High-Definition Zoom Mode, a High-Resolution X-Ray Microscope for Neurointerventional Treatment Procedures: A Blinded-Rater Clinical-Utility Study

Abstract

Purpose: To compare the visualization of neurointervention procedure and treatment devices using a 194 µm pixel Flat Panel Detector mode (FPD) and a 76 µm pixel Complementary Metal Oxide Semiconductor detector mode (HiDef ) of a new generation x-ray detector system using a blinded rater study. Materials and Methods: Deployment of flow diversion devices for the treatment of internal carotid artery aneurysms was performed under FPD and HiDef mode image guidance in a neurointervention phantom simulating patient cranium and tissue attenuation, embedded with 3D printed intracranial vascular models, each with an aneurysm in the ICA segment. Image sequence pairs of device deployments for each detector mode, under similar exposure and FOV conditions were evaluated by two blinded experienced neurointerventionists who independently selected their preferred image based on visualization of anatomical features, image noise and treatment device. They rated their selection as either similar; better; much better; substantially better than the other. Inter and Intra rater agreements were calculated and categorized as poor, moderate and good. Results: Both the raters demonstrating good inter and intra rater agreements, selected HiDef mode images with a frequency of at least 95% each and on an average rated the HiDef images as much better than FPD images with a frequency of 73% from a total of 60 image pairs. Conclusion: Due to their higher resolution, HiDef mode images are sharper and visually preferred compared to the FPD images. The improved imaging provided by the HiDef mode can potentially provide an advantage during neurointervention procedures.

Single-center experience of using high definition (Hi-Def) imaging during neurointervention treatment of intracranial aneurysms using flow diverters

“…Stent struts of the PED are better visualized in the Hi-Def images. In a recent preclinical blinded rater study, comparing the visualization of a PED deployment between the FPD mode and Hi-Def mode in a neurovascular phantom simulating patient head anatomy, two raters demonstrated good inter-rater and intra-rater agreement, selected Hi-Def mode images with a frequency of at least 95% each, and rated the Hi-Def images as much better in visual quality than FPD images from a rating scale of similar, better, much better, or substantially better 11. In a recently published case study on the use of the Hi-Def mode during treatment of an aneurysm using a PED, the physicians suggested that the use of the Hi-Def mode was very similar to the use of a surgical microscope during open surgeries 12.…”

“…The limitations of this work include its potential bias by the physicians involved in the survey. In a previously published blinded rater benchtop study,11 similar images of Pipeline deployment inside a neurovascular phantom that simulated patient vascular anatomy and bone and tissue attenuation were acquired in FPD mode and Hi-Def mode and were compared. To do the same during clinical interventions would require additional images only acquired for study purposes, potentially increasing the risk of additional x-ray exposure to the patient.…”

High‐Definition Zoom Mode: A High Resolution X‐ray Microscope for Neurointerventional Treatment Procedures

“…Structural details of the PED were easily visualized in Hi‐Def mode compared to FPD. An earlier preclinical investigation compared the visualization of PED deployment in 6 × 6 cm FOV Hi‐Def zoom mode and 6 × 6 cm FOV interpolated FPD mode images in a neurovascular 3‐dimensional printed vascular phantom with bone and simulated tissue attenuation. The Hi‐Def images were rated by well‐experienced neurointerventionists as either similar, better, much better, or substantially better than the FPD images.…”

Comparison of pulsatile flow dynamics before and after endovascular intervention in 3D-printed patient-specific internal carotid artery aneurysm models using 1000 fps photon-counting detectors for Simultaneous Biplane High Speed Angiography (SB-HSA)

“…Figure 1 shows an example of DSA performed at 3 fps during the treatment of a cerebral aneurysm using a PED. 4 The high resolution images are acquired using the 75-µm high spatial resolution Hi-Def mode of a novel dual resolution detector system by Canon Medical Systems Corporation. 5 Images acquired at such low frame rates do not have the necessary temporal resolution to accurately capture the patterns present in blood flow, such as streamlines and vortices.…”