Benefit of Advanced 3D DSA and MRI/CT Fusion in Neurovascular Pathology

Abstract

Digital subtraction angiography provides excellent spatial and temporal resolution; however, it lacks the capability to depict the nonvascular anatomy of the brain and spinal cord.A review of the institutional database identified five patients in whom a new integrated fusion workflow of cross-sectional imaging and 3D rotational angiography (3DRA) provided important diagnostic information and assisted in treatment planning. These included two acutely ruptured brain arteriovenous malformations (AVM), a small superficial brainstem AVM after radiosurgery, a thalamic microaneurysm, and a spine AVM, and fusion was crucial for diagnosis and influenced further treatment.Fusion of 3DRA and cross-sectional imaging may help to gain a deeper understanding of neurovascular diseases. This is advantageous for planning and providing treatment and, most importantly, may harbor the potential to minimize complication rates. Integrating image fusion in the work-up of cerebrovascular diseases is likely to have a major impact on the neurovascular field in the future.

Most Promising Approaches to Improve Brain AVM Management: ARISE I Consensus Recommendations

“…Several distinct imaging modalities can be employed, each offering its unique set of advantages and disadvantages. [15][16][17][18][19][20][21][22][23][24][25][26][27][28][29] Typically, the initial step in the assessment of bAVMs involves noninvasive cross-sectional neuroimaging using computed tomography and magnetic resonance imaging (MRI). While plain computed tomography can reveal the presence of a bAVM, it is primarily reserved for evaluating bAVM-related brain hemorrhage and associated complications, such as intraventricular hemorrhage, mass effect, and hydrocephalus.…”

“…20,22,23 Image fusion of 3D-DSA, 4D-DSA, and MRI/ computed tomography has emerged as another promising imaging technique to enhance the understanding of the anatomic angioarchitectural features of the bAVM, its relationship to adjacent brain parenchyma, and other structures; thereby advancing our diagnostic capabilities (Figure 1). 18,28 Additionally, cone beam CTA is extremely valuable in delineating the target bAVM for stereotactic radiosurgery (Figure 2). 37 Although DSA is a gold standard diagnostic tool, it carries the risk of thromboembolic stroke, 38 exposes patients to radiation, 39 and is generally more time-consuming and costly compared with noninvasive imaging modalities.…”