Three-dimensional Rotational Digital Subtraction Angiography Research Articles

RAPID aneurysm accurately measures aneurysm size on CT angiography compared to three-dimensional digital subtraction angiography.

Cerebral aneurysms are often identified and characterized on non-invasive CT Angiography (CTA) images, but digital subtraction angiography (DSA) is the gold standard for aneurysm evaluation. We compared cerebral aneurysm size measurements as measured from CTA processed by a semi-automated artificial intelligence software program (RAPID Aneurysm) and three-dimensional rotational DSA (3D-DSA). We performed a retrospective cohort study of consecutive patients with a cerebral aneurysm who underwent CTA and DSA with 3D reformations. CTA images were processed by RAPID Aneurysm to determine aneurysm height, width, and neck width. The reference standard was aneurysm measurements on 3D-DSA as measured by two neurointerventionalists. Both readers were blinded to RAPID Aneurysm measurements. Correlation and bias between these measurements were determined. Results from 50 patients with 50 aneurysms were compared. 32 patients (64%) were female. Median age was 65 (IQR: 56.25-71.75). 37 patients (74%) presented with ruptured aneurysms. The aneurysms represented a range of aneurysm sizes (1.9-33.3 mm; IQR 3.6-7.2 mm). RAPID Aneurysm size measurements showed excellent correlation and low bias (correlation, mean difference) when compared to the reference standard for aneurysm height (0.98, -0.9 mm), width (0.98, 0.1 mm), and neck width (0.94, 1.1 mm). The inter-reader comparison between the two neurointerventionalists was similarly excellent for aneurysm height (0.97, -0.4 mm), width (0.98, -0.2 mm), and neck width (0.89, 0.8 mm). RAPID Aneurysm measurement of cerebral aneurysm height, width, and neck width on CTA is strongly correlated to expert neurointerventionalist measurements on 3D-DSA.

Detection of the Vesical Arteries Using Three-dimensional Digital Subtraction Angiography Relevant to Intra-arterial Infusion Chemotherapy for Bladder Cancer Using Double-balloon Catheters.

This study aims to assess and measure the origin of the superior vesical artery and its distance from the anterior trunk of the internal iliac artery, to which the anticancer drug is infused via double-balloon-occluded arterial infusion bladder-preserving therapy for locally invasive bladder cancer. The 160 pelvic sides of 80 patients were analyzed. Double-balloon catheters were bilaterally introduced into the contralateral superior gluteal artery via the internal iliac arteries using a bilateral transfemoral approach. The proximal balloon is placed at the internal iliac artery, proximally from superior gluteal artery bifurcation, whereas the distal balloon at the origin of the superior gluteal artery to isolate the anterior trunk of the internal iliac artery discharging to the targeted vesical arteries between the balloons. The side hole between the distal and proximal balloons was adjusted at the origin of the anterior trunk of the internal iliac artery to allow clear visualization of the angiographic flow into the bladder. After the distal and proximal balloons were inflated, three-dimensional rotational digital subtraction angiography was performed by simultaneous contrast injection from one extension tube connected to bilateral catheters. The distance (X) between the origins of anterior trunk of the internal iliac artery and superior vesical artery was measured on three-dimensional digital subtraction angiography images, and the origin of the inferior vesical artery was investigated. All superior vesical artery originated from anterior trunk of the internal iliac artery. The mean x was 7.2 mm (range 1.0-22.0 mm). All inferior vesical arterys branched from anterior trunk of the internal iliac artery or its branches. Superior vesical artery commonly originates from the proximal portion of anterior trunk of the internal iliac artery close to superior gluteal artery bifurcation.

