Dual-energy Digital Subtraction Angiography Research Articles

Multilayer optics for harmonic control of angiography beamline sources

In recent work, multilayers with band-tailored optics for dual energy digital subtraction angiography (DDSA) applications have been designed and tested at SSRL. Control of various multilayer parameters, including period grading, ratio of high-to-low Z material thickness, number of layers, etc., was used to produce reflectors with bandwidths ranging from 0.6%–10% and efficiencies in the 30%–95% range. In this paper, we consider the control of multilayer bandshapes and the implementation of double-reflection multilayer configurations to further control the first harmonic (33 keV) bandwidth and to suppress or eliminate the 66 keV and 99 keV harmonics present on angiography beamlines driven by wiggler or micropole undulator sources.

Quantification of Volumetric Coronary Blood Flow With Dual-Energy Digital Subtraction Angiography

As a solution to the well-documented problems associated with visual interpretation of coronary arteriograms, more physiological methods of assessing coronary artery stenosis are being investigated. Volumetric coronary blood flow (BF) can be a valuable aid in the analysis of functional significance of arterial obstruction. The left anterior descending coronary artery (LAD) of 15 anesthetized pigs (40 to 50 kg) was dissected free from the epicardium in its proximal portion, and a transmit-time ultrasound flow probe of the appropriate size was applied. A vascular occluder was positioned distal to the flow probe for flow adjustments. Contrast injections (2 to 4 mL/s for 3 seconds) were made into the left main coronary artery during image acquisition with a motion-immune dual-energy digital subtraction angiography (DE DSA) system. Tissue-suppressed energy-subtracted images were used to generate time-density curves. BF measurements were made in the LAD vascular bed with use of the time-density curve, with consideration that blood was momentarily replaced with contrast during the injection. In 19 comparisons, the mean BF, measured with the use of DE DSA, correlated extremely well with the mean ultrasound flow (DE DSA=0.90 ultrasound+3.10 mL/min, r=.96). Also, contrast injection increased the BF by an average of only 15% during the image-acquisition time interval. Accurate BF measurements can be made with motion-immune DE DSA. The BF measurements can be completed before the onset of significant changes in BF due to contrast injection. Furthermore, it is possible to make the BF measurements during routine coronary arteriography.

CCD camera for dual-energy digital subtraction angiography

A motion immune dual-energy subtraction technique in which X-ray tube voltage and beam filtration were switched at 30 Hz between 60 kVp (2.0 mm Al filter) and 120 kVp (2.00 mm Al+2.5 mm Cu filter) was previously reported. In this study the effects of camera lag on the dual-energy iodine signal is investigated. The temporal lag of the lead oxide vidicon tested reduced the dual-energy iodine signal by a factor of 2.3, as compared to a mode that included 4 scrub frames between low- and high-energy images, for an iodine phantom with thicknesses of 0-86.0 mg/cm(2), imaged over a 15 cm thick Lucite phantom. On the other hand, the Charge-Coupled Device (CCD) camera has inherently no temporal lag and its versatile scanning characteristics make it near ideal for dual-energy DSA. The CCD camera eliminates the reduction of dual-energy iodine signal, since it does not mix low- and high-energy image data. Another benefit of the CCD camera is that the separation time between low and high-energy images is not limited to the frame period, as is the lead oxide vidicon; and as small as a 5-msec time difference is possible. The short time interval between low and high-energy images minimizes motion misregistration artifacts. Due to these advantages, the CCD camera significantly improves the utility of dual-energy DSA.

