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4D DSA a new technique for arteriovenous malformation evaluation: a feasibility study.

ABSTRACT: The angioarchitectural features of an arteriovenous malformation (AVM) provide key information regarding natural history and treatment planning. Because of rapid filling and vascular overlap, two-dimensional (2D) and three-dimensional (3D) digital subtraction angiography (DSA) are often suboptimal for evaluation of these features. We have developed an algorithm that derives a series of fully time-resolved 3D DSA volumes (four-dimensional (4D) DSA) at up to 30?frames/s from a conventional 3D DSA. The temporal/spatial resolution of 4D reconstructions is significantly higher than that provided by current MR angiography and CT angiography techniques. 4D reconstruction allows viewing of an AVM from any angle at any time during its opacification. This feasibility study investigated the potential of 4D DSA to improve the ability to analyze angioarchitectural features compared with conventional 2D and 3D DSA.2D, 3D, and 4D DSA reconstructions of angiographic studies of six AVMs were evaluated by three cerebrovascular neurosurgeons and one interventional neuroradiologist. These observers evaluated the ability of each modality to visualize the angioarchitectural features of the AVMs. They also compared the information provided using the combination of 2D and 3D DSA with that provided by a 4D DSA reconstruction.By consensus, 4D DSA provided the best ability to visualize the internal features of the AVM including intranidal aneurysms, fistulae, venous obstructions, and sequence of filling and draining. 2D and 3D images in comparison were limited because of overlap of the vasculature.In this small series, 4D DSA provided better ability to visualize the angioarchitecture of an AVM than conventional methods. Further experience is required to determine the ultimate utility of this technique.

SUBMITTER: Sandoval-Garcia C

PROVIDER: S-EPMC4740248 | biostudies-literature | 2016 Mar

REPOSITORIES: biostudies-literature

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4D DSA a new technique for arteriovenous malformation evaluation: a feasibility study.

Sandoval-Garcia Carolina C Royalty Kevin K Yang Pengfei P Niemann David D Ahmed Azam A Aagaard-Kienitz Beverly B Başkaya Mustafa K MK Schafer Sebastian S Strother Charles C

Journal of neurointerventional surgery 20150112 3

<h4>Background</h4>The angioarchitectural features of an arteriovenous malformation (AVM) provide key information regarding natural history and treatment planning. Because of rapid filling and vascular overlap, two-dimensional (2D) and three-dimensional (3D) digital subtraction angiography (DSA) are often suboptimal for evaluation of these features. We have developed an algorithm that derives a series of fully time-resolved 3D DSA volumes (four-dimensional (4D) DSA) at up to 30 frames/s from a c ...[more]

