Radiation Exposure During Cerebral Angiography and Embolization in Children

Keywords: angiography, children, embolization, radiation, outcome

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     Catheter-based cerebral angiography and embolization are important tools in the management of cerebrovascular diseases in the pediatric population.
     Radiation exposure during neurointerventional procedures in children is unclear.
     Of the 379 consecutive procedures performed from 2007-2010, 214 were diagnostic angiograms and 165 involved embolization. Mean age was 9.5 years (range: 4 days – 18 years), and 193 were female. The interventional procedures included intracranial (66), extracranial (90), and spinal (9) embolizations.
     Records for all pediatric patients who underwent cerebral angiography and/or embolization from 2007-2010 were retrospectively reviewed. Radiation dose data were obtained from fluoroscopic suites equipped with built-in cumulative dose (air kerma) and dose-area-product (DAP) measurement capability.
     The pathology that required neurointervention included intracranial arteriovenous malformation (AVM, 15), spinal AVM (8), aneurysms (15), Vein of Galen Malformation (VOGM, 19), dural arteriovenous fistula (dAVF, 21), facial and extracranial AVM (68), tumor (11), stroke (2), and others (6). Overall, the observed cumulative dose and DAP correlated well (r=0.87). The average cumulative dose for the cohort was 365.9 mGy (range: 21 – 2707 mGy). Radiation exposure during neurointervention was significantly higher than diagnostic angiography (566.3 and 191.0 mGy, respectively, p<0.001). Patients with spinal AVM (939.8 mGy), aneurysms (777.5 mGy), and dAVF (730.5 mGy) received higher amount of radiation. During the mean follow-up period of 2.1 years, one short-term complication (transient hair loss) related to radiation was noted.
     This is a retrospective study.
     The amount of radiation exposure during cerebral angiography and embolization was modest for the pediatric population, and the risk associated with radiation was low.
     The long-term effect of radiation exposure has yet to be determined.


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