Quantitative analysis of high-resolution, contrast-enhanced, cone-beam CT for the detection of intracranial in-stent hyperplasia.
BACKGROUND
Intracranial in-stent hyperplasia is a stroke-associated complication that requires routine surveillance.


OBJECTIVE
To compare the results of in vivo experiments to determine the accuracy and precision of in-stent hyperplasia measurements obtained with modified C-arm contrast-enhanced, cone-beam CT (CE-CBCT) imaging with those obtained by 'gold standard' histomorphometry. Additionally, to carry out clinical analyses comparing this CE-CBCT protocol with digital subtraction angiography (DSA).


METHODS
A non-binned CE-CBCT protocol (VasoCT) was used that acquires x-ray images with a small field-of-view and applies a full-scale reconstruction algorithm providing high-resolution three-dimensional (3D) imaging with 100 µm isotropic voxels. In an vivo porcine model, VasoCT cross-sectional area measurements were compared with gold standard vessel histology. VasoCT and DSA were used to calculate in-stent stenosis in 23 imaging studies.


RESULTS
Porcine VasoCT cross-sectional stent, lumen, and in-stent hyperplasia areas strongly correlated with histological measurements (r(2)=0.97, 0.93, 0.90; slope=1.14, 1.07, and 0.76, respectively; p<0.0001). Clinical VasoCT percentage stenosis correlated well with DSA percentage stenosis (r(2)=0.84; slope=0.76), and the two techniques were free of consistent bias (Bland-Altman, bias=3.29%; 95% CI -14.75% to 21.33%). An illustrative clinical case demonstrated the advantages of VasoCT, including 3D capability and non-invasive IV contrast administration, for detection of in-stent hyperplasia.


CONCLUSIONS
C-arm VasoCT is a high-resolution 3D capable imaging technique that has been validated in an animal model for measurement of in-stent tissue growth. Successful clinical implementation of the protocol was performed in a small case series.
Department of Radiology, New England Center for Stroke Research, University of Massachusetts Medical School, Worcester, Massachusetts, USA.
Thomas F
TF
Flood
Department of Radiology, New England Center for Stroke Research, University of Massachusetts Medical School, Worcester, Massachusetts, USA.
Imramsjah M J
IM
van der Bom
Department of Cell Biology, University of Massachusetts Medical School, Worcester, Massachusetts, USA.
Lara
L
Strittmatter
Department of Radiology, New England Center for Stroke Research, University of Massachusetts Medical School, Worcester, Massachusetts, USA.
Ajit S
AS
Puri
Department of Cell Biology, University of Massachusetts Medical School, Worcester, Massachusetts, USA.
Gregory M
GM
Hendricks
Department of Radiology, New England Center for Stroke Research, University of Massachusetts Medical School, Worcester, Massachusetts, USA.
Ajay K
AK
Wakhloo
Department of Radiology, New England Center for Stroke Research, University of Massachusetts Medical School, Worcester, Massachusetts, USA.
Matthew J
MJ
Gounis
D000368:Aged; D000818:Animals; D002544:Cerebral Infarction / Q000000981:diagnostic imaging* / Q000209:etiology; D054893:Cone-Beam Computed Tomography / Q000592:standards*; D006801:Humans; D006965:Hyperplasia / Q000000981:diagnostic imaging* / Q000209:etiology; D012189:Retrospective Studies; D015607:Stents / Q000009:adverse effects*; D013552:Swine
CT; CT Angiography; Intervention; Stent; Technology