PMID: 25583531

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Project description:Four-dimensional CBCT (4D-CBCT) imaging in the treatment room can provide verification of moving targets, facilitating the potential for margin reduction and consequent dose escalation. Reconstruction of 4D-CBCT images requires correlation of respiratory phase with projection acquisition, which is often achieved with external surrogate measures of respiration. However, external measures may not be a direct representation of the motion of the internal anatomy and it is therefore the aim of this work to develop a novel technique for markerless, self-sorted 4D-CBCT reconstruction.A novel 4D-CBCT reconstruction technique based on the principles of Fourier transform (FT) theory was investigated for markerless extraction of respiratory phase directly from projection data. In this FT technique, both phase information (FT-phase) and magnitude information (FT-magnitude) were separately implemented in order to discern projections corresponding to peak inspiration, which then facilitated the proceeding sort and bin processes involved in retrospective 4D image reconstruction. In order to quantitatively evaluate the accuracy of the Fourier methods, peak-inspiration projections identified each by FT-phase and FT-magnitude were compared to those manually identified by visual tracking of structures. The average phase difference as assigned by each method vs the manual technique was calculated per projection dataset. The percentage of projections that were assigned within 10% phase of each other was also computed. Both Fourier methods were tested on two phantom datasets, programmed to exhibit sinusoidal respiratory cycles of 2.0 cm in amplitude with respiratory cycle lengths of 3 and 6 s, respectively. Additionally, three sets of patient projections were studied. All of the data were previously acquired at slow-gantry speeds ranging between 0.6°/s and 0.7°/s over a 200° rotation. Ten phase bins with 10% phase windows were selected for 4D-CBCT reconstruction of one phantom and one patient case for visual and quantitative comparison. Line profiles were plotted for the 0% and 50% phase images as reconstructed by the manual technique and each of the Fourier methods.As compared with the manual technique, the FT-phase method resulted in average phase differences of 1.8% for the phantom with the 3 s respiratory cycle, 3.9% for the phantom with the 6 s respiratory cycle, 2.9% for patient 1, 5.0% for patient 2, and 3.8% for patient 3. For the FT-magnitude method, these numbers were 2.1%, 4.0%, 2.9%, 5.3%, and 3.5%, respectively. The percentage of projections that were assigned within 10% phase by the FT-phase method as compared to the manual technique for the five datasets were 100.0%, 100.0%, 97.6%, 93.4%, and 94.1%, respectively, whereas for the FT-magnitude method these percentages were 98.1%, 92.3%, 98.7%, 87.3%, and 95.7%. Reconstructed 4D phase images for both the phantom and patient case were visually and quantitatively equivalent between each of the Fourier methods vs the manual technique.A novel technique employing the basics of Fourier transform theory was investigated and demonstrated to be feasible in achieving markerless, self-sorted 4D-CBCT reconstruction.

Project description:BACKGROUND:Pulmonary arteriovenous malformations are abnormal direct connections between the pulmonary artery and pulmonary vein which result in a right-to-left shunt. They are associated with substantial morbidity and mortality mainly from the effects of paradoxical emboli. Potential complications include stroke, cerebral abscess, pulmonary haemorrhage and hypoxaemia. Embolisation is an endovascular intervention based on the occlusion of the feeding arteries the pulmonary arteriovenous malformations thus eliminating the abnormal right-to-left-shunting. This is an update of a previously published review. OBJECTIVES:To determine the efficacy and safety of embolisation in patients with pulmonary arteriovenous malformations including a comparison with surgical resection and different embolisation devices. SEARCH METHODS:We searched the Cystic Fibrosis and Genetic Disorders Group's Trials Register; date of last search: 10 April 2017.We also searched the following databases: the Australian New Zealand Clinical Trials Registry; ClinicalTrials.gov; International Standard Randomised Controlled Trial Number Register; International Clinical Trials Registry Platform Search Portal (last searched 27 August 2017). to be updatedWe checked cross-references and searched references from review articles. SELECTION CRITERIA:Trials in which individuals with pulmonary arteriovenous malformations were randomly allocated to embolisation compared to no treatment, surgical resection or embolisation using a different embolisation device. DATA COLLECTION AND ANALYSIS:Studies identified for potential inclusion were independently assessed for eligibility by two authors, with excluded studies further checked by a third author. No trials were identified for inclusion in the review and hence no analysis was performed. MAIN RESULTS:There were no randomised controlled trials included in the review; one ongoing trial has been identified which may be eligible for inclusion in the future. AUTHORS' CONCLUSIONS:There is no evidence from randomised controlled trials for embolisation of pulmonary arteriovenous malformations. However, randomised controlled trials are not always feasible on ethical grounds. Accumulated data from observational studies suggest that embolisation is a safe procedure which reduces morbidity and mortality. A standardised approach to reporting with long-term follow-up through registry studies can help to strengthen the evidence for embolisation in the absence of randomised controlled trials.

Dataset Information

4D DSA a new technique for arteriovenous malformation evaluation: a feasibility study.

Publications

4D DSA a new technique for arteriovenous malformation evaluation: a feasibility study.

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