From the Diagnostic and Interventional Neuroradiology Section (J.M.O., K.A.B., D.W.Z.), Department of Radiology and Nuclear Medicine.
Department of Neuroradiology (G.G., V.C., L.P.), Hôpital Gui de Chauliac, Centre Hospitalier Universitaire de Montpellier, University of Montpellier, Montpellier, France.
AJNR Am J Neuroradiol. 2019 Mar;40(3):524-530. doi: 10.3174/ajnr.A5973. Epub 2019 Feb 7.
The Sim&Size software simulates case-specific intraluminal Pipeline Embolization Device behavior, wall apposition, and device length in real-time on the basis of rotational angiography DICOM data. The purpose of this multicenter study was to evaluate whether preimplantation device simulation with the Sim&Size software results in selection of different device dimensions than manual sizing.
In a multicenter cohort of 74 patients undergoing aneurysm treatment with the Pipeline Embolization Device, we compared apparent optimal device dimensions determined by neurointerventionalists with considerable Pipeline Embolization Device experience based on manual 2D measurements taken from rotational angiography with computed optimal dimensions determined by Sim&Size experts blinded to the neurointerventionalists' decision. Agreement between manually determined and computed optimal dimensions was evaluated with the Cohen κ. The significance of the difference was analyzed with the Wilcoxon signed rank test.
The agreement index between manual selection and computed optimal dimensions was low (κ for diameter = 0.219; κ for length = 0.149, < .01). Computed optimal device lengths were significantly shorter (median, 14 versus 16 mm, = 402, = -0.28, < .01). No significant difference was observed for device diameters.
Low agreement between manually determined and computed optimal device dimensions is not proof, per se, that virtual simulation performs better than manual selection. Nevertheless, it ultimately reflects the potential for optimization of the device-sizing process, and use of the Sim&Size software reduces, in particular, device length. Nevertheless, further evaluation is required to clarify the impact of device-dimension modifications on outcome.
Sim&Size 软件基于旋转血管造影 DICOM 数据实时模拟特定病例的腔内 Pipeline 栓塞装置行为、贴壁和装置长度。本多中心研究的目的是评估基于旋转血管造影的 2D 测量进行手动测量与 Sim&Size 软件进行预植入装置模拟是否会导致选择不同的装置尺寸。
在一项接受 Pipeline 栓塞装置治疗的 74 例动脉瘤患者的多中心队列研究中，我们比较了神经介入医师根据手动 2D 测量确定的明显最佳装置尺寸，这些测量是基于旋转血管造影获得的，并与 Sim&Size 专家根据经验确定的计算最佳尺寸进行比较，Sim&Size 专家对神经介入医师的决策不知情。通过 Cohen κ 评估手动确定和计算最佳尺寸之间的一致性。通过 Wilcoxon 符号秩检验分析差异的显著性。
手动选择和计算最佳尺寸之间的一致性指数较低（直径的 κ 值为 0.219；长度的 κ 值为 0.149，<0.01）。计算出的最佳装置长度明显较短（中位数，14 与 16 毫米，=402，= -0.28，<0.01）。装置直径无显著差异。
手动确定和计算最佳装置尺寸之间的低一致性本身并不能证明虚拟模拟比手动选择更有效。然而，它最终反映了优化装置尺寸选择过程的潜力，使用 Sim&Size 软件尤其可以减少装置长度。然而，需要进一步评估以阐明装置尺寸修改对结果的影响。
