Initial evidence of a 50% reduction of contrast media using digital variance angiography in endovascular carotid interventions

Viktor I Óriás, Dávid Szöllősi, Marcell Gyánó, Dániel S Veres, Sándor Nardai, Csaba Csobay-Novák, Balázs Nemes, János P Kiss, Krisztián Szigeti, Szabolcs Osváth, Péter Sótonyi, Zoltán Ruzsa, Viktor I Óriás, Dávid Szöllősi, Marcell Gyánó, Dániel S Veres, Sándor Nardai, Csaba Csobay-Novák, Balázs Nemes, János P Kiss, Krisztián Szigeti, Szabolcs Osváth, Péter Sótonyi, Zoltán Ruzsa

Abstract

Purpose: In previous clinical studies Digital Variance Angiography (DVA) provided higher signal-to-noise ratio (SNR) and better image quality than Digital Subtraction Angiography (DSA). Our aim was to investigate whether this quality reserve of DVA provides an opportunity for the reduction of iodinated contrast media (ICM) in carotid X-ray angiography (CXA).

Method: Our prospective study enrolled 26 patients (67.0 ± 8.1 years) undergoing carotid percutaneous transluminal angioplasty. The SNR of DSA and DVA image pairs obtained by a standard (100 %, 6 mL ICM) or a low-dose (50 %, 3 mL ICM) protocol were compared. Visual evaluation of all images was performed by five specialists using a 5-grade rating scale. The quality of DSA100 and DVA50 videos was also compared.

Results: DVA provided more than two-fold SNR, the median SNRDVA/SNRDSA ratio was 2.06 (100 %) and 2.25 (50 %). In the visual evaluation, the DVA100 score (3.73 ± 0.06) was significantly higher than the DSA100 score (3.52 ± 0.07, Wilcoxon p < 0.001), and the DVA50 score (3.64 ± 0.13) was also significantly higher than the DSA50 score (3.01 ± 0.17, Wilcoxon p < 0.001). While the low-dose protocol significantly decreased the DSA score (Mann-Whitney p < 0.01, DSA100 vs DSA50), it had no effect on the DVA score (DVA100 vs DVA50). There was no statistical difference between the DSA100 and DVA50 scores. Evaluators preferred the diagnostic value of DVA50 to DSA100 videos in 61% of comparisons, the interrater agreement was 69 % (Fleiss' kappa 0.35, p < 0.001).

Conclusions: Our data show that DVA allows a substantial (50 %) ICM reduction in CXA without affecting the quality and diagnostic value of angiograms.

Keywords: Carotid artery disease; Digital subtraction angiography; Digital variance angiography; Dose management; Iodinated contrast media; Safety.

Conflict of interest statement

V.I.O., D.S and M.G. are part-time, J.P.K., K.S. and S.O. are full-time employees of Kinepict Health Ltd. K.S. and S.O. hold stocks of Kinepict Health Ltd, which is the manufacturer of the Kinepict Medical Imaging Tool. P.S. is a Scientific Advisor at Kinepict Health Ltd receiving no financial compensation for his work.

© 2020 The Authors.

Figures

Fig. 1
Fig. 1
Flowchart of the study. Solid lines represent institutional standard-of-care, while dashed lines represent study protocol. * Low-dose protocol was applied only in post-intervention angiography in 12 patients and 19 runs. No patient received more than 100 mL contrast media throughout the whole procedure. PTA: percutaneous transluminal angioplasty, PP: postprocessed, DSA: Digital Subtraction Angiography, DVA: Digital Variance Angiography, PACS: Picture Archiving and Communication System, SNR: Signal-to-Noise Ratio, nndo: number of ‘normal dose only patients’, nld: number of low dose patients.
Fig. 2
Fig. 2
Comparison of single-image evaluation scores. The box and whisker plot (upper panel) shows the median (line), the mean (x) and the interquartile range (box) of each group. Data were analysed by the Wilcoxon signed rank test (comparisons above the boxes) or by the Mann-Whitney U test (comparisons below the boxes), depending on the data structure (** p < 0.01, *** p < 0.001). Lower panel: Each point represents a repeated measurement obtained in the same position from the same patient using the normal and the low-dose protocol. The abscissa and the ordinate represent the mean of the DSA100 and DVA50 scores, respectively. The open circle shows the mean values of the 19 images. Abbreviations: DSA: Digital Subtraction Angiography; DVA: Digital Variance Angiography, n.s. not significant.
Fig. 3
Fig. 3
Comparison of representative images obtained with the standard (100 %, 6 mL ICM) and low-dose (50 %, 3 mL ICM) protocols. Images were taken of the same patient and same direction in two runs. All available image quality enhancement techniques (like PixelShift or noise filtering) were applied and brightness and contrast settings were equalized for all 4 images. Abbreviations: DSA: Digital Subtraction Angiography; DVA: Digital Variance Angiography.

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Source: PubMed

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