Forbrig Robert, Ozpeynirci Yigit, Grasser Matthias, Dorn Franziska, Liebig Thomas, Trumm Christoph G
Institute of Neuroradiology, University Hospital, LMU Munich, Marchioninistrasse 15, 81377, Munich, Germany.
Siemens Healthineers, Forchheim, Germany.
Eur Radiol. 2020 Aug;30(8):4504-4513. doi: 10.1007/s00330-020-06777-x. Epub 2020 Mar 19.
Modern endovascular treatment of unruptured intracranial aneurysms (UIAs) demands for observance of diagnostic reference levels (DRLs). The national DRL (250 Gy cm) is only defined for coiling. We provide dosimetric data for the following procedures: coiling, flow diverter (FD), Woven EndoBridge (WEB), combined techniques.
A retrospective single-centre study of saccular UIAs treated between 2015 and 2019. Regarding dosimetric analysis, the parameters dose area product (DAP) and fluoroscopy time were investigated for the following variables: endovascular technique, aneurysm location, DSA protocol, aneurysm size, and patient age.
Eighty-seven patients (59 females, mean age 54 years) were included. Total mean and median DAP (Gy cm) were 119 ± 73 (89-149) and 94 (73; 130) for coiling, 128 ± 53 (106-151) and 134 (80; 176) for FD, 128 ± 56 (102-153) and 118 (90; 176) for WEB, and 165 ± 102 (110-219) and 131 (98; 209) for combined techniques (p > .05). Regarding the aneurysm location, neither DAP nor fluoroscopy time was significantly different (p > .05). The lowest and highest fluoroscopy times were recorded for WEB and combined techniques, respectively (median 26 and 94 min; p < .001). A low-dose protocol yielded a 43% reduction of DAP (p < .001). Significantly positive correlations were found between DAP and both aneurysm size (r = .320, p = .003) and patient age (r = .214, p = .046).
This UIA study establishes novel local DRLs for modern endovascular techniques such as FD and WEB. A low-dose protocol yielded a significant reduction of radiation dose.
• This paper establishes local diagnostic reference levels for modern endovascular treatment techniques of unruptured intracranial aneurysms, including flow diverter stenting and Woven EndoBridge device. • Dose area product was not significantly different between endovascular techniques and aneurysm locations, but associated with aneurysm size and patient age. • A low-dose protocol yielded a significant reduction of dose area product and is particularly useful when applying materials with a high radiopacity (e.g. platinum coils).
颅内未破裂动脉瘤（UIA）的现代血管内治疗需要遵守诊断参考水平（DRL）。国家DRL（250 Gy cm）仅针对弹簧圈栓塞术定义。我们提供以下手术的剂量学数据：弹簧圈栓塞术、血流导向装置（FD）、编织型血管内桥接器（WEB）、联合技术。
对2015年至2019年间治疗的囊状UIA进行回顾性单中心研究。关于剂量学分析，研究了以下变量的剂量面积乘积（DAP）和透视时间参数：血管内技术、动脉瘤位置、数字减影血管造影（DSA）方案、动脉瘤大小和患者年龄。
纳入87例患者（59例女性，平均年龄54岁）。弹簧圈栓塞术的总平均和中位数DAP（Gy cm）分别为119±73（89 - 149）和94（73；130），FD为128±53（106 - 151）和134（80；176），WEB为128±56（102 - 153）和118（90；176），联合技术为165±102（110 - 219）和131（98；209）（p＞0.05）。关于动脉瘤位置，DAP和透视时间均无显著差异（p＞0.05）。WEB和联合技术的透视时间分别为最低和最高（中位数26和94分钟；p＜0.001）。低剂量方案使DAP降低了43%（p＜0.001）。发现DAP与动脉瘤大小（r = 0.320，p = 0.003）和患者年龄（r = 0.214，p = 0.046）均呈显著正相关。
这项UIA研究为FD和WEB等现代血管内技术建立了新的局部DRL。低剂量方案显著降低了辐射剂量。
• 本文为颅内未破裂动脉瘤的现代血管内治疗技术建立了局部诊断参考水平，包括血流导向支架置入术和编织型血管内桥接器装置。• 血管内技术和动脉瘤位置之间的剂量面积乘积无显著差异，但与动脉瘤大小和患者年龄相关。• 低剂量方案显著降低了剂量面积乘积，在应用高射线不透性材料（如铂弹簧圈）时尤其有用。
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