BACKGROUND To investigate the discrepancy between two-dimensional digital subtraction angiography and three-dimensional rotational angiography for small (<5 mm) cerebral aneurysms and the impact on decision making among neuro-interventional experts as evaluated by online questionnaire. MATERIALS AND METHODS Eight small (<5 mm) ruptured aneurysms were visually identified in 16 image sets in either two-dimensional or three-dimensional format for placement in a questionnaire for 11 invited neuro-interventionalists. For each set, two questions were posed: Question 1: "Which of the following is the preferred treatment choice: simple coiling, balloon remodeling or stent assisted coiling?"; Question 2: "Is it achievable to secure the aneurysm with pure simple coiling?" The discrepancies of angio-architecture parameters and treatment choices between two-dimensional-digital subtraction angiography and three-dimensional rotational angiography were evaluated. RESULTS In all eight cases, the neck images via three-dimensional rotational angiography were larger than two-dimensional-digital subtraction angiography with a mean difference of 0.95 mm. All eight cases analyzed with three-dimensional rotational angiography, but only one case with two-dimensional-digital subtraction angiography were classified as wide-neck aneurysms with dome-to-neck ratio < 1.5. The treatment choices based on the two-dimensional or three-dimensional information were different in 56 of 88 (63.6%) paired answers. Simple coiling was the preferred choice in 66 (75%) and 26 (29.6%) answers based on two-dimensional and three-dimensional information, respectively. Three types of angio-architecture with a narrow gap between the aneurysm sidewall and parent artery were proposed as an explanation for neck overestimation with three-dimensional rotational angiography. CONCLUSIONS Aneurysm neck overestimation with three-dimensional rotational angiography predisposed neuro-interventionalists to more complex treatment techniques. Additional two-dimensional information is crucial for endovascular treatment planning for small cerebral aneurysms.

中文翻译：

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二维和三维数字减影血管造影在规划小于 5 mm 的小脑动脉瘤血管内栓塞时的差异。

背景 调查二维数字减影血管造影和三维旋转血管造影对小（<5 mm）脑动脉瘤的差异以及通过在线问卷评估对神经介入专家决策的影响。材料和方法 在 16 个图像集中以二维或三维格式在 11 位受邀神经介入医师的问卷中目视识别八个小的（<5 毫米）破裂动脉瘤。对于每组，提出两个问题： 问题 1：“以下哪个是首选的治疗选择：简单卷曲、球囊重塑或支架辅助卷曲？”；问题 2：“是否可以通过单纯的简单盘绕来固定动脉瘤？” 评估了二维数字减影血管造影和三维旋转血管造影之间血管结构参数和治疗选择的差异。结果在所有8例中，三维旋转血管造影的颈部图像均大于二维数字减影血管造影，平均相差0.95 mm。所有 8 例病例均采用 3 维旋转血管造影进行分析，但只有 1 例采用二维数字减影血管造影术被归类为圆顶颈比 < 1.5 的宽颈动脉瘤。基于二维或三维信息的治疗选择在 88 个 (63.6%) 配对答案中有 56 个不同。简单卷取是 66 (75%) 和 26 (29. 6%) 分别基于二维和三维信息的答案。提出了三种在动脉瘤侧壁和载瘤动脉之间具有狭窄间隙的血管结构，作为对三维旋转血管造影术颈部高估的解释。结论 3D 旋转血管造影术对动脉瘤颈部的高估使神经介入医师倾向于使用更复杂的治疗技术。额外的二维信息对于小脑动脉瘤的血管内治疗计划至关重要。结论 3D 旋转血管造影术对动脉瘤颈部的高估使神经介入医师倾向于使用更复杂的治疗技术。额外的二维信息对于小脑动脉瘤的血管内治疗计划至关重要。结论 3D 旋转血管造影术对动脉瘤颈部的高估使神经介入医师倾向于使用更复杂的治疗技术。额外的二维信息对于小脑动脉瘤的血管内治疗计划至关重要。