Rationale and Objectives
The aim of this study was to compare conventional two-dimensional (2D) digital subtraction angiography (DSA) with three-dimensional (3D) rotational DSA in the investigation of intracranial aneurysm in terms of detection, size measurement, neck diameter, neck delineation, and relationship with surrounding vessels. A further aim was to compare radiation dose, contrast volume, and procedural time between the two protocols.
Materials and Methods
Thirty-five patients who presented with subarachnoid bleeds on computed tomography and were suspected of having intracranial aneurysms underwent conventional 2D DSA followed by 3D DSA. The 3D digital subtraction angiographic images were displayed as surface shaded display images. Aneurysm detection, sac size, neck diameter, neck delineation, and relationship of aneurysm to the surrounding vessels analyzed from the two protocols were compared. Radiation dose, contrast volume, and procedural time for both examinations were also compared.
Results
Three-dimensional DSA detected 44 aneurysms in 31 patients, with negative findings seen in four patients. A false-negative detection rate of 6.8% (three of 44) for 2D DSA was noted. There was no significant difference in aneurysm size between 3D and 2D DSA. The sizes of aneurysm necks were found to be significantly larger in 3D DSA than on 2D DSA. The aneurysm neck and relationship to surrounding vessels were significantly better demonstrated on 3D DSA than on 2D DSA. Radiation dose (entrance surface dose), contrast use, and procedural time with 3D DSA were significantly less than with 2D DSA.
Conclusions
Three-dimensional DSA improves the detection and delineation of intracranial aneurysms, with lower radiation dose, less contrast use, and shorter procedural time compared to 2D DSA. The size of the aneurysm neck on 3D DSA tended to be larger than on 2D DSA.
Cerebral aneurysm is a potentially life threatening disorder, which may result in spontaneous subarachnoid hemorrhage and is further complicated by hydrocephalus, vasospasm, and brain infarction. Apart from localizing the aneurysm, the aim of imaging is to measure the size and neck of the aneurysm, as well as determine the relationship of the aneurysm to the surrounding vessels. Imaging a cerebral aneurysm can be done using several imaging methods, with the noninvasive techniques being computed tomographic angiography and magnetic resonance angiography. The introduction of three-dimensional (3D) reconstruction of the rotational angiographic images has given reviewers the advantage of viewing the vascular anatomy in any angle and plane, thus making it useful for viewing small aneurysms or aneurysms in areas of arterial branching that may be missed on two-dimensional (2D) angiography. Hochmuth et al reported that compared to biplanar digital subtraction angiography (DSA), 3D rotational angiography allows more accurate depiction of anatomic details that are essential in planning surgical and endovascular treatment for intracranial aneurysms in terms of improving the delineation of aneurysmal neck (71%), the parent vessel (45%), and the relationship to adjacent vessels (50%). In addition, 3D DSA allows the detection of more aneurysms, especially small aneurysms (<3 mm), which are not detected on DSA . With regard to radiation dose, 3D DSA can also reduce the number of exposures compared to 2D DSA, not only to determine the working projection for therapy but also for procedures . However, unlike in previous studies in which only the standard projections of 2D DSA were compared to 3D DSA, in this study, we included additional 2D digital subtraction angiographic views in the evaluation and comparison.
In this study, we aimed to confirm the beneficiary role of 3D DSA in the diagnosis and characterization of cerebral aneurysms and to demonstrate the overall reductions of cost, time, and radiation dose. This is especially important in a developing nation where resources are scarce, so that procuring expensive equipment must be justified with clear benefits in terms of cost and time savings.
Materials and methods
Study Design
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Angiography
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Image Analysis
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Measurement of Radiation Dose
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Measurement of Contrast Volume
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Measurement of Procedural Time
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Statistical Analysis
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Results
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Aneurysm Detection
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Number, Sites and Sizes of Aneurysms
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Table 1
Frequency of Aneurysms According to Sac Size Measured on 2D DSA and 3D DSA
Size Category (mm) 2D DSA 3D DSA_n_ %n % 1–5 26 63.4 31 70.5 5–10 10 24.4 10 22.7 10–15 3 7.3 1 2.3 15–20 1 2.4 1 2.3 20–25 1 2.4 1 2.3 Total 41 100.0 44 100.0
DSA, digital subtraction angiography; 3D, three-dimensional; 2D, two-dimensional.
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View of the Aneurysm Neck
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Table 2
Delineation of Aneurysm Necks on 2D DSA and 3D DSA
Neck View 2D DSA 3D DSA_n_ %n % Not well delineated 19 46.34 1 2.27 Well delineated 1 2.44 43 97.73 Well delineated in additional view 21 51.22 NA NA Total 41 100.00 44 100.00
NA, not applicable.
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Diameter of the Aneurysm Neck
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Relationship of the Aneurysm to Surrounding Vessels
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Radiation Dose and Contrast Media Volume
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Procedural Time
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Discussion
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Conclusions
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References
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