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Stereoscopic Versus Monoscopic Viewing of Aneurysms: Experience of a Single Institution with a Novel Stereoscopic Viewing System
摘要： Stereoscopic viewing of computed tomographic angiography (CT-A) or magnetic resonance angiograms might increase the diagnostic potential of these imaging techniques. Our aim was to evaluate the benefits of a novel stereoscopic viewing system for aneurysm detection compared with standard monoscopic viewing. Retrospective patient data were used for 2 different evaluations. First, monoscopic and stereoscopic CT-A viewing was compared by 14 clinicians in 10 patients with challenging (i.e., small and initially CT-A negative) aneurysms. Second, stereoscopic CT-As and the reference standard, digital subtraction angiography (DSA), were compared in 15 patients with randomly selected aneurysms by 12 clinicians. The study participants rated the presence and location of any aneurysm and its morphological characteristics. The detection rates and interrater reliability were calculated. The first evaluation showed superior aneurysm detection in challenging cases using stereoscopic versus monoscopic CT-A viewing (median: monoscopic, 20%; interquartile range [IQR], 10%e32.5%; stereoscopic, 40%; IQR, 27.5%e42.5%). The interrater reliability analysis revealed good to excellent agreement among raters for aneurysm detection in both viewing modalities (monoscopic, intraclass correlation coefficient [ICC(2,1)], 0.798; [CI], 0.549e0.941; stereoscopic viewing, ICC(2,1), 0.895; 95% CI, 0.770e0.968). The second part demonstrated that stereoscopic CT-A viewing is comparable to DSA viewing for aneurysm detection (median: DSA, 80%; IQR, 73%e100%; stereoscopic CT-A, 87%; IQR, 87%e93%). The interrater reliability analysis revealed excellent absolute agreement in aneurysm detection between DSA and stereoscopic CT-A viewing (DSA: ICC(2,1), 0.971; 95% CI, 0.944e0.989; stereoscopic CT-A: ICC(2,1), 0.972; 95% CI, 0.945e0.989). The aneurysm detection rates correlated significantly with the participants’ years of experience. Stereoscopic viewing of CT-As increases the diagnostic accuracy and represents a promising technique to reduce the need for invasive DSA.
关键词： Stereoscopy,Aneurysm,3-Dimensional
更新于2025-09-23 15:23:52
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Aneurysm Wall Enhancement Detected by Contrast Computed Tomography Scan Is Associated With Aneurysm Shrinkage After Endovascular Aneurysm Repair for Abdominal Aortic Aneurysm
摘要： Background: Aneurysm expansion, and consequent endoleaks, after endovascular aneurysm repair (EVAR) is a major problem. Accurate prediction of aneurysm expansion is demanding for surgeons and remains difficult. Methods and Results: We retrospectively analyzed 157 cases of EVAR for abdominal aortic aneurysm (AAA) using a bifurcated main-body stent-graft. There were 62 cases of aneurysm shrinkage after EVAR, 63 cases of stable aneurysm, and 32 cases of aneurysm expansion. Type I endoleaks were significantly increased in the aneurysm expansion group (EXP) compared with the stable (STB) and shrinkage (SHR) groups (EXP: 15.6% vs. STB: 4.8% vs. SHR: 0%, P=0.005). Type II endoleaks were also significantly increased in EXP (EXP: 65.6% vs. STB: 36.5% vs. SHR: 6.5%, P<0.001). Aneurysm wall enhancement (AWE) on imaging, however, was significantly decreased in the EXP group (EXP: 18.8% vs. STB: 23.8% vs. SHR: 53.2%, P<0.001). In multivariate analysis, the occurrence of type II endoleaks significantly decreased (P<0.001) and that of AWE significantly increased the likelihood of aneurysm shrinkage (P=0.032). Conclusions: AWE following EVAR may be associated with aneurysm shrinkage.
