This report addresses the feasibility of virtual injection software based on contrast-enhanced cone-beam CTs (CBCTs) in the context of cerebrovascular lesion embolization. Intracranial arteriovenous malformation (AVM), dural arteriovenous fistula (AVF) and mycotic aneurysm embolization cases with CBCTs performed between 2013 and 2020 were retrospectively reviewed. Cerebrovascular lesions were reviewed by 2 neurointerventionalists using a dedicated virtual injection software (EmboASSIST, GE Healthcare; Chicago, IL). Points of Interest (POIs) surrounding the vascular lesions were first identified. The software then automatically displayed POI-associated vascular traces from vessel roots to selected POIs. Vascular segments and reason for POI identification were recorded. Using 2D multiplanar reconstructions from CBCTs, the accuracy of vascular traces was assessed. Clinical utility metrics were recorded on a 3-point Likert scale from 1 (no benefit) to 3 (very beneficial). Nine cases (7 AVM, 1 AVF, 1 mycotic aneurysm) were reviewed, with 26 POIs selected. Three POIs were in 2nd order segments, 8 POIs in 3rd order segments and 15 POIs in 4th order segments of their respective arteries. The reviewers rated all 26 POI traces – involving a total of 90 vascular segments – as accurate. The average utility score across the 8 questions were 2.7 and 2.8 respectively from each reviewer, acknowledging the software’s potential benefit in cerebrovascular embolization procedural planning. The operators considered CBCT-based virtual injection software clinically useful and accurate in guiding and planning cerebrovascular lesion embolization in this retrospective review. Future prospective studies in larger cohorts are warranted for validation of this modality.

中文翻译：

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使用虚拟注射软件模拟脑血管病变的超选择性导管插入术

本报告讨论了基于对比增强锥形束 CT (CBCT) 在脑血管病变栓塞背景下的虚拟注射软件的可行性。回顾性分析了 2013 年至 2020 年间进行 CBCT 的颅内动静脉畸形 (AVM)、硬脑膜动静脉瘘 (AVF) 和真菌性动脉瘤栓塞病例。脑血管病变由 2 位神经介入医师使用专用的虚拟注射软件（EmboASSIST，GE Healthcare；Chicago，IL）进行审查。首先确定血管病变周围的兴趣点 (POI)。然后，该软件会自动显示从血管根到选定 POI 的 POI 相关血管轨迹。记录血管段和 POI 识别的原因。使用 CBCT 的 2D 多平面重建，评估了血管痕迹的准确性。临床效用指标以 3 点李克特量表记录，从 1（无益处）到 3（非常有益）。回顾了 9 个病例（7 个 AVM、1 个 AVF、1 个真菌性动脉瘤），并选择了 26 个 POI。3 个 POI 位于 2 阶段，8 个 POI 位于 3 阶段，15 个 POI 位于各自动脉的 4 阶段。评审员将所有 26 条 POI 轨迹（共涉及 90 个血管段）评为准确。每位评论者对 8 个问题的平均效用分数分别为 2.7 和 2.8，这表明该软件在脑血管栓塞手术计划中的潜在益处。在本次回顾性研究中，操作者认为基于 CBCT 的虚拟注射软件在指导和规划脑血管病变栓塞方面具有临床实用性和准确性。