• 한국방사선학회논문지
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• 제12권4호
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• pp.511-518
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• 2018

이 연구는 뇌동맥자루의 임상적 진단에 사용되는 3차원 디지털 혈관조영술과 3차원 디지털 감산 혈관조영술을 동일 부위에 시행한 환자 53명의 영상에서 뇌동맥자루 경부 직경, 최대 직경, 최대 면적 및 체적을 측정하고, 각 검사법의 영상 노이즈와 피폭선량을 분석하여 뇌동맥자루 진단검사에서의 임상적 진단 차이를 비교하였다. 3차원 디지털 혈관조영술과 3차원 디지털 감산 혈관조영술에서 뇌동맥자루의 경부직경, 최대직경, 최대면적, 체적, 노이즈를 비교한 결과가 일치하거나 아주 미세한 차이로 나타났다. 하지만, 방사선피폭선량은 3차원 디지털 감산 혈관조영술에 비하여 3차원 디지털 혈관조영술이 현저히 낮게 발생하였다. 따라서 뇌동맥자루의 임상적 진단을 목적으로 시행하는 경우에는 환자의 피폭선량을 감소를 위해 3차원 디지털 혈관조영술이 우선적으로 사용되어야 할 것이다.

• Journal of Korean Neurosurgical Society
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• 제42권2호
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• pp.103-111
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• 2007

Objective : We evaluated the accuracy of multislice computerized tomographic angiography (MCTA) in the postoperative evaluation of clipped aneurysms by comparising it with three dimensional digital subtraction angiography (3D-DSA). Methods : Between May 2004 and September 2006, we included patients with ruptured cerebral aneurysm of the anterior circulation that was surgically clipped and evaluated by both postoperative MCTA and postoperative 3D-DSA. We measured the diagnostic performance and calculated the sensitivity and specificity of postoperative MCTA compared to 3D-DSA in the detection of aneurysm remnants. Results : A total of 11 neck remnants among the 92 clipped aneurysms (11.9%) were confirmed by 3D-DSA. According to Sindou's classification of aneurysm remnants, 8.7% of clipped aneurysms (8/92) had only neck remnant on 3D-DSA and 3.2% (3/92 aneurysms) had residuum of the neck and sac on 3D-DSA. There were 12 (13.04%) equivocal cases that were difficult to interpret based on the postoperative MCTA. The reasons for the equivocal cases included multiple clips (6 cases, 50.0%). beam-hardening effect (4 cases, 33.3%), motion artifact (1 case, 8.3%), fenestrated clip (1 case, 8.3%) and other combined causes. The sensitivity and specificity of the postoperative MCTA was 81.8% and 88.9%, respectively by ROC curve (p=0.000). Conclusion : MCTA is an accurate noninvasive imaging method used for the assessment of clipped aneurysms in the anterior circulation. If the image quality of postoperative MCTA is good quality and the patient has been treated with a single titanium clip, except a fenestrated clip, the absence of an aneurysm remnant can be diagnosed by MCTA alone and the need for postoperative DSA can be reduced in a large percentage of cases.

• 대한방사선기술학회지:방사선기술과학
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• 제24권2호
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• pp.23-28
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• 2001

The purpose of this study is to compare the 3-dimensional MR angiography(MRA) with digital subtraction angiography(DSA) for the evaluation of pedal artery. MR angiography was performed using three-dimensional FISP acquisition before, and four sequential acquisitions after the injection of gadolinium(0.2 mmol/kg, 3 ml/sec). MRA was compared with DSA for a correct identification of the arterial segment. Out of 168 segments, 32 segmints were invisible in both MRA and DSA. At the level of ankle, 48 segments were visible in both examinations, and 18 segments were visible only in MRA. In the foot area, 34 segments were visible in MRA, but not in DSA. Three arterial segments were visible only in DSA. 3D MRA is comparable to DSA for the evaluation of pedal artery, thus it gives additional Information for the planning of treatment in lower extremity artery.