关键词： Endovascular aneurysm repair,Abdominal aortic aneurysm,Aneurysm wall enhancement,Type II endoleak,Retrospective cohort
更新于2025-09-23 15:22:29
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Multimodal imaging in perifoveal exudative vascular anomalous complex with co-existent diabetic retinopathy
摘要： Perifoveal exudative vascular anomalous complex (PEVAC) is a recently described macular entity, which can be overlooked or confused with other retinal pathologies. On the basis of multimodal imaging features of 15 eyes with PEVAC, Sacconi et al.1 defined a PEVAC lesion as a unilateral, isolated, perifoveal, aneurysmal abnormality, occurring in otherwise healthy individuals, having characteristic angiographic and tomographic features and typically resistant to anti-vascular endothelial growth factor (anti-VEGF) therapy. Clinically, a PEVAC lesion is associated with intra-retinal fluid, haemorrhage and/or hard exudates. Querques et al.2 reported two cases of PEVAC and described the related angiographic and optical coherence tomography (OCT) features. In particular, there were no features of arterial hypertension, diabetes, or any other systemic or local vasculopathy, or signs of age-related macular degeneration. Multimodal imaging, in particular OCT-angiography along with OCT, fluorescein angiography and indocyanine angiography, have been used to provide a better understanding of the pathophysiological mechanisms of PEVAC. The purpose of this case report is to describe the imaging findings of a PEVAC lesion in a patient who had features of diabetic retinopathy.
关键词： aneurysm,perifoveal exudative vascular anomalous complex,diabetic retinopathy
更新于2025-09-23 15:22:29
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Combined use of Doppler OCT and en Face OCT Functions for Discrimination of an Aneurysm in the Lamina Cribrosa from a Disc Hemorrhage
摘要： purpose: In addition to retinal nerve fiber layer thickness measurements, the recently introduced AngioVue optical coherence tomography (OCT) offers corresponding layer-by-layer Doppler OCT and en face OCT functions, for simultaneous evaluation of perfusion and structure of the optic nerve head. We investigated the clinical usefulness of combined use of Doppler and en face Fourier-domain OCT functions of the AngioVue Fourier-domain OCT for discrimination of a disc hemorrhage and a disc hemorrhage–like atypical vessel structure located deep in the lamina cribrosa. Case report: We present our findings with AngioVue OCT on a disc hemorrhage and a spatially related retinal nerve fiber layer bundle defect in a glaucomatous eye (case 1). Both alterations were detected on en face OCT images without any Doppler OCT signal. We also report on an aneurysm suggestive for a disc hemorrhage on clinical examination and disc photography in a treated ocular hypertensive eye (case 2). The aneurysm was within the lamina cribrosa tissue at the border of the cup and the neuroretinal rim. This vascular structure produced strong Doppler signals but no structurally detectable signs on the en face OCT images. Conclusions: Combined evaluation of corresponding Doppler OCT and en face OCT images enables ophthalmologists to easily separate true disc hemorrhages from disc hemorrhage–like deep vascular structures. This is of clinical significance in preventing unnecessary intensification of pressure-lowering treatment in glaucoma.
关键词： Doppler optical coherence tomography,Aneurysm,AngioVue OCT,Optic disc hemorrhage,En face Fourier-domain OCT,Glaucoma progression
更新于2025-09-23 15:22:29
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Thermodynamics and structural stability of tissues for bio-imaging analysis – The case of intracranial aneurysm rupture risk assessment
摘要： Based on thermodynamic principles, structure stability analysis like stress response and fracture formation is well established for inorganic but not for organic bio-materials. In this study, three equations were established to assess intracranial aneurysm (IA) rupture risk based on patient's IA and internal carotid artery (ICA) angiography images, by incorporating tissue thermodynamics. Our objectives are: (1) establish foundations to help understand the physics behind the observed morphological changes prior to IA rupture, and (2) provide first-principles equations to aide in rupture risk assessment. Subsequently, we validated the new equations using available experimental and numerical simulation results, and revealed new IA rupture physics. In particular, our models correlated well with most of the available experiment and computer fluid dynamics simulation data. Among the three common structure failure modes, the axial stress and the bending moment loading are the control mechanism. The rupture risk reaches its peak when (1) the aneurysm inclination angle (ω) is close to 63.4°, (2) IA diameter / ICA diameter ?1, and (3) IA length / IA diameter ≈1.6. This study provides strong physical foundations and sound understanding to aid in rupture risk assessment. It presents insights on detailed thermodynamics that govern the previously observed IA rupture behaviors, reported from both experiments and numerical simulations. By integrating angiography images with first-principles tissue thermodynamics, we (1) advance the IA research, which is currently dominated by experimental and imaging-data-statistic approaches, and (2) introduce Calphad research into a new exciting research field - bio-imaging analysis.
