Department of Radiology; Department of Cell Biology; New England Center for Stroke Research;
Cardiovascular Diseases | Nervous System Diseases | Neurology | Radiology | Surgical Procedures, Operative
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 microm 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 (r(2)=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 (r(2)=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. already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
CT, CT Angiography, Intervention, Stent, Technology
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DOI of Published Version
J Neurointerv Surg. 2015 Feb;7(2):118-25. doi: 10.1136/neurintsurg-2013-010950. Link to article on publisher's site.
Journal of neurointerventional surgery
Flood TF, van der Bom IM, Strittmatter L, Puri AS, Hendricks GM, Wakhloo AK, Gounis MJ. (2015). Quantitative analysis of high-resolution, contrast-enhanced, cone-beam CT for the detection of intracranial in-stent hyperplasia. Radiology Publications and Presentations. https://doi.org/10.1136/neurintsurg-2013-010950. Retrieved from https://escholarship.umassmed.edu/radiology_pubs/115
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This work is licensed under a Creative Commons Attribution-Noncommercial 3.0 License