R/L), blood volume (BV-R/L), contrast clearance rate (C-R/L) and the maximum contrast enhancement values (peak-R/L) were obtained. Serum superoxide dismutase (SOD), creatine kinase (CK), lactic dehydrogenase (LDH) and malondialdehyde (MDA) were measured. The statistical correlation between the above parameters (CTPI, color-coded DSA, and biochemical markers) was analyzed.ResultsThe mean value of AF-R/L, BV-R/L, C-R/L and peak-R/L decreased linearly from 1.07 ± 0.08 to 0.75 ± 0.11, 1.03 ± 0.06 to 0.85 ± 0.14, 0.93 ± 0.15 to 0.71 ± 0.18, and 1.07 ± 0.01 to 0.47 ± 0.04, respectively. The correlation coefficients between AF-R/L and SOD, CK, LDH and MDA were 0.57, − 0.44, − 0.60, and − 0.62, respectively (p < 0.001). The correlation coefficients between Peak-R/L and SOD, CK, LDH, MDA were 0.59, 0.68, 0.71 and 0.66, respectively (p < 0.001). The correlation coefficient between AF-R/L and Peak-R/L was 0.70 (p < 0.001).ConclusionBoth CTPI and color-coded DSA could dynamically assess skeletal muscle IRI in rabbits.

Complex combination of femoropopliteal occlusive disease and arteriovenous fistula treated using color-coded digital subtraction angiography

Any quantitative assessment of blood flow using conventional angiography remains impossible with current technology. Physicians decide the clinical end point of a procedure by subjective interpretation. Color-coded digital subtraction angiography has been invented to meet this demand and is used primarily in neuroradiology. This report presents the endovascular treatment of a rare complex combination of peripheral artery disease and arteriovenous fistula using guidance of blood flow parameters, such as area under the curve.

Evaluation of skeletal muscle perfusion in canine hind limb ischemia model using color-coded digital subtraction angiography

ObjectiveTo evaluate perfusion alterations in skeletal muscle in a canine hind limb ischemia model using color-coded digital subtraction angiography (CC-DSA). MethodsTwelve beagles underwent embolization at the branch of their left deep femoral artery. Right hind limbs were used as the control group. Angiography was performed before and immediately after embolization. Upon CC-DSA analysis, time to peak (TTP) was measured before embolization in both sides of the beagles' hind limbs at the middle iliac artery, and the distant, middle and proximal femoral artery. Regions of interest (ROI) peak and ROI peak time were symmetrically computed in proximal and distal thigh muscles before and immediately after embolization. The data were analyzed and compared using the Wilcoxon signed rank test. ResultsBefore embolization, ROI peak in the proximal thigh was lower than in the ipsilateral distal thigh, whereas ROI peak time in the proximal thigh was longer than in the distal thigh. In the iliac femoral artery, there was no significant difference in ROI peak, ROI peak time, or TTP between right and left sides. After embolization, ROI peaks in proximal and distal skeletal muscles of the left hind limb were significantly lower than on the contralateral side. ROI peak time was significantly longer in the left proximal and left distal thigh compared to the contralateral side. There were no significant changes in ROI peak or ROI peak time in the right proximal and right distal thigh compared to pre-embolization values. Changes in ROI peak and ROI peak time were larger in the left proximal than in the left distal thigh. ConclusionCC-DSA provided real-time measurement of changes in vascular hemodynamics and skeletal muscle perfusion without increasing X-ray usage or contrast agent dose.

Color-coded Digital Subtraction Angiography for Assessing Acute Skeletal Muscle Ischemia-Reperfusion Injury in a Rabbit Model

This paper describes an ongoing investigation of imaging and characterization of ischemia-reperfusion (IR) and investigated the use of color-coded digital subtraction angiography (DSA) to assess reperfusion injury or potential injury. New Zealand white rabbits were subjected to right hindlimb ischemia (IR, n = 24) or sham operation (control, n = 6). After 3 hours, the IR rabbits underwent reperfusion and were assessed at 0, 6, 12, or 24 hours (n = 6 each). DSA of the bilateral vastus lateralis muscle of each animal was performed. The maximum contrast enhancement value of a consistent region of interest in the right and left hind limbs (peak enhancement-R/L) was determined. Associations between the relative ratio of the peak right limb to the peak left limb (peak-R/L) and the following blood indicators of IR injury were analyzed: lactic dehydrogenase (LDH), creatine kinase (CK), malondialdehyde (MDA), and superoxide dismutase (SOD). Serum LDH, CK, and MDA values in each IR group were significantly higher than those of the control group and were positively associated with the IR interval, whereas SOD was significantly lower and negatively associated. The mean peak-R/L decreased linearly with the IR interval from 1.07 ± 0.01 in the control group, and 0.93 ± 0.06, 0.79 ± 0.05, 0.65 ± 0.04, and 0.47 ± 0.04 at 0, 6, 12, and 24 hours in the IR groups. The coefficients of correlation between the peak-R/L and LDH, CK, MDA, SOD serum levels were -0.885, -0.908, -0.541, and 0.832, respectively. Color-coded DSA may be used for monitoring the dynamics of skeletal muscle IR injury.