关键词： Young's Modulus,Entropy,Thin-walled cylinders,Bio-imaging,Intracranial aneurysm
更新于2025-09-23 15:22:29
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Optical coherence tomography: Translation from 3D-printed vascular models of the anterior cerebral circulation to the first human images of implanted surface modified flow diverters
摘要： Background: The new generation of flow diverters includes a surface modification with a synthetic biocompatible polymer, which makes the device more biocompatible and less thrombogenic. Optical coherence tomography (OCT) can be used to visualize perforators, stent wall apposition, and intra-stent thrombus. Unfortunately real world application of this technology has been limited because of the limited navigability of these devices in the intracranial vessels. In this report, we share our experience of using 3D-printed neurovascular anatomy models to simulate and test the navigability of a commercially available OCT system and to show the application of this device in a patient treated with the new generation of surface modified flow diverters. Material and methods: Navigability of OCT catheters was tested in vitro using four different 3D-printed silicone replicas of the intracranial anterior circulation, after the implantation of surface modified devices. Intermediate catheters were used in different tortuous anatomies and positions. After this assessment, we describe the OCT image analysis of a Pipeline Shield for treating an unruptured posterior communicating artery (PCOM) aneurysm. Results: Use of intermediate catheters in the 3D-printed replicas was associated with better navigation of the OCT catheters in favorable anatomies but did not help as much in unfavorable anatomies. OCT image analysis of a PCOM aneurysm treated with Pipeline Embolization Device Shield demonstrated areas of unsatisfactory apposition with no thrombus formation. Conclusions: OCT improves the understanding of the flow diversion technology. The development of less thrombogenic devices, like the Pipeline Flex with Shield Technology, reinforces the need for intraluminal imaging for neurovascular application.
关键词： Pipeline device,Aneurysm,optical coherence tomography
更新于2025-09-23 15:21:01
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Computed Tomography of Acquired Aortic Diseases
摘要： Computed tomography angiography (CTA) has replaced catheter angiography in the evaluation of aortic disease. CTA is able to evaluate occlusive and aneurysmal disease of the aorta. Inflammatory conditions of the aorta can also be assessed with CTA.
关键词： Aortitis,CTA,Aorta,Atherosclerosis,Aortic aneurysm
更新于2025-09-23 15:21:01
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Back to the Future – Importance of Spectral Doppler
摘要： Spectral Doppler is a part of the comprehensive echocardiographic imaging of the blood flow characteristics. Both pulsed-wave (PWD) and continuous-wave Doppler (CWD) provide valuable information about the blood flow speed and direction pattern. Evaluation of blood flow characteristics is crucially important in patients who present with thoracic aortic false aneurysm (TAFA). In the case presented, spectral Doppler interrogation, using both PWD and CWD, helped with establishing accurate mechanism for TAFA and guided surgical management.
