Chung-Jung Lin MD, PhD, Abstract Co-Author: Research Grant, Siemens AG

Wan-Yuo Guo MD, PhD, Presenter: Research Grant, Siemens AG

Yi-Yang Lin MD, Abstract Co-Author: Nothing to Disclose

Feng-Chi Chang, Abstract Co-Author: Nothing to Disclose

Sheng-Che Hung MD, Abstract Co-Author: Nothing to Disclose

Markus Kowarschik PhD, Abstract Co-Author: Employee, Siemens AG

Janina Beilner MD, Abstract Co-Author: Employee, Siemens AG

Cheng-Yen Chang MD, Abstract Co-Author: Nothing to Disclose

   Cerebral circulation time provides instantaneous intravascular flow measurement from the time density curve (TDC) in digital subtraction angiography (DSA) series and accurately predicts flow changes in stenotic occlusive vessels. The purpose of our study was to compare the effectiveness of three major TDC variables for detecting flow changes in stenotic patients: relative time to maximum concentration (rTmax), maximum slope (MS), and area under curve (AUC).

 Seventy cases of unilateral carotid stenosis (group A) and 56 normal controls (group B) were retrospectively enrolled. Fixed contrast injection protocols and acquisition parameters were used in all angiographic series. The middle cerebral artery (M1), sigmoid sinus (SS), and internal jugular vein (JV) in the AP (anterior-posterior) view, and second branch of the middle cerebral artery (M2), parietal vein, and superior sagittal sinus (SSS) in the lateral view were chosen. rTmax, MS, and AUC of the TDC in individual ROIs were compared between the two groups using a DSA analyzer prototype.

rTmax in M1, SS, JV, M2, PV and SSS were significantly prolonged in group A compared to group B. Among all AUCs, only the AUC in SSS was significantly larger in group A than in group B. For the MSs, M1, M2, and SS showed significant decreases in group A compared to group B. The AUC for the SSS demonstrated the best single diagnostic performance at the optimal cutoff value of 536 with sensitivity 71% and specificity 64.5%.

Only the MSs for M1, M2, and the AUC for the SSS showed equivalent diagnostic performance with rTmax in differentiating carotid stenosis. rTmax thus remains the preferred measurement for all ROIs in routine DSAs.

Using rTmax alone in different ROIs provides sufficient, rapid in-room assessment of intravascular hemodynamic and thus improves patient safety in endovascular treatments.

Lin, C, Guo, W, Lin, Y, Chang, F, Hung, S, Kowarschik, M, Beilner, J, Chang, C, Finding the Optimal Parameter for the DSA Time Density Curve When Evaluating Flow Changes in Patients with Carotid Stenosis.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14012973.html