Characterizing tissue perfusion after lower extremity intervention using two-dimensional color-coded digital subtraction angiography

ObjectiveDigital subtraction angiography (DSA) of the peripheral arterial vasculature provides lumenographic information but only a qualitative assessment of blood flow. The ability to quantify adequate tissue perfusion of the lower extremities would enable real-time perfusion assessment during DSA of patients with peripheral arterial disease (PAD). In this study, we used a novel real-time imaging software to delineate tissue perfusion parameters in the foot in PAD patients. MethodsBetween March 2015 and June 2016, patients (N = 31) underwent lower extremity angiography using a two-dimensional perfusion (2DP) imaging protocol (Philips Healthcare, Andover, Mass). Of the 31 enrolled patients, 16 patients received preintervention and postintervention DSA images (18 angiograms), while contrast agent injection settings and the position of the foot, catheter, and C-arm were kept constant. The region of interest for perfusion measurements was taken at the level of the medial malleolus. Perfusion parameters included arrival time (AT) of contrast material, wash-in rate (WIR), time to peak (TTP) contrast intensity, and area under the curve (AUC). ResultsPatients (mean age, 67 years; male, 61%) undergoing 2DP had limbs classified as Rutherford class 3 (n = 9 limbs), class 4 (n = 11), and class 5 (n = 14) ischemia with a mean ankle-brachial index of 0.63. For the whole cohort, median (interquartile range) AT measured 5.20 (3.10-7.25) seconds; WIR, 61.95 (43.53-86.43) signal intensity (SI)/s; TTP, 3.80 (2.88-4.50) seconds; peak intensity, 725.00 (613.75-1138.00) SI; and AUC, 12,084.00 (6742.80-17,059.70) SI*s. A subset of patients had 2DP performed before and after intervention (n = 18 cases). A detectable improvement in SI and two-dimensional flow parameters was seen after intervention. Average AT of contrast material to the region of interest shortened after intervention with percentage decrease of 30.1% ± 49.1%, corresponding decrease in TTP of 17.6% ± 24.7%, increase in WIR of 68.8% ± 94.2% and in AUC of 10.5% ± 37.6%, decrease in mean transit time of 18.7% ± 28.1%, and increase in peak of 34.4% ± 42.2%. ConclusionsThe 2DP imaging allows measurement of blood flow in real time as an adjunct to DSA. The AT may be the most sensitive marker of perfusion change in the lower extremity. Quantitative thresholds based on 2DP hold promise for immediate treatment effectiveness assessment in patients with PAD.

Delayed Venous Drainage in Ruptured Arteriovenous Malformations Based on Quantitative Color-Coded Digital Subtraction Angiography

Clinically applicable hemodynamic risk factors to predict arteriovenous malformation (AVM) rupture are missing in the literature. The aim of this study was to use catheter angiography to identify hemodynamic parameters in ruptured and unruptured AVMs. Patients with frontal and temporal AVMs and Siemens syngo iFlow color-coding angiography were included in this study (n= 71). Clinical and radiologic data (age, sex, Spetzler-Martin [SM] and supplemented SM grade, and rupture status), and hemodynamic features (contrast mean transit time [MTT] of feeding arteries, draining veins, AVM nidus, and the cerebral circulation time [CCT]) were analyzed. Univariable analysis was performed to compare findings between ruptured and unruptured AVMs. In total, 35 ruptured and 36 unruptured AVMs were analyzed. Clinical characteristics and AVM grades were comparable between ruptured and unruptured AVMs. Ipsilateral CCT (5.2 vs. 4.0 seconds; P= 0.035), MTT between Tmax of the ipsilateral internal carotid artery and Tmax of sinus entry of the draining vein (3.2 vs. 2.0 seconds; P < 0.001), and MTT between Tmax at the start of venous outflow and Tmax of sinus entry (1.6 vs. 0.7 seconds; P<0.0001) were significantly longer in ruptured compared with unruptured AVMs. MTTs of nidus, between the internal carotid and feeding arteries, of the venous sinus passage as well as contralateral CCT and controlled ipsilateral CCT were comparable between both groups. Ruptured AVMs have significantly prolonged venous drainage times compared with unruptured AVMs; this suggests restricted AVM drainage and increased blood pressure within the AVM nidus. Prospective studies are needed to determine the predictive power of these measurements.

