Dose reduction in cone-beam CT scanning for intracranial stent deployment before coil embolization of intracranial wide-neck aneurysms

Kuriyama, Takumi; Sakai, Nobuyuki; Niida, Norimitsu; Sueoka, Masaki; Beppu, Masatoshi; Dahmani, Chihebeddine; Kojima, Iwao; Sakai, Chiaki; Imamura, Hirotoshi; Masago, Katsuhiro; Katakami, Nobuyuki

doi:10.1177/1591019916632489

Cited by 6 publications

(4 citation statements)

References 16 publications

(29 reference statements)

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“…The difference in acquisition techniques between our own study and the relevant literature is multifactorial (Table 3). Where other studies have maximised their CNR by using a 20‐sec single spin acquisition in combination with a 5‐mL/sec injection, 1,4,7,18 in our experience the propensity for patient movement, despite immobilisation, is too great for such a long acquisition. Our study also utilises a dual acquisition allowing for the creation of detailed volumed rendered reconstructions, the ability to reformat the data sequence using ‘motion correction’ as well as the production of dedicated subtraction maps necessary for stereotactic surgery planning.…”

Section: Discussionmentioning

confidence: 94%

Optimising image quality in intravenous cerebral cone beam computed tomography

Broadley,

Erskine,

Marshall

et al. 2023

J of Medical Radiation Sci

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IntroductionThe efficacy of intravenous cerebral Cone Beam Computed Tomography (IV CBCT) is well established; however, image quality has only ever been authenticated by subjective evaluation. The aim of this study was to quantify the factors pertinent to achieving consistent and optimal image quality when performing IV CBCT.MethodsBetween 1 March 2021 and 30 October 2022, 79 patients received IV CBCT. These candidates were divided into three main acquisition field size categories (22/32, 42 and 48 cm) according to the clinical indication. The images were analysed using both a quantitative assessment and a subjective evaluation. Here, a comparison of Hounsfield units (HUs), signal‐to‐noise ratio (SNR), contrast‐to‐noise ratio (CNR) and noise index was conducted for each study and compared relative to the acquisition field size. The subjective analysis was performed in a non‐blinded fashion where the diagnostic value (DV) of the exam was determined according to a graded scale. A phantom analysis for each of the acquisition field sizes was conducted and modulation transfer function (MTF) graphed.ResultsSignificantly higher HU, SNR, CNR and lower noise indices were achieved with the 42‐cm protocol than the 22/32 and 48‐cm protocols. Here a greater DV was also reported. The MTF demonstrates marginally improved spatial resolution for the 22‐cm protocol, but this is near equivocal for the 32‐, 42 and 48‐cm protocols.ConclusionThe use of larger acquisition field sizes provides improved image quality when performing IV CBCT as an alternative to intra‐arterial (IA) CBCT.

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Section: Discussionmentioning

confidence: 94%

Optimising image quality in intravenous cerebral cone beam computed tomography

Broadley,

Erskine,

Marshall

et al. 2023

J of Medical Radiation Sci

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“…IACBCT imaging modality is frequently obtained with a 10-20% diluted contrast [5,7]. A 14% dilution formula has been proposed for evaluation of stent-assisted coil embolization with CBCT [11]. One report recommends the use of 0.2 cm 3 /s contrast infusion rate and saline flush with a 300 mm Hg pressure bag rather than a dilution formula within the power injector [7].…”

Section: Discussionmentioning

confidence: 99%

Usefulness of Cone Beam Intra-Arterial CTA for Evaluation of Flow Diverters: A Practical Approach for Daily Use

Reyes¹,

Becerra²,

Alcala³

et al. 2018

Intervent Neurol

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Cone beam computed tomography (CBCT), initially used for evaluation of intraprocedural complications such as hemorrhage, has evolved to provide details of implanted devices such as flow diverters. The study aim is to present our experience in using CBCT with intra-arterial injection and provide a step-by-step approach for postprocessing in a practical protocol for daily use. IRB approval was obtained, and the neurointerventional database was retrospectively reviewed from July 2012 to June 2017. Patients who underwent cone beam intra-arterial CT angiography for evaluation of implanted flow diverter devices were reviewed. Patient demographics, aneurysm location (internal carotid artery [ICA]-cavernous, ICA-paraclinoid, and ICA-distal; middle cerebral artery [MCA], anterior cerebral artery [ACA]-acom, ACA-pericallosal, vertebral artery [VA]), type (saccular, dissecting fusiform, or blister) and size, device, injection technique (contrast dilution, rate, and volume), and reconstruction protocol were recorded. Acquired images were postprocessed using a Philips Xtravision workstation. Eighty patients (63 women and 17 men) met the inclusion criteria of our study. Age range was 25–80 years old. Treated aneurysms were located in the ICA-paraclinoid in 48 cases (60%), ICA-distal in 12 cases, ICA-cavernous in 8 cases, MCA in 4 cases, VA in 4 cases, ACA-acom in 2 cases, ACA-pericallosal in 2 cases; 69 were saccular, 8 fusiform, and 3 ruptured blister aneurysms. There were 52 small, 20 large, and 8 giant aneurysms. Pipeline (Medtronic, MN, USA) was the predominant device used in 77 procedures. Two injection techniques were used: 2.5 mL/s for a total volume of 55 mL with a 2-s imaging delay or 3 mL/s for a total volume of 70 mL with a 3-s imaging delay; contrast (Ioxilan 300 mgI/mL) dilution was 10–20% in all cases. The device’s landing zones, conformability, presence of deformities, and wall apposition were successfully visualized in all cases. Metal artifact reduction program was applied in 9 coiled aneurysms, and this was satisfactory as well.

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“…7,8 Stent-assisted coil embolization involves complete saccular filling with platinum coils. 9 Conebeam CT (CBCT) is used to verify the placement of the deployed stent, 9 stent and vessel wall connections, proper sizing of the stent, and the necessity of reimplantation. Therefore, it is necessary to obtain high-quality 3D images in a timely manner following stent-assisted coil embolization.…”

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confidence: 99%