Tests of variable-band multilayers designed for investigating optimal signal-to-noise versus artifact signal ratios in dual-energy digital subtraction angiography (DDSA) imaging systems

In recent work, various design techniques were applied to investigate the feasibility of controlling the bandwidth and bandshape profiles of tungsten/boron-carbon (W/B 4C) and tungsten/silicon (W/Si) multilayers for optimizing their performance in synchrotron radiation based angiographical imaging systems at 33 keV. Varied parameters included alternative spacing geometries, material thickness ratios, and numbers of layer pairs. Planar optics with nominal design reflectivities of 30–94% and bandwidths ranging from 0.6–10% were designed at the Stanford Synchrotron Radiation Laboratory, fabricated by the Ovonic Synthetic Materials Company, and characterized on Beam Line 4-3 at the Stanford Synchrotron Radiation Laboratory. In this paper we report selected results of these tests and review the possible use of the multilayers for determining optimal signal to noise vs artifact signal ratios in practical dual-energy digital subtraction angiography systems.

Optimization of beam parameters for dual‐energy digital subtraction angiography

Dual-energy digital subtraction angiography (DSA) is immune to the misregistration artifacts which plague conventional temporal subtraction DSA. However, since the signal-to-noise ratio (SNR) of dual-energy DSA is lower than temporal subtraction it is important to optimize the dual-energy technique with respect to the SNR. This study investigates the optimization of x-ray exposure parameters for the low- and high-energy x-ray beams, drawing upon our experience with dual-energy DSA studies in 20 cardiac patients. It is shown that the SNR is optimized, with respect to patient exposure, when the image intensifier (II) exposure for the high-energy beam is approximately 5 times higher than the low-energy beam. The unequal distribution of exposure between the low- and high-energy beams is achieved by selecting different video apertures for the two beams, and is therefore referred to as the "dual-aperture" technique. The dual-aperture technique achieves the same SNR as the single-aperture technique (which uses equal II exposures for the two beams) with 45% less patient exposure. In addition, the dual-aperture technique enhances the ability to maintain an optimum low-energy kVp, which increases the dual-energy signal amplitude. The optimum high-beam filter thickness for use with the dual-aperture approach is determined. The optimum filter thickness, which is dependent upon the desired tube loading, is found to range from 1.3 to 2.0 mm Cu for tube loads ranging from 188 to 688 J/beam pair.

Densitometric assessment of regional left ventricular systolic function during graded ischemia in the dog by use of dual-energy digital subtraction ventriculography

Densitometric analysis of images obtained by digital subtraction angiography (DSA) allows for more reproducible and less operator-dependent quantitation of ventricular function. Conventional DSA uses temporal subtraction but is limited by misregistration artifacts. Dual-energy digital subtraction angiography (DE-DSA) is immune to such misregistration artifacts. The ability of DE-DSA to quantitate changes in regional ventricular volume resulting from ischemia was tested. Densitometric analysis of both phase-matched and ejection fraction DE-DSA images was used to quantitate regional left ventricular systolic function during four levels of ischemia ranging from mild to severe in open-chest dogs ( n = 10). DE-DSA left ventriculograms were obtained by means of central venous injections of iodinated contrast medium. Ischemia was graded according to percentage of systolic wall thickening as measured by sonomicrometry. Phase-matched end-systolic images were obtained at each of four levels of ischemia by subtracting an end-systolic control image from each end-systolic ischemic image. Ejection fraction images were obtained at the control level and at each level of ischemia by subtracting an end-systolic image from an end-diastolic image of the same cardiac cycle. The resulting wall motion difference signals represent the changes in regional ventricular volumes and were quantitated by densitometry. Densitometry was able to detect the effect of all levels of ischemia on regional function, even the mildest. Densitometric analysis of both phase-matched and ejection fraction DE-DSA images provides a sensitive technique for detecting and quantitating the changes in regional left ventricular systolic volume that occur with ischemia.

