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.

中文翻译：

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锥形束动脉内CTA评估分流器的实用性：日常使用的实用方法。

锥束计算机断层扫描（CBCT）最初用于评估过程内并发症（如出血），现已发展成为可提供植入设备（如分流器）的详细信息。该研究的目的是介绍我们在将CBCT与动脉内注射一起使用方面的经验，并为日常使用的实用协议提供逐步进行后处理的方法。从2012年7月至2017年6月，获得了IRB的批准，并对神经介入数据库进行了回顾性审查。对接受了锥形束动脉内CT血管造影术以评估植入式分流器的患者进行了回顾。患者的人口统计资料，动脉瘤位置（颈内动脉[ICA]-海绵状，ICA-旁环和ICA-远端；大脑中动脉[MCA]，大脑前动脉[ACA] -acom，ACA-椎旁动脉，椎动脉[VA]） ，记录其类型（囊状，解剖性梭形或水疱）和大小，装置，注射技术（造影剂稀释度，速率和体积）以及重建方案。使用飞利浦Xtravision工作站对获取的图像进行后处理。80名患者（63名女性和17名男性）符合我们研究的纳入标准。年龄范围是25-80岁。所治疗的动脉瘤位于ICA旁淋巴样病变48例（60％），ICA远端12例，ICA海绵状8例，MCA 4例，VA 4例，ACA-acom 2例，ACA圆锥周膜2例; 囊状69例，梭形8例，水疱破裂3例。有52个小动脉瘤，20个大动脉瘤和8个大动脉瘤。管道（Medtronic，美国明尼苏达州）是77项手术中使用的主要设备。使用了两种注射技术：2。对于5毫升/秒，总体积为55毫升，延迟时间为2秒；对于3毫升/秒，对于总体积为70毫升，延迟时间为3秒。在所有情况下，造影剂（艾昔兰300 mgI / mL）的稀释度均为10-20％。在所有情况下，都可以成功看到设备的着陆区，顺应性，变形的存在以及墙的位置。金属伪影减少程序应用于9个盘绕的动脉瘤中，这也令人满意。