• Journal of Korean Neurosurgical Society
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• 제47권3호
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• pp.185-190
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• 2010

Objective : The aneurysm remnants rate was evaluated via three-dimensional digital subtraction angiography (3D-DSA) in the postoperative evaluation of clipped aneurysms. Methods : Data on surgically clipped aneurysms of anterior circulation obtained via postoperative 3D-DSA from February 2007 to March 2009 were gathered. The results of the postoperative 3D-DSA and of two-dimensional digital subtraction angiography (2D-DSA) for the detection of aneurysm remnants were compared, and an investigation was performed as to why 2D-DSA had missed some aneurysm remnants that were detected in the 3D-DSA. Various surgical factors that revealed aneurysm remnants in the 3D-DSA were also evaluated. Results : A total of 39 neck remnants of 202 clipped aneurysms (19.3%) were confirmed in 3D-DSA, and these were classified according to Sindou's classification of aneurysm remnants. Patients with only a neck remnant found in the 3D-DSA represented 17.3% (35/202 aneurysms) of the whole series, and those with a residuum of neck plus sac found in the 3D-DSA represented 1.9% (4/202 aneurysms). The causes of aneurysm remnants were no full visualization (14/39, 35.9%), parent and perforator artery protection (10/39, 25.6%), clip design problems (8/39, 20.5%), and broadnecked aneurysm (7/39, 17.9%). Conclusion : Patients with ${\leq}2$mm aneurysm remnants showed an increased risk of undetectable aneurysm remnants in the 2D-DSA. The most frequent location of the missed aneurysm in 2D-DSA was the anterior communicating artery. 3D-DSA showed more aneurysm remnants than what is indicated in the existing literature, the 2D-DSA.

• Journal of Korean Neurosurgical Society
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• 제64권5호
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• pp.726-731
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• 2021

Objective : Distinguishing between an infundibulum and a true aneurysm is clinically important. This study aimed to evaluate whether using source image based new three-dimensional rotational angiography (S-n3DRA) can increase the rate of aneurysm detection and improve distinction between a true aneurysm and an infundibulum. Methods : Twenty-two consecutive patients with 23 lesions, were evaluated by time-of-flight (TOF) magnetic resonance angiography (MRA), S-n3DRA, and digital subtraction angiography (DSA). The data were retrospectively and independently reviewed by two neurointerventionists, and the diagnoses based on TOF MRA, S-n3DRA, and DSA were compared. The diagnostic efficacy (interobserver agreement and diagnostic performance) of S-n3DRA was compared with that of TOF MRA. Results : S-n3DRA showed higher interobserver agreement (κ=0.923) than TOF MRA (κ=0.465) and significantly higher accuracy than MRA in distinguishing an aneurysm from an infundibulum (p=0.0039). Conclusion : Compared to MRA, S-n3DRA could provide better screening accuracy and information for distinguishing an aneurysm from an infundibulum. Therefore, S-n3DRA has the potential to reduce the need for DSA.

• 대한전자공학회논문지
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• 제20권1호
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• pp.63-71
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• 1983

본 논문에서는 디지탈 감산 기법을 이용한 양면 혈관 조영술 영상에서의 대응점 결정을 위하여 조영제 말단 추적 알고리즘을 사용하였고, 이 대응점 정보로부터 혈관의 3차원 영상을 재구성하는 과정을 확립하였으며, 개를 이용한 실험 결과도 포함되어 있다. 저자들에 의해 개발된 본 방법의 정확성을 입증하기 위해 사각에서 잡은 혈관 조영상과 계산을 통해 재구성된 영상을 비교하여 좋은 결과를 얻었다. 본 논문에서는 3가지의 새로운 알고리즘을 개발, 또는 응용하였는바, 첫째는, 순차적인 영상에서 조영제의 말단은 어느 투영면에서도 동일한 형태를 갖게 되므로, 상호 상관 계수의 접합법을 이용하여 조영제 말단을 추적해 가는 알고리즘이고, 둘째는, 기준좌표계에서 시선좌표계로의 전환을 4×4행렬 하나로 표시한 단순화 투시 변환 행렬의 구성이며, 셋째는, 조영제 말단 추적법이 적용될 수 없는 작은 혈관 영상에서의 대응점 확립을 위한 보조알고리즘의 적용이 그것이다. 또한 본 방법은 3차원 공간상에서의 조영제 말단 이동거리에 대한 정보로부터 혈류속도의 측정에도 이용될 수 있다.