The research of color-coded digital subtraction angiography in the normal cerebral hemodynamic parameters

Objective To investigate the value of color-coded digital subtraction angiography (iFlow) in the study of normal cerebral hemodynamic parameters, so as to set up parameter for normal cerebral hemodynamic. Methods From march 2013 to september 2016, We retrospectively analyze a total of 60 patients in wuhan general hospital of PLA. These patients were reexamined with digital subtraction angiography (DSA) due to follow-up for postembolization with aneurysms by naked coins, and were suspected as intracranial vascular diseases with normal angiography findings in DSA. In order to measure the time to peak (TTP) of contrast medium in region of interest (ROI). we set the ROI at these rigion: ROI-1: internal carotid artery bifurcation; ROI-2: cerebral middle artery bifurcation; ROI-3: the middle of superior sagittal sinus; ROI-4: torcular herophili area; ROI-5: the end of basilar artery. Results The TTPs of ROI-1 to ROI-4 in left internal carotid artery angiography and ROI-5 in left vertebral artery angiography are (2.70±0.37), (2.85±0.36), (7.98±1.54), (8.85±1.77), (3.02±0.58) s respectively. The TTPs of ROI-1 to ROI-4 in right internal carotid artery and ROI-5 in right vetebral artery angiography are (2.77±0.35), (2.87±0.36), (8.01±1.14), (8.77±1.26), (3.06±0.55) s respectively. Conclusion The technique of iFlow provides a reference value index in normal cerebral hemodynamic, and set up a noval method in the research of cerebral hemodynamic. Key words: Color-coded digital subtraction angiography; Cerebral perfusion; Hemodynamic; Time to peak

Quantitative flow measurement after placing a flow diverter for a distal internal carotid artery aneurysm

ObjectivesTo evaluate the differences in arterial flow after flow diverter placement using quantitative flow measurements based on digital subtraction angiography (DSA).MethodsBetween November 2013 and November 2015, all patients who had...

PC106. Characterizing Tissue Perfusion Following Lower Extremity Intervention Using 2D Color-Coded Digital Subtraction Angiography

PC106. Characterizing Tissue Perfusion Following Lower Extremity Intervention Using 2D Color-Coded Digital Subtraction Angiography

Evaluation of Distal Hemodynamic Changes of Lower Extremity after Endovascular Treatment: Correlation between Measurements of Color-Coded Quantitative Digital Subtraction Angiography and Ankle-Brachial Index

PurposeTo confirm the feasibility of using time-to-peak (TTP) measurements derived from color-coded digital subtraction angiography (ccDSA) imaging to assess improvements in distal circulation in relation to the ankle-brachial index (ABI). Materials and MethodsNineteen patients who underwent percutaneous transluminal angioplasty and/or stent placement (in 20 lower extremities) were evaluated. A region of interest (ROI) at the proximal superficial femoral artery (SFA) was selected for a reference TTP for quantitative assessments. The ROI measurements of the TTP interval between medial and lateral plantar/dorsalis pedis relative to the reference was regarded as the ΔTTP and used to assess distal hemodynamic improvement achieved by the revascularization. The ABI was obtained with a handheld Doppler ultrasound machine with a manually operated blood-pressure cuff. Correlation between the two methods was analyzed. ResultsThe ABI improved significantly from 0.44 ± 0.18 to 0.79 ± 0.20 (t = 10.11; P < .0001) after the intervention. TTP, which reflected the blood flow time from the proximal SFA to the foot, became much faster, from 11.86 seconds ± 4.26 to 6.75 seconds ± 2.03 (t = 6.57; P < .001). A good correlation was observed between the improvement ratios of ΔTTP and ABI (r = 0. 863). ConclusionsTTP measurements derived from ccDSA provide an easy and objective method for assessment of distal hemodynamic changes after endovascular treatment of lower-extremity peripheral arterial disease (PAD). It may provide a quantitative method to assess the adequacy of endovascular interventions and provide more objective suggestions for procedure endpoints, with potentially better clinical outcomes for patients with PAD.

