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Vascular assessment after clipping surgery using four-dimensional CT angiography.
Yusuke Kimura1, Takeshi Mikami2, Kei Miyata1
1Department of Neurosurgery, Sapporo Medical University, South 1 West 16, Chuo-ku, Sapporo, 060-8543, Japan.
Neurosurgical Review
|March 5, 2018
Summary
Computed tomography angiography (CTA) with volume rendering (VR) and 4D-CTA helps evaluate cerebral aneurysms after clipping surgery. Four-dimensional CTA improves imaging quality around metal artifacts from larger clips.
Area of Science:
- Neurosurgery
- Radiology
- Medical Imaging
Background:
- Computed tomography angiography (CTA) advancements allow for serial imaging follow-up after cerebral aneurysm clipping surgery.
- Metal artifacts from surgical clips can impede postoperative evaluation.
Purpose of the Study:
- To determine the critical volume and configuration of aneurysmal clips affecting postoperative evaluation.
- To assess the utility of volume rendering (VR) and four-dimensional CTA (4D-CTA) for visualizing larger metal artifacts.
Main Methods:
- 44 patients with cerebral aneurysms treated with clipping surgery were analyzed.
- Metal artifact volume was measured using CTA, correlated with clip type, and assessed via VR and 4D-CTA.
- Diagnostic accuracy for arteries and residual aneurysms was evaluated.
Main Results:
- A metal artifact volume cutoff of 2.32 mm³ was identified using VR.
- Patients with multiple, large, or fenestrated clips (Group 2) had significantly larger artifact volumes than those with simple, small clips (Group 1).
- VR showed superior post-clipping status in Group 1, while 4D-CTA provided superior imaging in 92.9% of Group 2 patients, mitigating artifact effects.
Conclusions:
- Metal artifact volume is dependent on the number, size, and configuration of cerebral aneurysm clips.
- 4D-CTA is effective in overcoming metal artifacts, enhancing postoperative evaluation in patients with complex clipping devices.
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