RT Journal Article
SR Electronic
T1 Quantitative analysis of high-resolution, contrast-enhanced, cone-beam CT for the detection of intracranial in-stent hyperplasia
JF Journal of NeuroInterventional Surgery
JO J NeuroIntervent Surg
FD BMJ Publishing Group Ltd.
SP 118
OP 125
DO 10.1136/neurintsurg-2013-010950
VO 7
IS 2
A1 Flood, Thomas F
A1 van der Bom, Imramsjah M J
A1 Strittmatter, Lara
A1 Puri, Ajit S
A1 Hendricks, Gregory M
A1 Wakhloo, Ajay K
A1 Gounis, Matthew J
YR 2015
UL http://jnis.bmj.com/content/7/2/118.abstract
AB 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 (r2=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 (r2=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.