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. 2021 Apr;27(2):307-313.
doi: 10.1177/1591019920961604. Epub 2020 Sep 26.

Virtual 2D angiography from four-dimensional digital subtraction angiography (4D-DSA): A feasibility study

Jay F Yu  1 , Leland Pung  2 , Hataka Minami  2 , Kerstin Mueller  2 , Rajkamal Khangura  1 , Robert Darflinger  1 , Steven W Hetts  1 , Daniel L Cooke  1
Affiliations

Virtual 2D angiography from four-dimensional digital subtraction angiography (4D-DSA): A feasibility study

Jay F Yu et al. Interv Neuroradiol. 2021 Apr.

Abstract

Background: Digital subtraction angiography (DSA) remains the gold standard for angiographic evaluation of cerebrovascular pathology, however, multiple acquisitions requiring additional time and radiation are often needed. In contrast, 3D-DSA provides volumetric information from a single injection but neglects temporal information. Four-dimensional-DSA (4D-DSA) combines temporal information of 2D-DSA with volumetric information of 3D-DSA to provide time-resolved tomographic 3D reconstructions, potentially reducing procedure time and radiation. This work evaluates the diagnostic quality of virtual single-frame 4D-DSA relative to 2D-DSA images by assessing clinicians' ability to evaluate cerebrovascular pathology.

Methods: Single-frame images of four projections from 4D-DSA and their corresponding 2D-DSA images (n = 15) were rated by two neurointerventional radiologists. Images were graded based on diagnostic quality (0 = non-diagnostic, 1 = poor, 2 = acceptable, 3 = good). Dose area product (DAP) for each case was recorded for all 2D-DSA, 4D-DSA acquisitions, and the overall procedure.

Results: The mean diagnostic quality of all four 4D-DSA projections from both raters was 1.75 while the mean of 2D-DSA projections was 2.8. Student's t-test revealed significant difference in diagnostic quality between 4D-DSA and 2D-DSA at all four projections (p < 0.001). On average 4D-DSA acquisitions accounted for 30% dose compared to the overall average aggregated dose per procedure.

Conclusions: The difference in image quality between virtual single-frame 4D-DSA and their respective 2D-DSA images is statistically significant. Furthermore, 4D-DSA acquisitions require less radiation dose than conventional procedures with 2D-DSA acquisitions.

Keywords: Digital subtraction angiography; brain arteriovenous malformation(s); dose area product; dural arteriovenous fistulas(s); intracerebral hemorrhage.

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Conflict of interest statement

Declaration of conflicting interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Example of virtual 4D-DSA projections (AP & lateral) compared to equivalent 2D-DSA image. Patient 1: (A) AP 2D-DSA; (B) AP 4D-DSA; (C) lateral 2D-DSA; (D) lateral 4D-DSA. Patient 2: (E) AP 2D-DSA; (F) AP 4D-DSA; (G) lateral 2D-DSA; (H) lateral 4D-DSA.
Figure 2.
Figure 2.
Example of virtual 4D-DSA projections (AP, lateral, patient-specific AP, patient-specific lateral) compared to equivalent 2D-DSA image for one patient. Patient 3: (A) AP 2D-DSA; (B) AP 4D-DSA; (C) lateral 2D-DSA; (D) lateral 4D-DSA; (E) patient-specific AP 2D-DSA; (F) patient-specific AP 4D-DSA; (G) patient-specific lateral 2D-DSA; (H) patient-specific lateral 4D-DSA.
Figure 3.
Figure 3.
Distribution of ratings by reviewer. (a) 4D-DSA scores. (b) 2D-DSA scores.
Figure 4.
Figure 4.
Example cases with inferior ratings for virtual 4D-DSA views. Small vessel structures are visualized in 2D-DSA images (A) but reduced image quality including vessel loss and filling defects are seen in the 4D-DSA equivalent (A-1). Surgical clips seen in 2D-DSA images show diminished image quality, but vessel structures can still be identified (B). In the 4D-DSA comparison image, surgical clips lead to reduction in the ability to identify vessels as well as additional artifact (B-1).
See this image and copyright information in PMC

References

    1. Davis B, Royalty K, Kowarschik M, et al. 4D digital subtraction angiography: implementation and demonstration of feasibility. AJNR Am J Neuroradiol 2013; 34: 1914–1921. - PMC - PubMed
    1. Lang S, Gölitz P, Struffert T, et al. 4D DSA for dynamic visualization of cerebral vasculature: a single-center experience in 26 cases. AJNR Am J Neuroradiol 2017; 38: 1169–1176. - PMC - PubMed
    1. Lescher S, Gehrisch S, Klein S, et al. Time-resolved 3D rotational angiography: display of detailed neurovascular anatomy in patients with intracranial vascular malformations. J Neurointerv Surg 2017; 9: 887–894. - PubMed
    1. Sandoval-Garcia C, Royalty K, Yang P, et al. 4D DSA a new technique for arteriovenous malformation evaluation: a feasibility study. J Neurointerv Surg 2016; 8: 300–304. - PMC - PubMed
    1. Sandoval-Garcia C, Yang P, Schubert T, et al. Comparison of the diagnostic utility of 4D-DSA with conventional 2D- and 3D-DSA in the diagnosis of cerebrovascular abnormalities. AJNR Am J Neuroradiol 2017; 38: 729–734. - PMC - PubMed

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