Volumetric analysis of intracranial vessels: a novel tool for evaluation of cerebral vasospasm

Neulen, Axel; Pantel, Tobias; Dieter, Anna; Kosterhon, Michael; Berres, Manfred; Thal, Serge C.; Brockmann, Marc A.; Kantelhardt, Sven R.

doi:10.1007/s11548-018-1844-1

Cited by 9 publications

(9 citation statements)

References 34 publications

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“…The SAH patients were managed clinically according to clinical standard protocols described previously (24)(25)(26). In brief, the SAH was diagnosed by cranial CT, followed by CTA and DSA to detect aneurysms.…”

Section: Clinical Managementmentioning

confidence: 99%

“…Imaging CTA and CTP were performed according to standard diagnostic protocols (80 kV; 50 mAs; 40 mL Imeron 400 administered via a power injector at an injection rate of 5 mL/s) using a Toshiba Aquilion 32 CT scanner with 32 slices (512 × 512 pixels; Software Base V3.20 • R003//Appl. : V3.10GR004), as described previously (24). Intracranial CTA was recorded from the foramen magnum up to the superior sagittal sinus.…”

Section: Data Collectionmentioning

confidence: 99%

Section: Volumetric Analysis Of Cta Datamentioning

confidence: 99%

“…The CTA data sets acquired within the scope of the diagnostics for DCI were subjected to a volumetric analysis of the intracranial vessels using Amira software version 5.4.2 (FEI Visualization Sciences Group, Hillsboro, OR, USA) following a standardized protocol (23,24). In brief, the bone was virtually subtracted and the intracranial vascular tree was then virtually reconstructed by applying a standardized windowing procedure (23,24) shown to have high interrater agreement in results for vessel volumes (24). The vessel volume and the length of the corresponding vessel segment were calculated according to a standardized algorithm, as previously described (23,24,29,30), for the following vessel segments: the basilar artery, the posterior cerebral artery, the internal carotid artery, the M1 and M2 segments of the middle cerebral artery, and the A1 and A2 segments of the anterior cerebral artery.…”

Section: Volumetric Analysis Of Cta Datamentioning

confidence: 99%

“…Our group has developed a method that enables a highly accurate virtual reconstruction of the intracranial vascular tree from CTA data and a volumetric analysis of entire vessel segments (23). In a previous study, we performed a volumetric evaluation of the M1 segment of the middle cerebral artery based on CTA data acquired as part of the DCI diagnostics for a cohort of SAH patients (24). We determined a volumetric threshold that could predict with moderate sensitivity and fair specificity the patients for whom endovascular treatment would subsequently be indicated (according to the diagnostic standards of our hospital) or who would experience a new cerebral infarction within 72 h. This demonstrated that such an assessment can identify severe vasospasms.…”

Section: Introductionmentioning

confidence: 99%

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Automated Grading of Cerebral Vasospasm to Standardize Computed Tomography Angiography Examinations After Subarachnoid Hemorrhage

et al. 2020

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Background: Computed tomography angiography (CTA) is frequently used with computed tomography perfusion imaging (CTP) to evaluate whether endovascular vasospasm treatment is indicated for subarachnoid hemorrhage patients with delayed cerebral ischemia. However, objective parameters for CTA evaluation are lacking. In this study, we used an automated, investigator-independent, digital method to detect vasospasm, and we evaluated whether the method could predict the need for subsequent endovascular vasospasm treatment. Methods:We retrospectively reviewed the charts and analyzed imaging data for 40 consecutive patients with subarachnoid hemorrhages. The cerebrovascular trees were digitally reconstructed from CTA data, and vessel volume and the length of the arteries of the circle of Willis and their peripheral branches were determined. Receiver operating characteristic curve analysis based on a comparison with digital subtraction angiographies was used to determine volumetric thresholds that indicated severe vasospasm for each vessel segment.Results: The automated threshold-based volumetric evaluation of CTA data was able to detect severe vasospasm with high sensitivity and negative predictive value for predicting cerebral hypoperfusion on CTP, although the specificity and positive predictive value were low. Combining the automated detection of vasospasm on CTA and cerebral hypoperfusion on CTP was superior to CTP or CTA alone in predicting endovascular vasospasm treatment within 24 h after the examination.Neulen et al. Automated Grading of Cerebral VasospasmsConclusions: This digital volumetric analysis of the cerebrovascular tree allowed the objective, investigator-independent detection and quantification of vasospasms. This method could be used to standardize diagnostics and the selection of subarachnoid hemorrhage patients with delayed cerebral ischemia for endovascular diagnostics and possible interventions.

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Section: Clinical Managementmentioning

confidence: 99%

Section: Data Collectionmentioning

confidence: 99%