Abstract
BACKGROUND AND PURPOSE: Quality of visualization of treatment devices during critical stages of endovascular interventions, can directly impact their safety and efficacy. Our aim was to compare the visualization of neurointerventional procedures and treatment devices using a 194-μm pixel flat panel detector mode and a 76-μm pixel complementary metal oxide semiconductor detector mode (high definition) of a new-generation x-ray detector system using a blinded-rater study.
MATERIALS AND METHODS: Deployment of flow-diversion devices for the treatment of internal carotid artery aneurysms was performed under flat panel detector and high-definition-mode image guidance in a neurointerventional phantom simulating patient cranium and tissue attenuation, embedded with 3D-printed intracranial vascular models, each with an aneurysm in the ICA segment. Image-sequence pairs of device deployments for each detector mode, under similar exposure and FOV conditions, were evaluated by 2 blinded experienced neurointerventionalists who independently selected their preferred image on the basis of visualization of anatomic features, image noise, and treatment device. They rated their selection as either similar, better, much better, or substantially better than the other choice. Inter- and intrarater agreement was calculated and categorized as poor, moderate, and good.
RESULTS: Both raters demonstrating good inter- and intrarater agreement selected high-definition-mode images with a frequency of at least 95% each and, on average, rated the high-definition images as much better than flat panel detector images with a frequency of 73% from a total of 60 image pairs.
CONCLUSIONS: Due to their higher resolution, high-definition-mode images are sharper and visually preferred compared with the flat panel detector images. The improved imaging provided by the high-definition mode can potentially provide an advantage during neurointerventional procedures.
ABBREVIATIONS:
- DA
- digital angiography
- FPD
- flat panel detector
- HiDef
- high definition
- PED
- Pipeline Embolization Device
- RP
- reference point
Footnotes
Disclosures: Ciprian Ionita—RELATED: Grant: Canon Medical Systems*; UNRELATED: Consultancy: Jacobs Institute; Employment: University at Buffalo, Comments: Assistant Professor; Grants/Grants Pending: National Institutes of Health*. Daniel R. Bednarek—UNRELATED: Grants/Grants Pending: Canon Medical Systems*; Royalties: Canon Medical Systems, Comments: dose-tracking system licensed through the University at Buffalo Technology Transfer Office.* Maxim Mokin—UNRELATED: Consultancy: Penumbra, Cerebrotech Medical Systems, Canon Medical Systems. Adnan H. Siddiqui—UNRELATED: Consultancy: Amnis Therapeutics, Boston Scientific, Canon Medical Systems, Cerebrotech Medical Systems, Cerenovus, Claret Medical, Corindus, EndoStream Medical, Guidepoint Global, Imperative Care, Integra, Medtronic, MicroVention, Northwest University Data and Safety Monitoring Board Chair for the HEAT trial, Penumbra, Rapid Medical, Rebound Therapeutics, Serenity Medical Evaluations, Silk Road Medical, StimMed, Stryker, Three Rivers Medical, VasSol, W.L. Gore & Associates; Employment: Jacobs Institute, University at Buffalo Neurosurgery; Stock/Stock Options: Amnis Therapeutics, Apama Medical, Blinktbi, Buffalo Technology Partners, Cardinal Health, Cerebrotech Medical Systems, Claret Medical, Cognition Medical, EndoStream Medical, Imperative Care, International Medical Distribution Partners, Rebound Therapeutics, Rist Neurovascular, Serenity Medical, Silk Road Medical, StimMed, Synchron, Three Rivers Medical, Viseon Spine; Other: Cerenovus, LARGE trial and ARISE II trial; Medtronic, SWIFT PRIME and SWIFT DIRECT trials; MicroVention, FRED trial and CONFIDENCE study, MUSC POSITIVE trial; Penumbra, Separator 3D Trial, COMPASS trial, INVEST trial, Comments: National Principal Investigator/Steering Committees. Stephen Rudin—RELATED: Grant: Canon Medical Systems, Comments: Also, previous work was supported by a grant from National Institutes of Health to the University at Buffalo (Toshiba Medical is now Canon Medical)*; UNRELATED: Patents (Planned, Pending or Issued): Canon Medical Systems*; Royalties: Canon Medical Systems, Comments: coauthor on Dose-Tracking System licensed to Canon by the University at Buffalo.* Jason Davies—RELATED: Grant: University at Buffalo Clinical and Translational Science Award (CTSA) UL1TR001412 KL2*; UNRELATED: Stock/Stock Options: RIST NEUROVASCULAR, INC. *Money paid to the institution.
This work was supported by National Institutes of Health grant No. R01EB2873 and equipment support from Canon Medical Systems.
- © 2018 by American Journal of Neuroradiology
Indicates open access to non-subscribers at www.ajnr.org