Absolute Cross-Sectional Area Measurements in Quantitative Coronary Arteriography by Dual-Energy DSA

Recent studies have emphasized the limitations of conventional coronary angiography. These limitations include the lack of correlation between the severity of coronary stenosis as estimated from coronary angiograms and the actual severity of stenotic lesions measured in postmortem hearts. As a result, attempts have been made to quantitate luminal dimension more precisely. The application of quantitative digital subtraction angiography (DSA) in the assessment of coronary artery lesion dimension has been limited by cardiac and respiratory motion artifacts. We have reported previously on a motion-immune dual-energy (DE) cardiac mode in which kVp and filtration are switched at 30 Hz. To assess the potential advantages of a videodensitometric technique for quantification of absolute vessel cross-sectional area (CSA), three different quantitative coronary arteriography (QCA) algorithms were compared. The three algorithms under comparison were a videodensitometric (V) algorithm, which does not require any geometric assumption for absolute vessel CSA measurement, and videodensitometric (VC) and edge detection (ED) algorithms, which do require the assumption of circular cross-section for CSA measurements. A cylindrical vessel phantom (0.5-4.75 mm in diameter) and a crescentic vessel phantom, producing 25% to 90% area stenosis, were imaged over the chest of a humanoid phantom. The low- and high-energy images were corrected for scatter and veiling glare before energy subtraction. For CSA measurements in crescentic vessel phantoms, the V algorithm produced significantly improved results (slope = 0.87, intercept = 0.51 mm2, r = .95) when compared to the VC (slope = 1.05, intercept = 4.19 mm2, r = .75) and the ED (slope = 1.57, intercept = 5.21 mm2, r = .60) algorithms.

Limitations of the lead oxide vidicon for dual-energy digital subtraction angiography

Dual-energy digital subtraction angiography (DSA) can be performed, with some modifications, using existing systems designed for conventional DSA work. However, the video camera generally found in such installations, the lead oxide vidicon, places significant limitations on the image quality of dual-energy DSA. If the video camera is operated in a 60 Hz, 266 line progressive scanning mode to maintain a nominal 30 subtraction images/s frame rate, the maximum available X-ray pulse width is limited to 5 ms. The resulting required increase in low-energy kVp reduces the dual-energy signal-to-noise ratio by approximately 40% for cardiac dual-energy DSA imaging. In addition, the performance of the video camera with respect to read-out lag is much more important for dual-energy DSA than conventional single-energy imaging. Measurements show that lag reduces the iodine contrast in dual-energy DSA by up to 20% when a 30 Hz vertical scan mode is used, and by up to 27% when a 60 Hz vertical scan mode is employed. Replacement of the lead oxide vidicon with a CCD camera removes these limitations.

A correlated noise reduction algorithm for dual-energy digital subtraction angiography.

It has long been recognized that the problems of motion artifacts in conventional time subtraction digital subtraction angiography (DSA) may be overcome using energy subtraction techniques. Of the variety of energy subtraction techniques investigated, non-k-edge dual-energy subtraction offers the best signal-to-noise ratio (SNR). However, this technique achieves only 55% of the temporal DSA SNR. Noise reduction techniques that average the noisier high-energy image produce various degrees of noise improvement while minimally affecting iodine contrast and resolution. A more significant improvement in dual-energy DSA iodine SNR, however, results when the correlated noise that exists in material specific images is appropriately cancelled. The correlated noise reduction (CNR) algorithm presented here follows directly from the dual-energy computed tomography work of Kalender who made explicit use of noise correlations in material specific images to reduce noise. The results are identical to those achieved using a linear version of the two-stage filtering process described by Macovski in which the selective image is filtered to reduce high-frequency noise and added to a weighted, high SNR, nonselective image which has been processed with a high-frequency bandpass filter. The dual-energy DSA CNR algorithm presented here combines selective tissue and iodine images to produce a significant increase in the iodine SNR while fully preserving iodine spatial resolution. Theoretical calculations predict a factor of 2-4 improvement in SNR compared to conventional dual-energy images. The improvement factor achieved is dependent upon the x-ray beam spectra and the size of blurring kernel used in the algorithm.(ABSTRACT TRUNCATED AT 250 WORDS)