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CCC (Circular Color Coding) versus Parametric Color Imaging:Which one wins for shunt point detectability in dural arteriovenous fistulae?

Tetsu Satow1, Satoru Oishi2, Masanobu Yamada3, Hiromichi Yokoyama3, and Jun C Takahashi11Department of Neurosurgery, National Cerebral and Cardiovascular Center, Osaka, JAPAN2Research and Development Center, Toshiba Medical Systems Corporation, Tochigi, JAPAN1Department of Radiology, National Cerebral and Cardiovascular Center, Osaka, JAPANASNR 2015 annual meeting April 27, 2015@Chicago

Poster ID: EP-107-2467Control #: 1712Financial DisclosuresSatoru Oishi is an employee of Toshiba Medical Systems Corporation.Other authors have no financial or other relations that could lead to conflicts of interest. 2Introduction In treating dural AVFs, the therapeutic goal is to occlude the dural vein close to the shunt point, whether by TAE or TVE. Thus, the detection of the shunt point is crucial in executing intervention. And we have presented a novel angiographic tool named CCC (circular color coding) which is a sequential, color-coded angiograms in preceding ASNR meeting (EP-54).

CCC(Circular Color Coding)

PurposeTo prove that CCC is more useful in detecting shunts of dural arteriovenous fistulae (dAVF) compared with parametric color coding images (time-to-peak: TTP)1)2). Strother et al. AJNR 2010Goelitz et al. Clin Neuroradiol 2013CCC vs DSA/TTP

CCCDSATTP (still image)Click the image to Activate the movieClick the image to Activate the movieMaterials and Methods (1)A total of 19 DSA acquisitions from dAVFs (cavernous sinus: 4, transverse-sigmoid: 13, superior sagittal sinus : 2) were used.

DSA, TTP images, and CCC were prepared.

8 physicians (4 experienced, certified neuroendovascular therapists: NET, and 4 younger neurosurgeons) were selected as readers.

They were divided into two groups (A and B) so as to include two experienced and younger physicians.7Materials and Methods (2)For group A, DSA sequence and TTP image were initially presented, and the observer was asked to answer the location(s) of shunt point and patterns of venous drainage. After viewing all 19 sets, CCC sequence of each case was presented in a randomized order, and the observer was asked again as to the shunt location and venous drainage.For group B, the same questionnaire were performed although they were initially exposed to CCC, followed by DSA/TTP combination.

The time to detection for each case was also recorded.8Group A2 experienced NET2 young neurosurgeons CCCShunt point detectionPatterns of venous drainageTime to detectionGroup B2 experienced NET2 young neurosurgeons DSA/TTPCCCDSA/TTPFlowchart of the studyOverall Results (19 cases@8 readers=152)AccuracyDSA+TTPCCC2detecting all the shunts521241detecting some of the shunts73250none detected273Shunt detectionAccuracyDSA+TTPCCC2detecting all drainage routes1191441detecting some of the routes3080none detected30Recognition of venous drainage patternsP