Contrast-enhanced angiographic cone-beam CT of cerebrovascular stents: experimental optimization and clinical application.
OBJECTIVE
With modern imaging techniques, visualization of neurovascular stents remains challenging. We present a method for contrast-enhanced C-arm CBCT that provides detailed and simultaneous visualization of neurovascular stents and host arteries.


METHODS
CBCT was performed with a rotational angiography system by acquiring 620 projection frames over a 200° arc at 80 kVp and a total of 260 mAs. A superselective intra-arterial contrast injection protocol was optimized in swine experiments and implemented in 57 clinical examinations. High-resolution 3D reconstructions were evaluated by 3 blinded interventional neuroradiologists. Reviewers rated the images by answering questions related to both the quality of the stent and artery visualization and the clinical utility of the images. Raw agreement statistics, ICC, and κ statistics were computed for the questionnaire results.


RESULTS
Of 57 clinical evaluations, 5 were not evaluated due to the use of large balloon-mounted stents (n = 4) and a failed contrast injection (n = 1). In 50 of 52 evaluated examinations, the reviewers agreed that simultaneous stent and vessel visualization was of diagnostic quality. There was strong agreement that stent-vessel wall apposition could be assessed (κ = 0.79). CBCT detected contrast filling defects (κ = 0.85) and vascular calcification (κ = 0.68). Artifacts resulting from the aneurysm coil mass impaired the delineation of adjacent structures (κ = 0.72).


CONCLUSIONS
We have developed a technique that enables simultaneous clinically useful imaging of neurovascular stents and their host arteries that is unobtainable with other current imaging modalities. Further improvements are required to reduce artifacts from large coil masses due to x-ray scattering.
Department of Radiology, University of Massachusetts Medical School, Worcester, Massachusetts 01655, USA.
N V
NV
Patel
M J
MJ
Gounis
A K
AK
Wakhloo
N
N
Noordhoek
J
J
Blijd
D
D
Babic
D
D
Takhtani
S-K
SK
Lee
A
A
Norbash
D000818:Animals; D001807:Blood Vessel Prosthesis; D002533:Cerebral Angiography / Q000379:methods*; D003287:Contrast Media / Q000008:administration & dosage; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000000981:diagnostic imaging* / Q000601:surgery*; D007479:Iopamidol / Q000008:administration & dosage; D008297:Male; D011379:Prognosis; D011856:Radiographic Image Enhancement / Q000379:methods*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D015607:Stents; D013552:Swine; D014057:Tomography, X-Ray Computed / Q000379:methods*; D016896:Treatment Outcome
D003287:Contrast Media; D007479:Iopamidol