Single-center experience of using high definition (Hi-Def) imaging during neurointervention treatment of intracranial aneurysms using flow diverters

Background A new dual resolution imaging X-ray detector system (Canon Medical Systems Corporation, Tochigi, Japan) has a standard resolution 194 μm pixel conventional flat-panel detector (FPD) mode and a high-resolution 76 μm high-definition (Hi-Def) mode in a single unit. The Hi-Def mode enhances the visualization of the intravascular devices. Objective We report the clinical experience and physician evaluation of this new detector system with Hi-Def mode for the treatment of intracranial aneurysms using a Pipeline embolization device (PED). Methods During intervention at our institute, under large field of view (FOV) regular resolution FPD mode imaging, the catheter systems and devices were first guided to the proximity of the treatment area. Final placement and deployment of the PED was performed under Hi-Def mode guidance. A post-procedure 9-question physician survey was conducted to qualitatively assess the impact of Hi-Def mode visualization on physicians' intraoperative decision-making. One-sample t-test was performed on the responses from the survey. Dose values reported by the X-ray unit were also recorded. Results Twenty-five cases were included in our study. The survey results indicated that, for each of the nine questions, the physicians in all cases indicated that the Hi-Def mode improved visualization compared with the FPD mode. For the 25 cases, the mean cumulative entrance air kerma was 2.35 Gy, the mean dose area product (DAP) was 173.71 Gy.cm 2, and the mean X-ray exposure time was 39.30 min. Conclusions The Hi-Def mode improves visualization of flow diverters and may help in achieving more accurate placement and deployment of devices.