Impact of Risk Factors on the Size of Ruptured Intracranial Saccular Aneurysms

Background: Un-ruptured intracranial aneurysms (UIAs) are common and prevalence is about 2 to 8%. Several studies have shown that the decision to treat un-ruptured aneurysms should not be based on aneurysm size alone. A study suggest that treatment of UIAs smaller than 7 mm in hypertensive patients and smokers may be beneûcial.
 Aim and objective: The goal of this study is analysis of correlation of age, gender, location of the aneurysm, history of hypertension and cigarette smoking, previous history of SAH with the size of ruptured aneurysms.
 Materials and Methods: This hospital based observational cross-sectional study was conducted in the Department of Neurology & Neurosurgery, Dhaka Medical College Hospital (DMCH), Dhaka. Total 44 patients with SAH were taken by inclusion & exclusion criteria. The aneurysms size, site of location and aneurysm multiplicity was assessed by three-dimensional rotational digital subtraction angiography (DSA).
 Results:The mean age of the study population was 49.24 ±11.5. About half of the population were within 51-60 years. The male female ratio was 1:1.2. Out of 44 population, 93.2% were presented with headache, 90.9% with vomiting. In this study aneurysms mean size was 5.72±4.010 mm. 93.2% of aneurysms were below 10 mm, 75.0% were below 7 mm and 50.0% below 5 mm. Size of ruptured aneurysm is small in hypertensive population and is significant (p-value 0.037). Aneurysm size was significantly (p- value 0.013) smaller in case of smoker. Mean aneurysm size in hypertensive smoker population was significantly (p-value-0.004) smaller than hypertensive non-smoker. Population with one risk factor had mean aneurysm size was 8.32±6.84 mm, two risk factors had 5.26±1.86mm, three risk factors had 4.79±2.05 mm and more than three risk factors had 2.85±1.43.
 Conclusion: This study shows that more the risk factors, smaller the size of aneurysms. Therefore, history of hypertension, cigarette smoking, female sex, age and positive family history should be considered in the assessment of treatment of un-ruptured intracranial aneurysms.
 Bangladesh Journal of Neuroscience 2019; Vol. 35 (2): 86-94

Application of low injection rate and low contrast agent dose in three-dimensional rotational digital subtraction angiography of the intracranial aneurysm.

The objective of this article is to explore the feasibility of low injection rate and low contrast agent dose in three-dimensional rotational digital subtraction angiography (3D DSA) of the intracranial aneurysm. Fifty-one patients with suspected intracranial aneurysms were included. The catheter tip was kept within the internal carotid artery at the epistropheus level. Patients were divided into three groups randomly according to injection rate: group A (1.5 ml/s, n = 18), group B (2.0 ml/s, n = 18), and group C (3.0 ml/s, n = 15). The noise, signal-to-noise ratio (SNR), and carrier-to-noise ratio (CNR) of C2, C6, M1, and A1 segments were calculated. The continuous subtraction images and reconstructed images were evaluated by two technicians. No significant differences were found in noise between groups A and B, and groups A and C. Significant differences were found in the SNR and CNR of M1 and A1 segments between groups A and B, and groups B and C, but for C2 and C6 segments, they were not significant. Significant differences were found in the SNR and CNR of all segments between groups A and C. Significant differences were found in the contrast agent dose between all three groups. No significant differences were found in scores evaluated by two physicians between the three groups. The personalized injection protocol of low injection rate and low contrast agent dose in 3D DSA of the intracranial aneurysm is feasible. The application of this protocol can reduce the dose of iodine and obtain satisfactory images.

Size Ratio: A Morphological Factor Predictive of the Rupture of Cerebral Aneurysm?

Determining factors predictive of the natural risk of rupture of cerebral aneurysms is difficult. We studied morphological factors associated with rupture in a study model of patients with mirror location intracranial aneurysms, one aneurysm that had ruptured and one that had not, each patient served as their own control attempting to eliminate confounding variables. We collected five one-dimensional measurements and four two-dimensional indices from three-dimensional rotational digital subtraction angiography images of patients in the proposed study model and explored their correlation with aneurysm rupture. Parameters were analyzed with a paired Student's t test for significance and significant parameters were further examined by multivariate conditional logistic regression analysis. Fifty-two patients with 52 pairs of intracranial aneurysms in a mirror location were studied. The maximum perpendicular height, neck diameter, maximum width, maximum height, aspect ratio, size ratio, and bottleneck factor were significantly associated with ruptured aneurysms on bivariate analysis. A logistic regression analysis showed that only size ratio, which was defined as the ratio of the maximal height to parent artery average diameter, is independently correlated with ruptured intracranial aneurysms. In a case-control study of patients with mirror location intracranial aneurysms, size ratio was identified as the unique morphological factor associate with the rupture of cerebral aneurysms.

