J Cerebrovasc Endovasc Neurosurg.  2013 Jun;15(2):76-84. 10.7461/jcen.2013.15.2.76.

Quantitative Analysis of Intraoperative Indocyanine Green Video Angiography in Aneurysm Surgery

• Son YJ
• Kim JE
• Park SB
• Lee SH
• Chung YS
• Yang HJ

• KMID: 1980433
• DOI: http://doi.org/10.7461/jcen.2013.15.2.76

Abstract

OBJECTIVE
Indocyanine green (ICG) videoangiography (VA) is being used in assessment of blood flow during cerebrovascular surgery. However, data collected during ICG angiography are usually interpreted qualitatively. In this study, quantitative analysis of ICG angiogram was attempted.
MATERIALS AND METHODS
ICG VA, performed during aneurysm surgery was analyzed retrospectively. The angiogram was captured serially in regular time interval. The stacked images were then fed into an image analysis program, ImageJ. The selected areas of interest were as follows: parent and branch vessels, and dome of aneurysm. Changes of signals of measurement points were plotted. The time to peak, washout time, and the peak intensity between areas were compared.
RESULTS
Among the 16 cases enrolled in this study, five cases were anterior communicating artery aneurysms, and 11 cases were middle cerebral artery bifurcation aneurysms. There was no signal intensity of aneurysm dome in our series. No difference in time to peak or maximum signal intensity was observed between vessels in each case. The average time to peak was 9.0 and washout time was 31.3 seconds. No significant difference in time profile was observed between anterior communicating artery aneurysms and middle cerebral artery bifurcation aneurysms.
CONCLUSION
Findings of this study demonstrate that quantitative analysis is possible using a personal computer and common video capture and analysis software. It can be a good adjunctive to evaluation of vascular status during aneurysm surgery. It displays time profiles of multiple points of interest over time, and is helpful in objective evaluation of changes of blood flow over time. It might be helpful in various fields of cerebrovascular surgery.

Keyword

Indocyanine green video angiography; Aneurysm; Quantitative analysis; ImageJ

MeSH Terms

Aneurysm
Angiography
Humans
Indocyanine Green
Intracranial Aneurysm
Microcomputers
Middle Cerebral Artery
Parents
Retrospective Studies
Indocyanine Green

Figure

• 

  Fig. 1 Comparison of graph details according to sampling interval. A, D are made in 0.1 seconds; B, E in 0.2 seconds; C, F in 0.4 seconds. The waves in the lower row (D, E, and F) are five times magnified view of a part of waves, shaded area, in the upper row (A, B, and C). It is notable that there is some loss of detail in the 0.4 second interval compared to 0.1 and 0.2 second intervals (F). The horizontal bar in A, B, and C is 10 seconds, in D, E, and F is 2 seconds.

• 

  Fig. 2 Example of good data quality (A, B, and C) and of poor quality (D, E, and F). A and D are photographs of operative fields, B and E are averaged images of serial captures of indocyanine green (ICG) videoangiography (VA), C and F are graphs. There is no blurring of contours of structures in B (1: M2 inferior division, 2: M2 superior division, arrow: aneurysm) whereas E shows blurring due to panning of the field during recording (M1: middle cerebral artery main trunk proximal to bifurcation, M2S: superior division of M2, Arrowhead: inferior division of M2, arrow: aneurysm). C (M2I: inferior division of M2, M2S: superior division of M2, An: aneurysm) shows good waveforms, compared to waves in F (M1: middle cerebral artery main trunk proximal to bifurcation, M2S: superior division of M2, M2I: inferior division of M2, An: aneurysm).

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  Fig. 3 Time profile of wave. 1: time to peak, 2: washout time. Arrowhead marks the point of transition of the curve. In this case, time to peak is 24.0 seconds, washout time 44.0.

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  Fig. 4 A case of an anterior communicating artery aneurysm. A is a photograph of the operative field. B to F are graphs of measurement depicted in A. B is a graph of point 1 (A1); C, point 2 (ipsilateral A1); E, point 3 (contralateral A2); F, point 4 (aneurysm). D is combined graphs B, C, E, and F. There is no difference in time profile between vessels, whereas no definite signal intensity at the aneurysm.

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