关键词： thoracic aortic false aneurysm,spectral Doppler
更新于2025-09-10 09:29:36
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The Application of FLOW 800 ICG Videoangiography Color Maps for Neurovascular Surgery and Intraoperative Decision Making
摘要： BACKGROUND: Indocyanine green (ICG) videoangiography can assess cerebral blood flow, but results are primarily qualitative. FLOW 800 software measures fluorescence dynamics and creates a semiquantitative color delay map for assessment of relative sequence of blood flow within the vasculature. METHODS: We retrospectively reviewed 23 consecutive patients for whom FLOW 800 ICG videoangiography was used. They harbored aneurysms, arteriovenous malformations (AVMs), dural arteriovenous fistula (dAVF), or hemangioblastoma. Patients’ characteristics, FLOW 800 data, and clinical findings were recorded. Color map data were readily available intraoperatively and guided surgery. RESULTS: The cohort included 10 patients with AVMs, 11 with aneurysms, 1 with dAVF, and 1 with hemangioblastoma. Approximately two thirds of patients underwent intraoperative angiography. FLOW 800 data provided semiquantitative data regarding localization, flow status in major feeding arteries, and dominance of the arterialized draining veins for AVMs, more than data from ICG videoangiography alone. For complex aneurysms, color maps confirmed relative adequate flow in parent and branching vessels. For the foramen magnum dAVF, the location of the dominant transdural connection was appreciated only via flow analysis. Flow analysis created the blood flow map of a large complex solid brainstem hemangioblastoma and guided devascularization. All FLOW 800 findings agreed with intraoperative and postoperative angiography. CONCLUSIONS: ICG videoangiography with FLOW 800 analysis can provide semiquantitative and relative flow magnitude data that are efficient and noninvasive. This process helps identify early arterialized veins and their flow status during AVM and dAVF surgery and can confirm adequate relative flow within branching vessels during aneurysm surgery when clip-induced stenosis is suspected.
关键词： Videoangiography,Dural arteriovenous fistula,Brain arteriovenous malformations,Indocyanine green,Ligation,FLOW 800,Cerebral aneurysm
更新于2025-09-10 09:29:36
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An ellipsoid convex enhancement filter for detection of asymptomatic intracranial aneurysm candidates in CAD frameworks
摘要： Various kinds of enhancement filters have been developed in computer-aided diagnostic (CAD) frameworks for asymptomatic intracranial aneurysms in magnetic resonance angiography (MRA). However, many bending or branching portions on vessels are also enhanced by the conventional filters as false positives in 3.0 T MRA, which can visualize smaller vessels compared with 1.5 T MRA. To overcome this problem, this study focused on developing an ellipsoid convex enhancement (ECE) filter, which can selectively enhance aneurysms while reducing false positive contrasts on bending or branching portions on vessels, for detection of asymptomatic intracranial aneurysm candidates in CAD frameworks. The ECE filter was mathematically designed to enhance various convex regions in the intensity space such as convex aneurysms, in which the ratio of the shortest and longest diameters for aneurysms corresponds to the ratio of reciprocals of the square roots of the first and third eigenvalues of a Hessian matrix. The proposed ECE filter was evaluated by measuring an average contrast for false positive models and free-response receiver operating characteristic curves between two simple CAD frameworks using the ECE and conventional filters based on a leave-one-out-by-patient test. MRA images for thirty patients (male: 10, female: 20; age: 48–86 yr, mean: 69.2) with 31 unruptured aneurysms (longest diameter: 2.0–5.5 mm, mean: 3.7 mm) were selected for this study. The average contrast for false positive models was reduced by 51.4% using the ECE filter, compared with the conventional filter for the convex regions with ratios of the shortest and longest diameters less than 0.4. The number of false positives per case was decreased from 41.1 to 22.8 on average at a sensitivity of 87% by using the ECE filter. The ECE filter would be useful for boosting the performance of the CAD framework of asymptomatic intracranial aneurysms by providing higher contrast aneurysms and lower contrast false positives such as bending or branching portions on vessels.
关键词： unruptured intracranial aneurysm,ellipsoid convex enhancement (ECE) filter,magnetic resonance angiography (MRA),computer-aided diagnosis (CAD)
更新于2025-09-04 15:30:14