Saemann Attill, de Wilde Daniel, Rychen Jonathan, Roethlisberger Michel, Żelechowski Marek, Faludi Balázs, Cattin Philippe Claude, Psychogios Marios-Nikos, Soleman Jehuda, Guzman Raphael
Department of Neurosurgery, University Hospital of Basel, 4031 Basel, Switzerland.
Faculty of Medicine, University of Basel, 4056 Basel, Switzerland.
Brain Sci. 2024 Sep 26;14(10):968. doi: 10.3390/brainsci14100968.
BACKGROUND/OBJECTIVES: Detailed morphometric analysis of an aneurysm and the related vascular bifurcation are critical factors when determining rupture risk and planning treatment for unruptured intracranial aneurysms (UIAs). The standard visualization of digital subtraction angiography (DSA) and its 3D reconstruction on a 2D monitor provide precise measurements but are subject to variability based on the rater. Visualization using virtual (VR) and augmented reality platforms can overcome those limitations. It is, however, unclear whether accurate measurements of the aneurysm and adjacent arterial branches can be obtained on VR models. This study aimed to assess interrater reliability and compare measurements between 3D VR, standard 2D DSA, and 3D DSA reconstructions, evaluating the reliability and accuracy of 3D VR as a measurement tool.
A pool of five neurosurgeons performed three individual analyses on each of the ten UIA cases, measuring them in completely immersed 3D VR and the standard on-screen format (2D DSA and 3D reconstruction). This resulted in three independent measurements per modality for each case. Interrater reliability of measurements and morphology characterization, comparative differences, measurement duration, and VR user experience were assessed.
Interrater reliability for 3D VR measurements was significantly higher than for 3D DSA measurements (3D VR mean intraclass correlation coefficient [ICC]: 0.69 ± 0.22 vs. 3D DSA mean ICC: 0.36 ± 0.37, = 0.042). No significant difference was observed between 3D VR and 2D DSA (3D VR mean ICC: 0.69 ± 0.22 vs. 2D DSA mean ICC: 0.43 ± 0.31, = 0.12). A linear mixed-effects model showed no effect of 3D VR and 3D DSA (95% CI = -0.26-0.28, = 0.96) or 3D VR and 2D DSA (95% CI = -0.02-0.53, = 0.066) on absolute measurements of the aneurysm in the anteroposterior, mediolateral, and craniocaudal dimensions.
3D VR technology allows for reproducible, accurate, and reliable measurements comparable to measurements performed on a 2D screen. It may also potentially improve precision for measurements of non-planar aneurysm dimensions.
背景/目的：在确定未破裂颅内动脉瘤（UIA）的破裂风险和规划治疗方案时，对动脉瘤及其相关血管分叉进行详细的形态计量分析是关键因素。数字减影血管造影（DSA）的标准可视化及其在二维显示器上的三维重建可提供精确测量，但会因评估者而异。使用虚拟（VR）和增强现实平台进行可视化可以克服这些局限性。然而，目前尚不清楚在VR模型上能否获得动脉瘤及相邻动脉分支的准确测量值。本研究旨在评估评估者间的可靠性，并比较三维VR、标准二维DSA和三维DSA重建之间的测量结果，以评估三维VR作为测量工具的可靠性和准确性。
五名神经外科医生对十例UIA病例分别进行三次独立分析，在完全沉浸式三维VR和标准屏幕格式（二维DSA和三维重建）下进行测量。这导致每个病例每种模式有三次独立测量。评估测量的评估者间可靠性、形态特征、比较差异、测量持续时间和VR用户体验。
三维VR测量的评估者间可靠性显著高于三维DSA测量（三维VR组内相关系数[ICC]均值：0.69±0.22，而三维DSA均值ICC：0.36±0.37，P = 0.042）。三维VR和二维DSA之间未观察到显著差异（三维VR均值ICC：0.69±0.22，而二维DSA均值ICC：0.43±0.31，P = 0.12）。线性混合效应模型显示，三维VR和三维DSA（95%CI = -0.26 - 0.28，P = 0.96）或三维VR和二维DSA（95%CI = -0.02 - 0.53，P = 0.066）对动脉瘤前后径、内外径和头尾径的绝对测量值没有影响。
三维VR技术能够实现与二维屏幕测量相当的可重复、准确和可靠的测量。它还可能潜在地提高非平面动脉瘤尺寸测量的精度。
