Purpose

To assess the benefit and radiation dose of four-dimensional (4D) digital subtraction angiography (DSA) - a time resolved three-dimensional (3D) DSA application - to evaluate the flow and architecture of aneurysms and vascular malformations.

Methods

All patients with cerebrovascular disease were considered who underwent 4D-DSA at our institution between January 2015 and February 2016. For the aneurysm patients, we evaluated the image quality in terms of the visualization of contrast flow in the aneurysm on a 3-point scale (excellent, fair and poor). Interrater agreement between two raters was estimated using Cohen's Kappa statistics. For the shunt disease patients, the additional information obtained from the 4D-DSA was described for each disease. The median radiation dose and volume of contrast medium required for the acquisitions were estimated.

Results

A total of 173 patients underwent 4D-DSA; 126 intracranial aneurysms, 10 arteriovenous malformations (AVM), 15 dural arteriovenous fistula (dAVF) and 22 other diseases. For aneurysm patients, excellent and fair visualization of the intra-aneurysmal flow was observed in 27.7%, 72.3%, and excellent (κ = 0.9) agreement between the raters was found. For AVM and dAVF patients, 4D-DSA clarified the complex vasculature by viewing the discrete time phase of contrast filling. Median radiation dose for intracranial lesions was 79.6 mGy for 6s 4D-DSA, and 175 mGy for 12s 4D-DSA. The median amount of contrast medium used was 18.0 ml for 6s 4D-DSA and 21.0 ml for 12s 4D-DSA.

Conclusions

4D-DSA provided additional information regarding intra-aneurysmal flow and contributed to detect different component of nidus or shunt points.

中文翻译：

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用于颅内动脉瘤和血管畸形的时间流可视化的4D数字减影血管造影

目的

为了评估三维（4D）数字减影血管造影（DSA）的益处和辐射剂量-时间分辨三维（3D）DSA应用-评估动脉瘤和血管畸形的流量和结构。

方法

我们将所有在2015年1月至2016年2月期间在我们机构接受过4D-DSA治疗的脑血管疾病患者纳入考虑范围。对于动脉瘤患者，我们以3分制对动脉瘤中的造影剂流动进行可视化来评估图像质量（优秀，公平和恶劣）。使用Cohen的Kappa统计数据估算了两个评估者之间的评估者间协议。对于分流疾病患者，描述了每种疾病从4D-DSA获得的其他信息。估计采集所需的中值放射剂量和造影剂体积。

结果

共有173例患者接受了4D-DSA；126例颅内动脉瘤，10例动静脉畸形（AVM），15例硬脑膜动静脉瘘（dAVF）和22种其他疾病。对于动脉瘤患者，动脉瘤内血流的良好和公正可视化率分别为27.7％，72.3％，并且评估者之间的一致性（κ= 0.9）非常好。对于AVM和dAVF患者，4D-DSA通过查看造影剂填充的离散时间阶段来阐明复杂的脉管系统。6s 4D-DSA颅内病变的中位辐射剂量为79.6 mGy，12s 4D-DSA为175 mGy。6s 4D-DSA使用的造影剂中位数为18.0 ml，12s 4D-DSA使用21.0 ml。

结论

4D-DSA提供了有关动脉瘤内血流的其他信息，并有助于检测脑袋或分流点的不同成分。