4D Digital Subtraction Angiography for the Temporal Flow Visualization of Intracranial Aneurysms and Vascular Malformations
Introduction
Four-dimensional digital subtraction angiography (4D-DSA) is a recently developed application that allows for the reconstruction of a modified three (3D) DSA acquisition into a series of fully time-resolved 3D-DSA volumes at frame rates of up to 30/s. It has been reported that 4D-DSA provides higher temporal and spatial resolution than currently available MR angiography or CT angiography.1,2 Recent studies have indicated that 4D-DSA facilitated the evaluation of complex vascular lesions such as arteriovenous malformations (AVM) or dural arteriovenous fistulas (dAVFs).3, 4, 5, 6, 7 However, little is known about the potential efficacy of this new imaging technology for other neurovascular diseases, e.g. intracranial aneurysms, spinal vascular diseases and acute ischemic stroke. For instance, whether 4D-DSA can detect the intra-aneurysmal flow patterns (e.g. inflow / outflow) or not remains unknown.
The purpose of this study was to review the 4D-DSA images for different types of neuro vascular diseases and to evaluate the benefits of this novel imaging technology in the clinical settings. The radiation dose and contrast medium dose required for the acquisition were also evaluated.
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Patient population
The study was approved by the institutional review board (IRB) of our hospital (27-236(8121)). Between January 2015 and February 2016, patients that were diagnosed with any type of cerebrovascular disease and underwent 4D-DSA were included in this study. Informed consents for procedures were obtained from all patients. The IRB waived specific informed consent for this study, because the data were obtained from routine procedures and analyzed retrospectively. However, the IRB requested that we
Patient demographics
For all 173 patients (66 male and 107 female), 4D-DSA was successfully performed. The median age was 62 (range 14–84 years). 126 patients were diagnosed with intracranial aneurysms, 10 with AVMs and 15 with dAVFs. The others 22 patients presented with 6 ischemic strokes, 6 spinal vascular malformations, 7 stenosis of intracranial arteries, 2 intracerebral hemorrhages and 1 tumor. 6s 4D-DSA was performed on 138 patients (120 with aneurysms, 4 with AVMs/dAVFs, and 14 with others). 12s 4D-DSA was
Additional information obtained from the time resolved 3D-DSA
The clinical applications of 4D-DSA have been reported mainly for the evaluation of intracranial AVMs.3,4,6,7 Our initial experience of 4D-DSA indicated that the clinical application of this new imaging technology can be further expanded to the evaluation of intracranial aneurysms. Additional information provided by the time resolved 3D-DSA includes the visually appreciated speed and direction of the blood flow in the target vessel. For instance, 27.7% of the aneurysm cases examined in this
Conclusions
4D-DSA helps understanding the complex vascular structures and flow dynamics in different types of neurovascular diseases.
Declaration of Interest
This study was partially supported by a research grant (ID C00221023) from Siemens Healthcare K.K. C.D. and K.O. are employees of Sie mens Healthcare K.K. The other authors report no conflicts of interest.
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Research Institute: Department of Neurosurgery, The Jikei University School of Medicine Tokyo.
Grant Support: This study was partially supported by a research grant (ID C00221023) from Siemens Healthcare K.K.
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These authors contributed equally to this work.