Purpose Use post processing techniques to assess the neck diameters of intracranial aneurysms using intraluminal navigation and to assess aneurysm volumes. Comparison of aneurysm volumes calculated using modeling methods with approximation method commonly used in clinical practice.

Materials and methods Intracranial 3D Digital subtraction angiographic images obtained on a Siemens Artis Zee angiography suite were reviewed on 23 patients with intracranial aneurysms. Post processing was performed on a dedicated Leonardo workstation. Vessel segmentation was performed. After applying thresholding, intraluminal navigation was performed using the platform to assess the geometry of the aneurysm neck. Neck width and length as well as aneurysm volumes were measured. Relationship of the neck to adjacent arterial ostia was also assessed.

Results Aneurysm neck dimensions (length and width) were very well visualized in the intraluminal navigation images. Relationship of vessel ostia to the neck were also well evaluated in this series. Automated aneurysm volume calculations compared well with standard A*B*C/2 approximations with aneurysm diameters measured manually from orthogonal DSA and 3D DSA images. Comparison between two techniques was performed using Bland-Altman diagrams.

Conclusion Intraluminal navigation by post processing provides another tool to look at the neck of an intracranial aneurysm to allow better planning for endovascular embolization procedures. Particularly, neck width and length assessment would allow for selection of adjunctive balloon or stent assisted coiling techniques if the neck is wide in 2 dimensions. Also aneurysm volumes calculated by this method compare well with approximation formulas and potentially provide more accurate calculations for determination of packing density.

References

1. . Brinjikji W, Cloft HJ, et al. Difficult Aneurysms for Endovascular Treatment: Overwide or Undertall?AJNR Am J Neuroradiol 2009;30:1513–1517. Originally published online on May 20, 2009, 10.3174/ajnr.A1633.

2. . Erhardt S, Marbacher S, et al. Comparison between routine cylindrical cerebral aneurysm volume approximation and three-dimensional volume measurements in experimental aneurysms. Neurol Res. 2014 Aug;36(8):739–45. doi:10.1179/1743132813Y.0000000316. Epub 2014 Jan 20.

Disclosures: K. Raghuram: None. A. Saleem: None.