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Original research
Diagnostic quality and accuracy of low dose 3D-DSA protocols in the evaluation of intracranial aneurysms
  1. Monica S Pearl1,
  2. Collin Torok2,
  3. Zinovy Katz1,
  4. Steven A Messina2,
  5. Jordi Blasco3,
  6. Rafael J Tamargo4,
  7. Judy Huang4,
  8. Richard Leigh5,
  9. Steven Zeiler5,
  10. Martin Radvany1,
  11. Tina Ehtiati6,
  12. Philippe Gailloud1
  1. 1Division of Interventional Neuroradiology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
  2. 2Division of Neuroradiology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
  3. 3Neurointerventional Department C.D.I, Hospital Clinic of Barcelona, Barcelona, Spain
  4. 4Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
  5. 5Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
  6. 6Siemens Corporate Research, Baltimore, Maryland, USA
  1. Correspondence to Dr Monica S Pearl, Division of Interventional Neuroradiology, The Johns Hopkins Hospital, 1800 Orleans Street, Bloomberg Building, 7218, Baltimore, MD 21287, USA; msmit135{at}jhmi.edu

Abstract

Background 3D-DSA is the ‘gold standard’ imaging technique for the diagnosis and characterization of intracranial aneurysms.

Objective To compare the image quality and accuracy of low dose 3D-DSA protocols in patients with unruptured intracranial aneurysms.

Materials and methods The standard manufacturer 5 s 0.36 μGy/f protocol and one of three low dose 3D-DSA protocols (5 s 0.10 μGy/f, 5 s 0.17 μGy/f, 5 s 0.24 μGy/f) were performed in 12 patients with unruptured intracranial aneurysms. Three interventional neuroradiologists, two neurosurgeons, and two neurologists rated the image quality of all 3D reconstructions as good, acceptable, or poor. Three interventional neuroradiologists measured two dimensions of each aneurysm for all protocols. The radiation dose metric Ka,r (reference point air kerma, in mGy) was recorded for each 3D-DSA protocol.

Results The standard 5 s 0.36 μGy/f protocol earned the highest average subjective rating of 2.76, followed by the 5 s 0.24 μGy/f (2.72), and 5 s 0.17 μGy/f (2.59) protocols. The ranges of differences in aneurysm measurements between the 5 s 0.24 μGy/f protocol and the standard were <0.5 mm. The median Ka,r metrics for each protocol were as follows: 5 s 0.36 μGy/f (89.0 mGy), 5 s 0.24 μGy/f (57.7 mGy), 5 s 0.17 μGy/f (45.9 mGy), and 5 s 0.10 μGy/f (27.6 mGy).

Conclusions Low dose 3D-DSA protocols with preserved image quality are achievable, and can help reduce exposure of patients and operators to unnecessary radiation. The 5 s 0.24 μGy/f protocol generates one-third smaller radiation dose than the standard 5 s 0.36 μGy/f protocol without compromising diagnostic image quality or accuracy.

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