Four-dimensional computed tomography angiography analysis of internal carotid arteries opacification at the skull base t
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ORIGINAL ARTICLE
Four-dimensional computed tomography angiography analysis of internal carotid arteries opacification at the skull base to detect delayed cerebral ischemia: a feasibility study Julien Ognard1,2,7 · Mourad Cheddad El Aouni1,3 · Brieg Dissaux1,3 · Raphel Jomaah4 · Pierre-Yves Rousseau5 · Valerie Burdin2,6 · Douraied Ben Salem1,2 · Jean-Christophe Gentric1,3 Received: 29 April 2020 / Accepted: 22 September 2020 © CARS 2020
Abstract Purpose Delayed cerebral ischemia represents a significant cause of poor functional outcome for patients with vasospasm after subarachnoid hemorrhage. We investigated whether delayed cerebral ischemia could be detected by the arterial opacification of internal carotid artery at the level of the skull base. Methods In this exploratory, nested retrospective cohort diagnostic accuracy study, patients with clinical and/or transcranial Doppler suspicion of vasospasm who underwent four-dimensional computed tomography angiography were included. They were split into two groups for the main endpoint analysis, according to the actually adopted morphological (cerebral infarction) and clinical criteria (neurologic deterioration) of delayed cerebral ischemia. Opacification with a temporal resolution of 0.15 s of both internal carotid arteries at the skull base level was obtained through a semi-automated segmentation method based on skeletonization, and analyzed by a wavelet transform (rbio2.2, level 1). The results obtained by k-means clustering were analyzed with regard to the state of delayed cerebral infarction. Results Over ten patients included and analyzed, five patients presented a delayed cerebral ischemia, two of them in both side. The semi-automated processing and analysis clustered two different types of opacification curves. The obtaining of a nonlinear opacification pattern was associated (p < 0.001) with delayed cerebral ischemia. Conclusions The analysis of arterial opacification of internal carotid arteries at skull base by the proposed processing is feasible and leads to cluster two types of opacification that may help to early detect and prevent delayed cerebral ischemia, in particularly when examinations are artifacted by aneurysm treatment materials. Keywords Delayed cerebral ischemia · Wavelet transform · 4D-CTA · Vasospasm · k-means clustering · Sensitivity and specificity
Introduction
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Julien Ognard [email protected]
1
Neuroradiology Unit, Department of Radiology, University Hospital of Brest, Brest, France
2
Laboratory of medical information processing—LaTIM INSERM UMR 1101, Brest, France
3
Western Brittany Thrombosis Study Group GETBO EA3878, Brest, France
4
Faculty of Arts and Science, University of Toronto, Toronto, Canada
5
Neurology Unit, University Hospital of Brest, Brest, France
6
Institut Mines Telecom Atlantique, Plouzané, France
Cerebral vasospasm is defined as a reduction of the lumen of a conducting artery in the subarachnoid space. About sixty percent of patients present angiographic vasospasm after an aneurysm-related sub
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