Dose reduction in cone-beam CT scanning for intracranial stent deployment before coil embolization of intracranial wide-neck aneurysms

Abstract

Purpose

Flat panel detector (FD)-equipped angiography machines are increasingly used for neuro-angiographic imaging. During intracranial stent-assisted coil embolization procedures, it is very important to clearly and quickly visualize stent shape after deployment in the vessel. It is necessary to quickly visualize stents by cone-beam computed tomography (CBCT). The aim of this study was to compare CBCTs at 10 and 20 s, and to confirm that this method is useful for neuro-endovascular treatment procedures.

Materials and methods

We treated 30 patients with wide-necked intracranial aneurysms with a flexible, self-expanding neurovascular stent and subsequent aneurysm embolization with platinum micro-coils. We performed the CBCT after stent deployment. We compared the 10 s and 20 s CBCTs, using the full width one-half maximum (FWHM) visualization.

Results

Accurate stent placement with subsequent coil occlusion of the aneurysms was feasible in all patients. Stent struts were clearly visualized on both 10 s and 20 s CBCTs. Importantly, 10 s CBCT can reduce the radiation dose by about 42%, compared with 20 s CBCT. Performing 10 s CBCT with a 14% dilution of the contrast medium may significantly improve image acquisition during stent-assisted coil embolization.

Conclusions

Reduced-dose, 10 s CBCT can visualize stents in clinical cases, while significantly reducing radiation exposure.

Keywords

Aneurysm brain coil embolization flat panel detector cone-beam computed tomography embolization radiation dose radiation exposure stent

Get full access to this article

View all access options for this article.

References

Mocco

Snyder

Albuquerque

. Treatment of intracranial aneurysm with the Enterprise stent: A multicenter registry. J Neurosurg 2009; 110: 35–39.

Patel

Gounis

Wakhloo

. Contrast-enhanced angiographic cone-beam CT of cerebrovascular stents: Experimental optimization and clinical application. Am J Neuroradiol 2011; 32: 137–144.

Van der Bom

IMJ

Hou

Puri

. Reduction of coil mass artifacts in high-resolution flat detector conebeam CT of cerebral stent-assisted coiling. Am J Neuroradiol 2013; 34: 2163–2170.

Tsuruta

Matsumaru

Hamada

. Analysis of closed-cell intracranial stent characteristics using cone-beam computed tomography with contrast material. Neuro Med Chir (Tokyo) 2013; 53: 403–408.

Kwon

Kim

Kwon

. Endovascular treatment of wide-necked aneurysms by using two micro catheters: Techniques and outcomes in 25 patients. Am J Neuroradiol 2005; 26: 894–900.

Tamatani

Ito

Abea

. Evaluation of the stability of aneurysms after embolization using detachable coils: Correlation between stability of aneurysms and embolized volume of aneurysms. Am J Neuroradiol 2002; 23: 762–767.

Imamura

Sakai

Adachi

. Long-term results of endovascular embolization of cerebral aneurysms. J Neuroendovasc Ther 2010; 4: 133–139.

Sakamoto

Ikegawa

Kobayashi

. A study of operator's hand and finger exposure dose reduction during angiographic procedures. Jap J Radiolog Technol 2007; 65; 1: 25–34.

Struffert

Kloska

Engelhorn

. Optimized intravenous Flat Detector CT for non-invasive visualization of intracranial stents: First results. Eur Radiol 2011; 21: 411–418.

10.

Saake

Breuer

Goelitz

. Flat detector computed tomography angiography with intravenous contrast application: Feasibility for visualization of cerebral arterial vasculature. J Neuroimaging 2013; 23: 414–420.

11.

Richter

Engelhorn

Struffert

. Flat panel detector angiographic CT for stent-assisted coil embolization of broad-based cerebral aneurysms. Am J Neuroradiol 2007; 28: 1902–1908.

12.

Patel

Gounis

Wakhloo

. Contrast-enhanced angiographic cone-beam CT of cerebrovascular stents: Experimental optimization and clinical application. Am J Neuroradiol 2011; 32: 137–144.

13.

Kuriyama

Sakai

Furukawa

. Examination of factors useful for choosing a method to assist coil embolization of unruptured cerebral aneurysm. Jap J Radiolog Technol 2013; 69: 1232–1240.

14.

Sánchez-Crespo

Andreo

Larsson

. Positron flight in human tissues and its influence on PET image spatial resolution. Europ J Nuclear Med Molec Imag 2004; 31: 44–51.

15.

Saake

Breuer

Goelitz

. Flat detector computed tomography angiography with intravenous contrast application: Feasibility for visualization of cerebral arterial vasculature. J Neuroimag 2013; 23: 414–420.

16.

Struffert

Kloska

Engelhorn

. Optimized intravenous flat detector CT for non-invasive visualization of intracranial stents: First results. Europ Radiol 2011; 21: 411–418.

17.

Ebrahimi

Claus

Lee

. Stent conformity in curved vascular models with simulated aneurysm necks using flat-panel CT: An in vitro study. Am J Neuroradiol 2007; 28: 823–829.

18.

Ionescu

Metcalfe

Cody

. Spatial resolution limits of multislice computed tomography (MS-CT), C-arm-CT and flat panel-CT (FP-CT) compared to MicroCT, for visualization of a small metallic stent. Academ Radiol 2011; 18: 866–875.

19.

Benndorf

Strother

Claus

. Angiographic CT in cerebrovascular stenting. Am J Neuroradiol 2005; 26: 1813–1818.

20.

Patel

Gounis

Wakhloo

. Contrast-enhanced angiographic cone-beam CT of cerebrovascular stents: Experimental optimization and clinical application. Am J Neuroradiol 2011; 32: 137–144.

21.

Kuriyama

Sakai

Niida

. Importance of three-dimensional fusion image after stent-assisted coil embolization of unruptured aneurysm. Jap J Radiolog Technol 2012; 68: 1652–1661.

22.

Schäfer

Borgert

Rasche

. Motion-compensated and gated cone beam filtered back-projection for 3-D rotational X-ray angiography. IEEE Trans Med Imag 2006; 25: 898–906.

23.

Tacher

Bhagat

Rao

. Image quality improvements in C-Arm CT (CACT) for liver oncology applications: Preliminary study in rabbits. Minim Invasive Ther Allied Technol 2013; 22: 297–303.

24.

Loubele

Bogaerts

Van Dijck

. Comparison between effective radiation dose of CBCT and MSCT scanners for dentomaxillofacial applications. Eur J Radiol 2009; 71: 461–468.