Computed Tomography Angiography versus Digital Subtraction Angiography as a Primary Diagnostic Tool in Nontraumatic Subarachnoid Hemorrhage: Cost-Effectiveness Analysis Study

Salih, Mira; Moore, Justin M.; Ogilvy, Christopher S.

doi:10.1016/j.wneu.2021.05.103

Cited by 8 publications

(6 citation statements)

References 23 publications

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“…The cost of DSA imaging compared with MRI/A has been studied in the context of other vascular pathology, such as subarachnoid hemorrhage, 32,33 but this may be difficult to extrapolate to the moyamoya patient population, where imaging cost is less clear in the literature. Our data show a substantial difference-a 6.5-fold savings by the use of MRI/A over DSA-in the cumulative hospital and professional billing costs between these 2 imaging modalities.…”

Section: Cost Comparisonsmentioning

confidence: 99%

Magnetic Resonance Imaging/Angiography Versus Catheter Angiography for Annual Follow-up of Pediatric Moyamoya Patients: A Cost Outcomes Analysis

et al. 2023

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BACKGROUND:Digital subtraction angiography (DSA) assesses revascularization in pediatric moyamoya patients after surgery, but MRI and angiography (MRI/A) may provide comparable data.OBJECTIVE:To evaluate DSA and MRI/A with respect to clinical utility in postoperative follow-up, complication profile, and relative cost at 1 year.METHODS:All pediatric moyamoya patients who received bilateral indirect revascularization between 2011 and 2020 were retrospectively reviewed at 1 institution. Patients who underwent MRI/A-only, DSA-only, or both after 1 year were compared.RESULTS:Eighty-two patients were included. At 1 year, patients who underwent either MRI/A (n = 29) or DSA (n = 40) had no significant differences in detection rate of new at-risk hypovascular territories (6.9% vs 2.5%, P = .568) or need for subsequent revascularization beyond the mean 40 ± 24-month follow-up period (3.4% vs 5.0%, P > .9). Among patients who underwent both MRI/A and DSA (n = 13), both studies identified the same at-risk territories. No patients experienced MRI/A-related complications, compared with 3 minor DSA-related complications. The use of MRI/A yielded a 6.5-fold reduction in cost per study vs DSA at 1 year.CONCLUSION:Using DSA to follow moyamoya patients after indirect revascularization is generally safe but associated with a low rate of minor complications and a 6.5-fold greater financial cost relative to MRI/A. These data support changing practice to eliminate the use of DSA when following routine bilateral moyamoya cases in the absence of clinical symptoms or specific concerns. Using MRI/A as the primary postoperative follow-up modality in this select population provides noninferior care and greater patient access, while reducing cost and potentially decreasing risk.

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Section: Cost Comparisonsmentioning

confidence: 99%

Magnetic Resonance Imaging/Angiography Versus Catheter Angiography for Annual Follow-up of Pediatric Moyamoya Patients: A Cost Outcomes Analysis

et al. 2023

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“…97 DSA alone incurs more costs than the non-invasive imaging modalities of CTA or MRA. Despite this, a recent cost-effectiveness analysis of CTA versus DSA as a primary diagnostic tool in nontraumatic subarachnoid hemorrhage concluded that DSA was more cost-effective, especially in the setting of a likely intervention, 98 suggesting that cost considerations are significantly impacted by the clinical scenario.…”

Section: Limitationsmentioning

confidence: 99%

Cerebral Digital Subtraction Angiography in Acute Intracranial Hemorrhage: Considerations in Critically Ill Children

Harrar

Sun

Goss³

et al. 2022

J Child Neurol

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Cerebrovascular disorders are an important cause of morbidity and mortality in children. Although minimally invasive, cerebral digital subtraction angiography (DSA) has been shown to be safe in children and is a valuable, and perhaps underutilized, technique for the diagnosis and management of pediatric cerebrovascular disorders in the critical care setting. Through a case-based approach, we explore the utility of DSA in critically ill children with acute intracranial hemorrhage (ICH). We discuss the use of DSA in the acute management of aneurysm and arteriovenous malformation rupture as well as cerebral vasospasm. Those caring for critically ill children with acute ICH should consider cerebral DSA as part of a comprehensive approach to the diagnosis and management of these conditions.

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“…DSA is of great significance in the clinical diagnosis of vascular diseases. It is the most effective detection method in the interventional diagnosis and treatment of cardiovascular and cerebrovascular diseases and is the “gold standard” for the diagnosis of vascular diseases [ 11 , 12 ]. In recent years, deep learning has been widely used in the field of image processing by virtue of its ultra-high prediction accuracy in recognition applications, and the use of deep learning to process some tasks is simpler and more effective than other algorithms.…”

Section: Introductionmentioning

confidence: 99%

Deep Learning‐Based Digital Subtraction Angiography Characteristics in Nursing of Maintenance Hemodialysis Patients

2022

Contrast Media & Molecular Imaging

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This study is aimed at exploring the diagnostic value of digital subtraction angiography (DSA) based on faster region-based convolutional networks (Faster-RCNN) deep learning for maintenance hemodialysis (MHD) diseases and to provide a theoretical basis for clinical nursing. A total of 50 MHD patients who were clinically diagnosed in the Blood Purification Center were randomly divided into the control group and the experimental group (25 cases for each group). The control group was given routine nursing intervention, and the experimental group was given overall nursing intervention under the supervision of DSA. A faster RCNN multitarget detection network was constructed to analyze the average accuracy of various vascular structures in the test set. The self-rating anxiety scale (SAS) and self-rating depression scale (SDS) were used to evaluate the degree of anxiety and depression. The urine volume before and after the operation, local hematoma after a puncture, the incidence of complications, and nursing satisfaction were recorded. The results showed that the average accuracy of the vein, internal carotid artery, circle of Willis, venous sinus, and venous vessels was 0.876, 0.916, 0.994, 0.925, and 0.732, respectively. The success rate of surgery in the experiment group was higher than that in the control group, and the difference had statistical significance ( P < 0.05 ). The SAS score and SDS score in the experimental group were significantly lower than those in the control group ( P < 0.05 ). The total incidence rate of complications in the experimental group (16.00%) was significantly lower than that in the control group (44.00%) ( P < 0.05 ). The satisfaction rate of the experimental group was significantly higher than that of the control group ( P < 0.05 ). The Faster-RCNN model had the best effect in differentiating the circle of Willis and a poor effect in differentiating venous vessels. DSA based on Faster-RCNN can significantly improve the success rate of puncture in MHD patients. The implementation of holistic nursing intervention under its supervision can significantly reduce postoperative complications and improve patient satisfaction with nursing compared with routine nursing.

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Computed Tomography Angiography versus Digital Subtraction Angiography as a Primary Diagnostic Tool in Nontraumatic Subarachnoid Hemorrhage: Cost-Effectiveness Analysis Study

Cited by 8 publications

References 23 publications

Magnetic Resonance Imaging/Angiography Versus Catheter Angiography for Annual Follow-up of Pediatric Moyamoya Patients: A Cost Outcomes Analysis

Magnetic Resonance Imaging/Angiography Versus Catheter Angiography for Annual Follow-up of Pediatric Moyamoya Patients: A Cost Outcomes Analysis

Cerebral Digital Subtraction Angiography in Acute Intracranial Hemorrhage: Considerations in Critically Ill Children

Deep Learning‐Based Digital Subtraction Angiography Characteristics in Nursing of Maintenance Hemodialysis Patients

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