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Four-dimensional computed tomography angiography analysis of internal carotid arteries opacification at the skull base to detect delayed cerebral ischemia: a feasibility study

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Abstract

Purpose

Delayed cerebral ischemia represents a significant cause of poor functional outcome for patients with vasospasm after subarachnoid hemorrhage. We investigated whether delayed cerebral ischemia could be detected by the arterial opacification of internal carotid artery at the level of the skull base.

Methods

In this exploratory, nested retrospective cohort diagnostic accuracy study, patients with clinical and/or transcranial Doppler suspicion of vasospasm who underwent four-dimensional computed tomography angiography were included. They were split into two groups for the main endpoint analysis, according to the actually adopted morphological (cerebral infarction) and clinical criteria (neurologic deterioration) of delayed cerebral ischemia. Opacification with a temporal resolution of 0.15 s of both internal carotid arteries at the skull base level was obtained through a semi-automated segmentation method based on skeletonization, and analyzed by a wavelet transform (rbio2.2, level 1). The results obtained by k-means clustering were analyzed with regard to the state of delayed cerebral infarction.

Results

Over ten patients included and analyzed, five patients presented a delayed cerebral ischemia, two of them in both side. The semi-automated processing and analysis clustered two different types of opacification curves. The obtaining of a nonlinear opacification pattern was associated (p < 0.001) with delayed cerebral ischemia.

Conclusions

The analysis of arterial opacification of internal carotid arteries at skull base by the proposed processing is feasible and leads to cluster two types of opacification that may help to early detect and prevent delayed cerebral ischemia, in particularly when examinations are artifacted by aneurysm treatment materials.

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Acknowledgments

The authors thank Karim Haioun, Jeroen Tijhaar, Chloe Steveson and Roy Irwan for their implications in the drafting of the manuscript.

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Authors and Affiliations

  1. Neuroradiology Unit, Department of Radiology, University Hospital of Brest, Brest, France

    Julien Ognard, Mourad Cheddad El Aouni, Brieg Dissaux, Douraied Ben Salem & Jean-Christophe Gentric

  2. Laboratory of medical information processing—LaTIM INSERM UMR 1101, Brest, France

    Julien Ognard, Valerie Burdin & Douraied Ben Salem

  3. Western Brittany Thrombosis Study Group GETBO EA3878, Brest, France

    Mourad Cheddad El Aouni, Brieg Dissaux & Jean-Christophe Gentric

  4. Faculty of Arts and Science, University of Toronto, Toronto, Canada

    Raphel Jomaah

  5. Neurology Unit, University Hospital of Brest, Brest, France

    Pierre-Yves Rousseau

  6. Institut Mines Telecom Atlantique, Plouzané, France

    Valerie Burdin

  7. Service d’Imagerie Médicale, CHU de la Cavale Blanche, Boulevard Tanguy-Prigent, 29609, Brest, France

    Julien Ognard

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  1. Julien Ognard
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Correspondence to Julien Ognard.

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Conflict of interest

Pr. JC. Gentric is consultant for Medtronic, Stryker, Balt, Penumbra (paid lectures)/Advisory Board and stock options: Intradys. Dr. J. Ognard is consultant for Canon Medical Systems (paid lectures). The other authors declare that they have no conflict of interest.

Research involving human participant

All procedures performed in this study with human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki Declaration and its later amendments. The study protocol was approved by the institutional review board (as an ancillary to PULSAN Study, NCT03535181), which waived written consent.

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Informed consent for all the participant of the study was obtained. Written consent was waived by institutional review board.

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Ognard, J., Cheddad El Aouni, M., Dissaux, B. et al. Four-dimensional computed tomography angiography analysis of internal carotid arteries opacification at the skull base to detect delayed cerebral ischemia: a feasibility study. Int J CARS 15, 2005–2015 (2020). https://doi.org/10.1007/s11548-020-02268-y

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  • DOI: https://doi.org/10.1007/s11548-020-02268-y

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