Intravenous C-Arm Conebeam CT Angiography following Long-Term Flow-Diverter Implantation: Technologic Evaluation and Preliminary Results

Yu, Simon C.H.; Lee, K.T.; Lau, Tak-Wing; Wong, George Kwok Chu; Pang, V.K.Y.; Chan, Kwong‐Yau

doi:10.3174/ajnr.a4558

Cited by 9 publications

(12 citation statements)

References 28 publications

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“…To our knowledge, this is the first study in which an alternative imaging technique has been shown to be comparable with DSA after FD treatment; in recent studies, contrast-enhanced MRA, [21][22][23] 3D TOF-MRA, 21,22 C-arm conebeam CT, 24,25 and CTA 22 were all inferior to DSA due to metal artifacts originating from the FD wires. Although a recent study comparing contrastenhanced MRA with DSA demonstrated good imaging of the aneurysm sac after FD treatment, the assessability of the stent lumen, however, remained difficult due to metal artifacts.…”

Section: Discussionmentioning

confidence: 82%

Subtraction CTA: An Alternative Imaging Option for the Follow-Up of Flow-Diverter-Treated Aneurysms?

Mamady¹,

Korte²,

Aquarius

et al. 2018

AJNR Am J Neuroradiol

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BACKGROUND AND PURPOSE: This was a pilot study to explore the diagnostic accuracy and safety of subtraction CTA combined with a single-energy metal artifact reduction algorithm (SEMAR) compared to DSA for the evaluation of intracranial aneurysm occlusion after flow diverter treatment. MATERIALS AND METHODS: We included patients treated with a flow diverter for an unruptured intracranial aneurysm between November 2015 and November 2016. The patient cohort comprised 2 groups: those who underwent follow-up imaging 1 month after flow-diverter treatment and those with a known residual intracranial aneurysm after flow diverter treatment who underwent imaging at regular follow-ups. Full-brain subtraction CTA was performed on a 320-detector row CT system. A low-dose non-enhanced volume acquisition was followed by a contrast-enhanced volume CTA. Iterative and noise-reduction filters, SEMAR, and SURE Subtraction algorithms were applied. DSA was performed on a flat panel C-arm angiography system. Standard posteroanterior, lateral, 3D, and detailed 2D acquisitions were performed. Imaging was independently scored by 2 clinicians. Aneurysm occlusion (Raymond scale) was our primary outcome parameter. RESULTS: Thirteen intracranial aneurysms were evaluated with subtraction CTA and DSA. Nine aneurysm remnants were demonstrated by both subtraction CTA and DSA. The sensitivity and specificity of subtraction CTA for the detection of aneurysm occlusion were 100% (95% CI, 82.41%-100%) and 100% (95% CI, 67.55%-100%), respectively. Agreement between readers was perfect (ϭ 1.0). The smallest neck remnant detected on subtraction CTA was 1.2 mm. No complications occurred. CONCLUSIONS: Subtraction CTA with single-electron metal artifact reduction is effective in the reduction of metal artifacts of flow diverters and might therefore be a viable alternative in the assessment of intracranial aneurysm occlusion after flow diverter treatment.

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Section: Discussionmentioning

confidence: 82%

Subtraction CTA: An Alternative Imaging Option for the Follow-Up of Flow-Diverter-Treated Aneurysms?

Mamady¹,

Korte²,

Aquarius

et al. 2018

AJNR Am J Neuroradiol

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“…CBCT is a useful method in the evaluation of stent architecture, deployment, wall-apposition, and microvascular anatomy. 4,6,9,10 Contrast injection (either intravenous or intraarterial) is helpful to depict intrastent thrombus or endoleak. 3 Different percentages of contrast dilution ranging 10%-20% (10%-20% contrast media/80%-90% saline) have been adopted to avoid excess opacification of the parent vessel that may otherwise hamper proper visualization of the FD.…”

Section: Discussionmentioning

confidence: 99%

A technical note on intra-arterial cone-beam computed tomography for the evaluation of flow-diverter stents: Image quality differences between diluted and non-diluted contrast medium

et al. 2019

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Background Design of flow-diverter stents for flexibility, tractability, and low profile limits their radiopacity on conventional digital subtraction angiography. Cone-beam computed tomography (CBCT) offers higher spatial resolution for the evaluation of flow-diverter stents. However, CBCT requires optimal dilution and timing of contrast medium for simultaneous visualization of the stent, arterial lumen, and vessel wall. There are only limited data on the effects of different contrast dilutions on CBCT image quality in neurointerventional applications. Materials and methods In our institution, intra-arterial CBCTs were acquired during stent deployment and at follow-ups with 10% diluted contrast. We had recently started acquiring intra-arterial CBCTs with non-diluted contrast. Retrospective analysis of our flow-diverter data identified eight cases with different aneurysm locations who had intra-arterial CBCT with 10% diluted contrast immediately after flow-diverter stent deployment and with non-diluted contrast technique during follow-ups. For each case, the image quality between diluted and non-diluted contrast techniques was compared qualitatively by assessing stent visualization and quantitatively by plotting gray-scale intensity values along the vessel lumen. Results In two sets of CBCT images per each case, there was no substantial difference between diluted and non-diluted CBTC techniques for the evaluation of stent architecture and lumen opacification. Gray-scale intensity values perpendicular to the lumen revealed similar intensity values along the neighboring parenchyma, vessel wall, and lumen for the two different contrast techniques. Conclusion Intra-arterial CBCT angiography can be performed without contrast dilution and still achieve adequate image quality in certain cerebral aneurysms treated with flow diverter. The non-diluted contrast technique avoids the time loss during preparation of diluted contrast and installation of diluted contrast to the injector in angiography suites with a single power injector.

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“…FPV-CTA protocols have been developed either without injection 5 or with diluted contrast material injection. 17,18 The major advantage of protocols with contrast material injection (IV or intra-arterial) is that they may help to depict intrastent thrombus or endoleak (ie, contrast media filing between the FDS and the inner wall of the parent artery) caused by incorrect apposition of the stent.…”

Section: Discussionmentioning

confidence: 99%

“…Such protocols have been used to evaluate the accuracy of the FDS deployment intraoperatively 4 and for follow-up imaging. 4,17 The potential of the visualization of the accurate deployment of FDS appears of tremendous importance owing to the fact that most intraoperative, postprocedure, or delayed complications, like thromboembolic events or even stent occlusion, seem to be related to FDS kinking or misdeployment. 19 In our series, we did not record any symptomatic ischemic complication caused by kinking or misdeployment of the FDS.…”

Section: Discussionmentioning

confidence: 99%

Clinical Impact of Flat Panel Volume CT Angiography in Evaluating the Accurate Intraoperative Deployment of Flow-Diverter Stents

Clarençon

Maria

Gabrieli

et al. 2017

AJNR Am J Neuroradiol

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Intravenous C-Arm Conebeam CT Angiography following Long-Term Flow-Diverter Implantation: Technologic Evaluation and Preliminary Results

Cited by 9 publications

References 28 publications

Subtraction CTA: An Alternative Imaging Option for the Follow-Up of Flow-Diverter-Treated Aneurysms?

Subtraction CTA: An Alternative Imaging Option for the Follow-Up of Flow-Diverter-Treated Aneurysms?

A technical note on intra-arterial cone-beam computed tomography for the evaluation of flow-diverter stents: Image quality differences between diluted and non-diluted contrast medium

Clinical Impact of Flat Panel Volume CT Angiography in Evaluating the Accurate Intraoperative Deployment of Flow-Diverter Stents

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