Sandoval-Garcia C, Yang P, Schubert T, Schafer S, Hetzel S, Ahmed A, Strother C
From the Departments of Neurological Surgery (C.S.-G., A.A.)
Department of Neurosurgery (P.Y.), Changhai Hospital, Second Military Medical University, Shanghai, China.
AJNR Am J Neuroradiol. 2017 Apr;38(4):729-734. doi: 10.3174/ajnr.A5137. Epub 2017 Mar 9.
4D-DSA is a time-resolved technique that allows viewing of a contrast bolus at any time and from any desired viewing angle. Our hypothesis was that the information content in a 4D-DSA reconstruction was essentially equivalent to that in a combination of 2D acquisitions and a 3D-DSA reconstruction.
Twenty-six consecutive patients who had both 2D- and 3D-DSA acquisitions were included in the study. The angiography report was used to obtain diagnoses and characteristics of abnormalities. Diagnoses included AVM/AVFs, aneurysms, stenosis, and healthy individuals. 4D-DSA reconstructions were independently reviewed by 3 experienced observers who had no part in the clinical care. Using an electronic evaluation form, these observers recorded their assessments based only on the 4D reconstructions. The clinical evaluations were then compared with the 4D evaluations for diagnosis and lesion characteristics.
Results showed both interrater and interclass agreements (κ = 0.813 and 0.858). Comparing the 4D diagnosis with the clinical diagnosis for the 3 observers yielded κ values of 0.906, 0.912, and 0.906. The κ values for agreement among the 3 observers for the type of abnormality were 0.949, 0.845, and 0.895. There was complete agreement on the presence of an abnormality between the clinical and 4D-DSA in 23/26 cases. In 2 cases, there were conflicting opinions.
In this study, the information content of 4D-DSA reconstructions was largely equivalent to that of the combined 2D/3D studies. The availability of 4D-DSA should reduce the requirement for 2D-DSA acquisitions.
4D-DSA是一种时间分辨技术，可在任何时间从任何所需视角观察对比剂团注。我们的假设是，4D-DSA重建中的信息内容与二维采集和三维DSA重建组合中的信息内容基本等效。
本研究纳入了26例连续进行二维和三维DSA采集的患者。血管造影报告用于获取异常的诊断和特征。诊断包括动静脉畸形/动静脉瘘、动脉瘤、狭窄以及健康个体。3名未参与临床护理的经验丰富的观察者独立审查4D-DSA重建。这些观察者使用电子评估表，仅根据4D重建记录他们的评估。然后将临床评估与4D评估的诊断和病变特征进行比较。
结果显示观察者间和组内一致性（κ分别为0.813和0.858）。将3名观察者的4D诊断与临床诊断进行比较，κ值分别为0.906、0.912和0.906。3名观察者对异常类型的一致性κ值分别为0.949、0.845和0.895。26例中有23例临床诊断与4D-DSA在是否存在异常方面完全一致。2例存在意见分歧。
在本研究中，4D-DSA重建的信息内容在很大程度上等同于二维/三维联合研究的信息内容。4D-DSA的应用应可减少对二维DSA采集的需求。
