How to perform DSA-based Cerebral Aneurysm Flow measurements

This poster is published under an open license. Please read the disclaimer for further details.

Congress:

ECR 2016

Poster Number:

C-1919

Type:

Educational Exhibit

Keywords:

Haemodynamics / Flow dynamics, Aneurysms, Stents, Catheters, Catheter arteriography, Vascular, Neuroradiology brain, Cardiovascular system

Authors:

D. Ruijters¹, N. Benachour², T. Grünhagen¹, F. van Nijnatten¹, O. Bonnefous³, J. Moret³, L. SPELLE³; ¹Best/NL, ²Clichy/FR, ³Paris/FR

DOI:

10.1594/ecr2016/C-1919

DOI-Link:

https://dx.doi.org/10.1594/ecr2016/C-1919

Fig. 1: Example of a 3DRA (red) overlaid on the flow DSA run, with part of the parent...

Fig. 8: The contrast wave travelling through the artery and aneurysm for a given time...

Fig. 9: The average flow vector field within the region of interest.

Fig. 14: The flow velocity averaged within the aneurysm outline as a function of time.

Learning objectives

Performing cerebral aneurysm flow measurements in the cathlab using DSA requires a number of steps to be performed correctly. These measurements can be used to peri-interventionally assess flow diverter efficacy. This poster explains step-by-step the appropriate approach leading to successful flow measurements, as well as how to avoid potential pitfalls.

Background

Aneurysm treatment by flow diverter stents aims at inducing thrombosis in the aneurysm sac by reducing the blood inflow. However, thrombosis and complete aneurysm occlusion may take several months, and during the treatment there used to be no reliable indicator whether this will be achieved. Flow measurements based on digital subtraction angiography (DSA) acquisitions [1] immediately before and after stent placement in combination with the use of post-processing software allows calculation of the mean aneurysm flow amplitude (MAFA) ratio. This ratio represents the change in...

Findings and procedure details

The measurement of flow in a cerebral aneurysm and the feeding artery using the combination of high-speed DSA and dedicated post-processing software depends on several steps that have to be performed appropriately. General The calculation of the flow information requires a 3D rotational angiography (3DRA) and a dedicated high frame-rate (60 frames per second) DSA run. During the DSA run contrast medium is injected at a very modest pace. The contrast medium intensity becomes modulated by the cardiac cycle. As a result, there is more...

Conclusion

The aneurysm and arterial flow can be quantified during interventional treatment with flow diverting stents, provided that the necessary steps are correctly performed.

Personal information

Daniel Ruijters, Thijs Grünhagen, Fred van Nijnatten, Odile Bonnefous Philips Healthcare, Image Guided Therapy Systems Innovation, Veenpluis 4-6, 5680DA Best, the Netherlands mailto: [email protected] Nidhal Benachour, Jacques Moret, Laurent Spelle Bicêtre University hospital Paris NEURI center, Department of NRI 78, rue du Général Leclerc 94275 Le Kremlin Bicêtre, cedex, France www.neuri.fr www.linnc.com

References

Bonnefous, O., Mendes Pereira, V., Ouared, R., Brina, O., Aerts, H., Hermans, R., van Nijnatten, F., Stawiaski, J., Ruijters, D.: Quantification of arterial flow using digital subtraction angiography. Med. Phys. 39, 6264–6275 (2012) Pereira, V.M., Bonnefous, O., Ouared, R., Brina, O., Stawiaski, J., Aerts, H., Ruijters, D., Narata, A.P., Bijlenga, P., Schaller, K., Lovblad, K.-O.: A DSA-Based Method Using Contrast-Motion Estimation for the Assessment of the Intra-Aneurysmal Flow Changes Induced by Flow-Diverter Stents. AJNR Am. J. Neuroradiol. 34, 808–815 (2013) Pereira, V.M., Ouared, R., Brina,...