Endovascular coil embolization for ruptured kissing aneurysms associated with A1 fenestration

Background:Fenestration of intracranial arteries is a rare anomaly, and is frequently associated with cerebral aneurysms. In this paper, we report rare kissing aneurysms associated with A1 fenestration.Case Description:A 71-year-old woman presented with subarachnoid hemorrhage. Diagnostic digital subtraction angiography revealed two saccular aneurysms at the proximal junction of a fenestration and posterior aspect of the fenestration that appeared to be ‘kissing’ each other. Emergent endovascular coil embolization was performed.Conclusion:Kissing aneurysms associated with fenestration of the horizontal segment in the anterior cerebral artery are rare, and have not been reported. During treatment of such specific types of aneurysms by endovascular treatment, three-dimensional rotational digital subtraction angiography was very useful for deciding the appropriate working angles.

Endovascular embolization of small ruptured intracranial aneurysms using a biplane angiographic system with three-dimensional rotational digital subtraction angiography

Endovascular coiling of small, ruptured intracranial aneurysms is controversial because of technical difficulties. We analyzed the clinical and angiographic effects of endovascular treatment of 39 small (⩽5 mm) ruptured intracranial aneurysms (in 37 patients) at our institution between March 2004 and March 2007. Procedures were carried out on a biplane angiographic system with three-dimensional rotational digital subtraction angiography. Immediately after embolization, 30 aneurysms were completely occluded and nine had a residual neck. The volumetric percentage occlusion was 45.2 ± 9.7%. Angiographic and clinical follow-up was at 6.1 months and 15.9 months, respectively. Delayed rebleeding was not observed. Complications directly related to the procedure were encountered in two patients (one coil migration and one intraoperative rupture). For 34 patients, the final outcome was excellent or good, one suffered a moderate disability, one a severe disability and one patient died. The results suggest that endovascular embolization is effective and safe for patients with small ruptured intracranial aneurysms.

ＦＰＤシステムを用いた頭部３Ｄ‐ＤＳＡにおける視野サイズの検討

In interventional neuroradiology, three-dimensional rotational digital subtraction angiography (3D-DSA) is very useful for the spatial grasp of the location and size of an intracranial cerebral aneurysm. The purposes of this study were to evaluate the property of three-dimensional image dependence on the respective field of view (FOV) size in a flat-panel detector (FPD) using vessel phantoms, and to optimize clinically. The indices of three-dimensional image properties such as profile curve (FWHM, FWTM), digital value, and image noise were evaluated using a vessel phantom with a different diameter. As a result, in the case of a 6-inch FOV size of the FPD, the relative diametral rate of change from the actual value of the vessel phantom was least for all FOV sizes. This study demonstrated that the difference in FOV size in 3D-DSA affects the three-dimensional object's reproducibility. Furthermore, as for this 3D-DAS system, three-dimension images such as a VR image might be processed more faithfully, since an FOV size of 6 inches has the highest reproducibility of objects.

Three-dimensional digital rotation angiography for embolization therapy of uterine leiomyomas: first results

To evaluate three-dimensional rotational digital subtraction angiography (3D-RDSA) in the embolization of the uterine artery in the treatment of symptomatic uterine leiomyomas (fibroids). Eight women with complex pelvic vessel anatomy caused by large fibroids were embolized using 3D-RDSA. The raw data were sent to an external workstation, and video files with a resolution of one image/3 degrees and a scan range of 180 degrees in a surface-shaded display mode were produced. The primary goal was to assess an image intensifier angulation for the optimal visualization of the origin of the uterine artery. In addition, the intervention parameters were compared with those of 48 patients with standard angiography. The analysis revealed no single angulation that can be recommended for standard angiography. No statistical differences were found between both groups concerning fluoroscopy time, dosage area product and amount of administered contrast medium (p > 0.05). It can be stated that 3D-RDSA is a feasible method that facilitates the catheterization of the uterine artery even in patients with complex pelvic vessel anatomy, with the potential to reduce the radiation exposure and the amount of administered contrast medium in future embolization therapy of symptomatic uterine fibroids.