• 한국정보과학회논문지:소프트웨어및응용
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• 제30권12호
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• pp.1247-1254
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• 2003

현재 경동맥 내막절제술 시행을 위한 경동맥 협착증의 정도 측정에는 디지털감산조영술(DSA), 회전조영술(rotational angiography), 컴퓨터단층조영술(CTA) 및 자기공명조영술(MRA)로부터 얻어진 경동맥의 투영 영상을 이용하여 북미, 유럽 표준 및 총경동맥 방법이 사용되고 있다. 본 논문에서는 기존의 기계적인 측경기를 이용하는 전형적인 경동맥 협착 측정 방법의 단점을 극복하고, 측정자간의 변화율을 최소화하기 위해 자기공명조영술의 단면 영상을 사용하고 컴퓨터화한 새로운 협착증 정도 측정 방법을 개발하였다. 영상 분할에 사용되는 방법중 가장 널리 사용되고 효율적인 명암값 임계치 방법을 사용하여 경동맥 및 동맥의 내강을 분할하였다. 또한, 각 증례의 측정된 총경동맥의 혈관두께를 사용하여 분할된 경동맥으로부터 혈관을 제거 하였고, 혈관이 제거된 경동맥을 혈류 영역과 플라그 영역으로 분할하였다. 각 단면 영상에서의 경동맥 협착증 정도 측정은 (분할된 플라그 영역/혈류영역 및 플라그를 합한 면적) * 100% 식으로 계산된다.

• Journal of Korean Neurosurgical Society
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• 제62권1호
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• pp.35-45
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• 2019

Objective : To describe our experiences with a fully equipped high-end digital subtraction angiography (DSA) system within a hybrid operating room (OR). Methods : A single-plane DSA system with 3-dimensional rotational angiography, cone-beam computed tomography (CBCT), and real-time navigation software was used in our hybrid OR. Between April 2014 and January 2018, 191 sessions of cerebrovascular procedures were performed in our hybrid OR. After the retrospective review of all cases, the procedures were categorized into three subcategorical procedures : combined endovascular and surgical procedure, complementary rescue procedure during intervention and surgery, and frameless stereotaxic operation. Results : Forty-nine of 191 procedures were performed using hybrid techniques. Four cases of blood blister aneurysms and a ruptured posterior inferior cerebellar artery aneurysm were treated using bypass surgery and endovascular trapping. Eight cases of ruptured aneurysm with intracranial hemorrhage (ICH) were treated by partial embolization and surgical clipping. Six cases of ruptured arteriovenous malformation with ICH were treated by Onyx embolization of nidus and subsequent surgical removal of nidus and ICH. Two (5.4%) of the 37 cases of pre-mature rupture during clipping were secured by endovascular coil embolization. In one (0.8%) complicated case of 103 intra-arterial thrombectomy procedures, emergency surgical embolectomy with bypass surgery was performed. In 27 cases of ICH, frameless stereotaxic hematoma aspiration was performed using $XperGuide^{(R)}$ system (Philips Medical Systems, Best, the Netherlands). All procedures were performed in single sessions without any procedural complications. Conclusion : Hybrid OR with a fully equipped DSA system could provide precise and safe treatment strategies for cerebrovascular diseases. Especially, we could suggest a strategy to cope flexibly in complex lesions or unexpected situations in hybrid OR. CBCT with real-time navigation software could augment the usefulness of hybrid OR.