Practical Dose Parameter Values for the Prediction of the Adverse Effect of Neuro-interventional Radiation: Relationships between the Dose Parameters and Temporary Alopecia after Intracranial Coil Embolization

Abstract Objective To present values for the dose parameters predictive of alopecia as an adverse effect induced by neuroembolization using a biplane fluoroscopy. Methods This study included a total of 151 patients (52 men, mean age of 55.1 ± 12.2 years) treated for intracranial neuroembolization between 2014 to 2018 as following criteria: 1) obtainable dose report with digital subtraction angiographic image records, 2) no history of radiation exposure 6 months prior to the first procedure, and 3) and clinical follow-up performed through 12 months following the procedure. Patients were divided into two groups according to their presentation of alopecia during the follow-up period. Results Eighteen (11.9%) patients developed alopecia 10 to 30 days after the procedure (average, 18.5 ± 5.3 days). Sixteen (88.9%) patients in the alopecia group were affected by projection of the A-plane fluoroscopy. Area under the ROC analysis curves (AUC) of 0.865 ( p = 0.000) and 0.831( p = 0.000) were used to compute the optimal A-plane dose area product (DAP, 255.4 Gy-cm 2 ; sensitivity, 0.875; specificity, 0.805; Youden J = 0.682) and cumulative dose (CD, 4437.5 mGy; sensitivity, 0.750; specificity, 0.805; Youden J = 0.556) cuff-off values, respectively, capable of distinguishing patients with alopecia (n = 16) from subtotal patients (n = 149) Conclusions The DAP and the CD may be useful, intuitive factors for predicting the adverse effects of the neurointerventional radiation. Further multicenter research should be performed to confirm the efficacy and utility of the reference values of DAP and CD for preventing excessive irradiation during neurointerventional procedures.