Parametric Digital Subtraction Angiography Imaging for the Objective Grading of Collateral Flow in Acute Middle Cerebral Artery Occlusion

To report the feasibility of parametric color-coded digital subtraction angiography (DSA) in complementing the traditional, subjective way of leptomeningeal collateral assessment in acute middle cerebral artery (MCA) occlusions. Thirty-three consecutive patients with acute MCA occlusion who received endovascular treatment were recruited for investigation. Eighteen of 33 consecutive patients were included. The target downstream territory (TDT) of MCA and reference point at terminal internal carotid artery of each patient was contoured by 5 raters independently on the basis of anteroposterior 2-dimensional DSA. Two parameters of relative maximum density of TDT (rDensitymax) and peak time interval (ΔPT) between reference and TDT were extracted by the use of parametric DSA analysis software. Interrater reliability was tested with intraclass correlation coefficients. Parameters with sufficient interrater reliability entered validity evaluation. Then, the correlation test with the American Society of Interventional and Therapeutic Neuroradiology collateral grading system and efficacy in predicting favorable clinical outcome was evaluated. The intraclass correlation coefficient of rDensitymax and ΔPT were 0.983, 95% confidence interval 0.968-0.993 and 0.831, 95% confidence interval 0.705-0.923, respectively. The parameter rDensitymax showed a strong correlation with the American Society of Interventional and Therapeutic Neuroradiology collateral grading system score (r of Spearman correlation test= 0.869, P < 0.001) and mRS at 3 months (partial correlation coefficient= 0.616, P= 0.009), whereas ΔPT_average did not. A cut-off point of 0.224 in rDensitymax predicted a favorable clinical outcome with high sensitivity and specificity. The relative maximum contrast density of MCA territory on 2-dimensional DSA measured by parametric imaging technique appears to be a simple and reliable metric for the assessment of leptomeningeal collaterals in cases of acute MCA occlusion.

Quantitative Assessment of Neovascularization after Indirect Bypass Surgery: Color-Coded Digital Subtraction Angiography in Pediatric Moyamoya Disease.

For the postoperative follow-up in pediatric patients with Moyamoya disease, it is essential to evaluate the degree of neovascularization status. Our aim was to quantitatively assess the neovascularization status after bypass surgery in pediatric Moyamoya disease by using color-coded digital subtraction angiography. Time-attenuation intensity curves were generated at ROIs corresponding to surgical flap sites from color-coded DSA images of the common carotid artery, internal carotid artery, and external carotid artery angiograms obtained pre- and postoperatively in 32 children with Moyamoya disease. Time-to-peak and area under the curve values were obtained. Postoperative changes in adjusted time-to-peak (ΔTTP) and ratios of adjusted area under the curve changes (ΔAUC ratio) of common carotid artery, ICA, and external carotid artery angiograms were compared across clinical and angiographic outcome groups. To analyze diagnostic performance, we categorized clinical outcomes into favorable and unfavorable groups. The ΔTTP at the common carotid artery increased among clinical and angiographic outcomes, in that order, with significant differences (P = .003 and .005, respectively). The ΔAUC ratio at the common carotid artery and external carotid artery also increased, in that order, among clinical and angiographic outcomes with a significant difference (all, P = .000). The ΔAUC ratio of ICA showed no significant difference among clinical and angiographic outcomes (P = .418 and .424, respectively). The ΔTTP for the common carotid artery of >1.27 seconds and the ΔAUC ratio of >33.5% for the common carotid artery and 504% for the external carotid artery are revealed as optimal cutoff values between favorable and unfavorable groups. Postoperative changes in quantitative values obtained with color-coded DSA software showed a significant correlation with outcome scores and can be used as objective parameters for predicting the outcome in pediatric Moyamoya disease, with an additional cutoff value calculated through the receiver operating characteristic curve.

Objective assessment of the endpoint of transcatheter arterial chemoembolization using color-coded digital subtraction angiography

