CBCT-based 3D MRA and angiographic image fusion and MRA image navigation for neuro interventions

Abstract

Digital subtracted angiography (DSA) remains the gold standard for diagnosis of cerebral vascular diseases and provides intraprocedural guidance. This practice involves extensive usage of x-ray and iodinated contrast medium, which can induce side effects. In this study, we examined the accuracy of 3-dimensional (3D) registration of magnetic resonance angiography (MRA) and DSA imaging for cerebral vessels, and tested the feasibility of using preprocedural MRA for real-time guidance during endovascular procedures.Twenty-three patients with suspected intracranial arterial lesions were enrolled. The contrast medium-enhanced 3D DSA of target vessels were acquired in 19 patients during endovascular procedures, and the images were registered with preprocedural MRA for fusion accuracy evaluation. Low-dose noncontrasted 3D angiography of the skull was performed in the other 4 patients, and registered with the MRA. The MRA was overlaid afterwards with 2D live fluoroscopy to guide endovascular procedures.The 3D registration of the MRA and angiography demonstrated a high accuracy for vessel lesion visualization in all 19 patients examined. Moreover, MRA of the intracranial vessels, registered to the noncontrasted 3D angiography in the 4 patients, provided real-time 3D roadmap to successfully guide the endovascular procedures. Radiation dose to patients and contrast medium usage were shown to be significantly reduced.Three-dimensional MRA and angiography fusion can accurately generate cerebral vasculature images to guide endovascular procedures. The use of the fusion technology could enhance clinical workflow while minimizing contrast medium usage and radiation dose, and hence lowering procedure risks and increasing treatment safety.

Simulation of superselective catheterization for cerebrovascular lesions using a virtual injection software

“…A few studies reported the benefit of augmented fluoroscopy for neurointerventional procedures in increasing operator confidence, reducing radiation dose, and reducing contrast injected into the patient. In these publications, volumes used for 3D-roadmapping were mainly extracted from pre-op imaging (Zhang et al 2017 ; Ruijters et al 2011 ; Zhang et al 2016 ; Kishore et al 2020 ), with no time constraint to segment the structures of interest, but inherent risks of misregistration due to change in patient position. In some other studies, the whole vasculature from the CBCT was used as overlay (Blanc et al 2015 ; Jang et al 2016 ), as careful segmentation of the targeted vessels was too time-consuming to be performed intraoperatively.…”

Evaluation of Autogenous Fresh Demineralized Tooth Graft Prepared at Chairside for Dental Implant (Clinical and Histological Study)

“…Each patient received 16 -20 μSv per exposer and a total of 80-100 μSv for all exposers including the preoperative examination which is very low in comparison to the annual minimum radiation dose for the general public 1mSv/y (1mSv = 1000 μSv) (14,15) Also all the patient used lead collar for thyroid protection during all exposers and all the exposers were performed over a period of 9 months including pre-operative radiographic examination. Implant clinical evaluation: assess Presence of pain, gingival condition around the implant using Modified sulcus bleeding index (MSBI) (16).…”

Computed tomography cavernosography combined with volume rendering to observe venous leakage in young patients with erectile dysfunction

“…With the development of image technology, especially three-dimensional DSA image fusion technology, 32,33 embolization is now reconsidered as a minimally invasive treatment in our department. Through CT cavernosography and three-dimensional DSA image fusion, which can provide navigation images, penile veins embolization can be more accurate, and operation time can be shorten to reduce radiation dose.…”