Increase in fluoroscopic radiation dose in successive sessions of multistage Onyx embolization of brain arteriovenous malformations compared with the first session
Increase in fluoroscopic radiation dose in successive sessions of multistage Onyx embolization of brain arteriovenous malformations compared with the first session
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DOI：
10.1136/neurintsurg-2017-013706
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发表时间：
2018-12-01
影响因子：
4.8
通讯作者：
Lee, Deok Hee
中科院分区：
文献类型：
--
作者：
Sheen, Jae Jon;Jiang, Yuan Yuan;Lee, Deok Hee
背景与目的玛瑙栓塞术是治疗脑动静脉畸形（AVMs）的一种方法。然而，多阶段栓塞通常涉及前几次放射致密的玛瑙铸型，这可能会影响透视辐射剂量。我们比较了初始和最终栓塞期间的透视剂量。材料与方法2014年1月至2016年9月，对18例脑动静脉畸形患者进行了2次以上的多期Onyx栓塞治疗。获得了总透视时间（分钟）、剂量面积积（DAP, Gyxcm(2)）和正侧面累积风量（CAK, mGy）。我们比较了最后一次栓塞与初次栓塞的正面和侧面透视剂量率（剂量/时间）。测定了注射的玛瑙体积与辐射剂量的关系。结果初、末术式在额平面上的透视剂量率差异有统计学意义(初始剂量率为0.668 Gyxcm(2)/min，末术式为0.848 Gyxcm(2)/min， P=0.02；CAK：初始12.7 mGy/min，最终23.1 mGy/min， P=0.007)。侧位的DAP初始值为0.365 Gyxcm(2)/min，最终值为0.519 Gyxcm(2)/min， P=0.03；CAK：初始6.2 mGy/min，最终12.9 mGy/min， P=0.01)。两平面累积Onyx体积（瓶）与辐射剂量比的相关性均呈增加趋势（rho 0.4325 ~ 0.7053； P=0.0011 ~ 0.0730）。结论由于x线透视时的自动暴露控制功能，在多阶段脑AVM栓塞术中，由于存在放射性致密的玛瑙块，连续的玛瑙栓塞手术增加了x线照射剂量。
Background and purpose Onyx embolization is a treatment for brain arteriovenous malformations (AVMs). However, multistage embolization usually involves the presence of radiodense Onyx cast from the previous sessions, which may influence the fluoroscopic radiation dose. We compared the fluoroscopic dose between the initial and final embolization sessions. Materials and method From January 2014 to September 2016, 18 patients underwent multistage Onyx embolization (more than twice) for brain AVMs. The total fluoroscopic duration (minutes), dose-area product (DAP, Gyxcm(2)), and cumulative air kerma (CAK, mGy) of both the frontal and lateral planes were obtained. We compared the frontal and lateral fluoroscopic dose rates (dose/time) of the final embolization session with those of the initial session. The relationship between the injected Onyx volume and radiation dose was tested. Results The initial and final procedures on the frontal plane showed significantly different fluoroscopic dose rates (DAP: initial 0.668 Gyxcm(2)/min, final 0.848 Gyxcm(2)/min, P=0.02; CAK: initial 12.7 mGy/min, final 23.1 mGy/min, P=0.007). Those on the lateral plane also showed a similar pattern (DAP: initial 0.365 Gyxcm(2)/min, final 0.519 Gyxcm(2)/min, P=0.03; CAK: initial 6.2 mGy/min, final 12.9 mGy/min, P=0.01). The correlation between the cumulative Onyx volume (vials) and radiation dose ratio of both planes showed an increasing trend (rho 0.4325-0.7053; P=0.0011-0.0730). Conclusion Owing to the automatic exposure control function during fluoroscopy, successive Onyx embolization procedures increase the fluoroscopic radiation dose in multistage brain AVM embolization because of the presence of radiodense Onyx mass.