Objective To objectively evaluate the endpoint ot transcatheter arterial chemoembolization (TACE) using two dimensional color-coded digital subtraction angiography (2D-ccDSA).Methods Retrospective analysis of twenty-four patients diagnosed with hepatocellular carcinoma (HCC),treated by TACE and evaluated by post-processed 2D-ccDSA.All patients were examined by DSA before and after TACE procedure,all these DSA series were converted into color-code images,the time density curve (TDC) was derived from the 2D-ccDSA imaging.Time-to-peak (TTP) was measured for the ostia of the catheter,the origin of the tumor feeding artery (TFA) and the embolized site of the TFA; maximal TDC enhancement was measured for selected spots of the tumor parenchyma.The tumor blood supply time (TBST) for pre and post-TACE was calculated accordingly.Data were interpreted with paired t test using SPSS.Results The TTP of the ostia of the catheter and the origin of the tumor feeding artery (TFA) before TACE were (3.47 ± 0.96) and (4.09 ± 1.09) s,after the TACE were (3.49 ± 1.02) and (3.78 ± 1.05) s,respectively.There was no statistical difference between the pre-and post-procedural TTP of the two landmarks (t values were 0.10 and 1.15,P values were 0.92 and 0.26).TTP at the embolized site of the main TFA were [(4.62± 1.16) and (5.59± 1.57)s]for pre and post-TACE,the tumor blood supply time (TBST) was greatly delayed compared with that after the TACE procedure [(1.82± 1.10)s and (0.52±0.41)s].The mean maximal TDC enhancements of the tumor parenchyma areas were (3.03±0.88)units before TACE and (1.10±0.67)units after TACE.The differences were all statistically significant (t values were 3.32,6.04 and 8.93,respectively,P＜0.01) Conclusion It is feasible to use 2D-ccDSA to objectively assess the endpoint of TACE procedures. Key words: Liver neoplasms ; Angiography,digital subtraction; Radiology,interventional

Application of color-coded digital subtraction angiography in treatment of indirect carotid-cavernous fistulas: Initial experience

BackgroundParametric-colored digital subtraction angiography using Tmax is almost a routine angiographic imaging procedure, currently. The current feasibility study is aimed to using the imaging to monitor treatment effects while embolizing indirect carotid-cavernous fistulas (CCF). MethodsTen patients with CCFs receiving embolization and 40 patients with normal circulation time were recruited. Their color-coded DSAs were used to define the Tmax of selected intravascular ROIs. A total of 19 ROIs in the internal carotid artery (ICA) (cervical segment of ICA in AP view (I0), cavernous segment of ICA in AP view (I1), supraclinoid segment of ICA in AP view (I2) and cervical segment of ICA in lateral view (I0′), cavernous portion of ICA in lateral view (IA), supraclinoid portion of ICA in lateral view (IB)), ACA (first segment of anterior cerebral artery, second segment of anterior cerebral artery (A1, A2)), middle cerebral vein (MCA) first segment of MCA ((M1), second segment of MCA (M2)), frontal vein (FV), parietal vein (PV), superior sagittal sinus (SSS), sigmoid sinus (SS), internal jugular vein (JV), fistula, superior ophthalmic vein (SOV), inferior petrosal vein (IPS), and MCV were selected. Relative Tmax was defined as the Tmax at selected ROIs minus Tmax at I0 or I0′. An intergroup comparison between the normal and treatment groups and pre- and post-treatment comparison of the peri-therapeutic rTmax for the treatment group were performed. ResultsrTmax's for the normal group were as follows: Anterior-posterior view: I1: 0.16, I2: 0.32, A1: 0.31, M1: 0.35, SSS: 6.16, SS: 6.56, and MCV: 3.86 seconds. Lateral view: IA: 0.05, IB: 0.20, A2: 0.53, M2: 0.95, FV: 4.84, PV: 5.12, IPS: 4.62, JV: 6.81, and MCV: 3.86 seconds. Before embolization, rTmax of the IPS, SS, and JV for the treatment group were shortened (p < 0.05). No rTmaxs for any arterial ROIs in the fistula group were significantly different. After embolization, the rTmaxs for all venous ROIs returned to normal except for two which were partially obliterated. ConclusionThis postprocessing method does not require extra radiation exposure and contrast media. It facilitates real-time hemodyamic monitoring and may help determining the endpoint of embolization, which increases patient safety.

Ｃ‐Ａｒｍ ＣＴを備えた脳血管撮影装置での経動脈的造影剤投与法による脳血液量の計測（Ｎｅｕｒｏ ＰＢＶ）および頭蓋内血流動態評価画像（ｉＦｌｏｗ）の検討

【目的】CアームCTを備えた血管撮影装置での新たなアプリケーションである脳血液量（CBV）の計測（Neuro PBV）と，頭蓋内血流動態画像（iFlow）について報告する．【方法】Neuro PBVはマスク撮影後に造影剤を注入して2度目の撮影を行い，両者の差から組織造影剤濃度分布を得てCBVを算出し，iFlowは造影剤の経時的な血管内移動をカラーマップ表示するものである．それぞれの有効性と適切な撮影方法を検討した．【結果】撮影手順を確立し，両者とも良好な画像を得ることができた．【結論】現状では撮影方法を含めた検討が必要であるが，脳血管内治療において有用な情報を提供するツールになると思われる．