Schmitt Niclas, Berting Andreas, Herweh Christian, Hilgenfeld Tim, Preisner Fabian, Wucherpfennig Lena, Bendszus Martin, Vollherbst Dominik F, Möhlenbruch Markus A
Invest Radiol. 2025 Sep 4. doi: 10.1097/RLI.0000000000001235.
Cerebral angiography remains the gold standard for the diagnosis and endovascular management of cerebral aneurysms. Three-dimensional rotational angiography (3D-RA) provides superior anatomic resolution compared with conventional 2D imaging; however, it is associated with relatively high radiation exposure, raising specific concerns regarding the ocular lens dose. This study aims to evaluate the potential of copper (Cu) filtration for reducing radiation dose in 3D-RA.
Forty subsequent patients undergoing endovascular treatment of unruptured cerebral aneurysms were included. All received 3D-RA using the ARTIS icono angiography system (Siemens Healthineers). In 20 patients, standard hardware with a 0.8 mm aluminum (Al) filter was applied; in the subsequent 20 patients, the Al filter was replaced by a 0.1 mm Cu filter. Image quality was assessed quantitatively through contrast-to-noise ratio (CNR) and qualitatively using a 5-point scale.
There were no differences in image quality between the two groups in the 3D neurovascular native/contrast images, both quantitatively (eg, mean CNR ± SD, Al: 20.72 ± 1.82 vs Cu: 20.66 ± 1.54; P = 0.93) and qualitatively (mean score ± SD, Al: 4.55 ± 0.54 vs Cu: 4.63 ± 0.46; P = 0.75), with excellent image quality achieved in both groups. Total radiation dose was lower with the Cu filter (e.g., mGy ± SD, Al: 110.63 ± 10.75 vs Cu: 68.70 ± 6.03; Gy·cm2 ± SD, Al: 6.26 ± 1.57 vs 3.35 ± 0.67, P < 0.001 respectively), corresponding to a dose reduction of 38% (entrance-skin dose) and 46% (dose-area product).
The use of a copper filter in cerebral 3D-RA substantially reduces radiation dose without compromising diagnostic quality, representing a practical advancement in patient safety in 3D-RA. The method integrates seamlessly into existing protocols and can be readily implemented in clinical practice.
脑血管造影术仍是脑动脉瘤诊断和血管内治疗的金标准。与传统二维成像相比，三维旋转血管造影（3D-RA）提供了更高的解剖分辨率；然而，它与相对较高的辐射暴露相关，引发了对晶状体剂量的特殊关注。本研究旨在评估铜（Cu）过滤在降低3D-RA辐射剂量方面的潜力。
纳入40例连续接受未破裂脑动脉瘤血管内治疗的患者。所有患者均使用ARTIS icono血管造影系统（西门子医疗）进行3D-RA检查。20例患者应用带有0.8毫米铝（Al）过滤器的标准硬件；在随后的20例患者中，Al过滤器被0.1毫米Cu过滤器取代。通过对比噪声比（CNR）定量评估图像质量，并使用5分制进行定性评估。
在3D神经血管原始/造影图像中，两组的图像质量在定量（例如，平均CNR±标准差，Al：20.72±1.82 vs Cu：20.66±1.54；P = 0.93）和定性（平均评分±标准差，Al：4.55±0.54 vs Cu：4.63±0.46；P = 0.75）方面均无差异，两组均获得了优异的图像质量。Cu过滤器的总辐射剂量较低（例如，mGy±标准差，Al：110.63±10.75 vs Cu：68.70±6.03；Gy·cm2±标准差，Al：6.26±1.57 vs 3.35±0.67，P分别<0.001），对应入口皮肤剂量降低38%，剂量面积乘积降低46%。
在脑部3D-RA中使用铜过滤器可大幅降低辐射剂量，且不影响诊断质量，这代表了3D-RA在患者安全方面的一项实际进展。该方法可无缝整合到现有方案中，并可在临床实践中轻松实施。
