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PT  - JOURNAL ARTICLE
AU  - Strother, C.M.
AU  - Bender, F.
AU  - Deuerling-Zheng, Y.
AU  - Royalty, K.
AU  - Pulfer, K.A.
AU  - Baumgart, J.
AU  - Zellerhoff, M.
AU  - Aagaard-Kienitz, B.
AU  - Niemann, D.B.
AU  - Lindstrom, M.L.
TI  - Parametric Color Coding of Digital Subtraction Angiography
AID  - 10.3174/ajnr.A2020
DP  - 2010 May 01
TA  - American Journal of Neuroradiology
PG  - 919--924
VI  - 31
IP  - 5
4099  - http://www.ajnr.org/content/31/5/919.short
4100  - http://www.ajnr.org/content/31/5/919.full
SO  - Am. J. Neuroradiol.2010 May 01; 31
AB  - BACKGROUND AND PURPOSE: Color has been shown to facilitate both visual search and recognition tasks. It was our purpose to examine the impact of a color-coding algorithm on the interpretation of 2D-DSA acquisitions by experienced and inexperienced observers. MATERIALS AND METHODS: Twenty-six 2D-DSA acquisitions obtained as part of routine clinical care from subjects with a variety of cerebrovascular disease processes were selected from an internal data base so as to include a variety of disease states (aneurysms, AVMs, fistulas, stenosis, occlusions, dissections, and tumors). Three experienced and 3 less experienced observers were each shown the acquisitions on a prerelease version of a commercially available double-monitor workstation (XWP, Siemens Healthcare). Acquisitions were presented first as a subtracted image series and then as a single composite color-coded image of the entire acquisition. Observers were then asked a series of questions designed to assess the value of the color-coded images for the following purposes: 1) to enhance their ability to make a diagnosis, 2) to have confidence in their diagnosis, 3) to plan a treatment, and 4) to judge the effect of a treatment. The results were analyzed by using 1-sample Wilcoxon tests. RESULTS: Color-coded images enhanced the ease of evaluating treatment success in &amp;gt;40% of cases (P &amp;lt; .0001). They also had a statistically significant impact on treatment planning, making planning easier in &amp;gt;20% of the cases (P = .0069). In &amp;gt;20% of the examples, color-coding made diagnosis and treatment planning easier for all readers (P &amp;lt; .0001). Color-coding also increased the confidence of diagnosis compared with the use of DSA alone (P = .056). The impact of this was greater for the naïve readers than for the expert readers. CONCLUSIONS: At no additional cost in x-ray dose or contrast medium, color-coding of DSA enhanced the conspicuity of findings on DSA images. It was particularly useful in situations in which there was a complex flow pattern and in evaluation of pre- and posttreatment acquisitions. Its full potential remains to be defined. APanteroposteriorAVFarteriovenous fistulaAVMarteriovenous malformationDSAdigital subtraction angiographyHSVhue, saturation, valueImaskpixel intensity in the mask frameImaxmaximal enhancementIpeakpeak pixel intensityTTPtime to peak