Time-resolved 3D rotational angiography: display of detailed neurovascular anatomy in patients with intracranial vascular malformations

Abstract

Time-resolved 3DRA with 4D VRTs and MPRs is technically feasible and provides a detailed display of the angioarchitecture at the fistulous point or the nidus. Visualization of all angiographic features demands additional post-processing. Further standardization of evaluation tools and studies with blinded independent reviewers are necessary before the new technique can replace conventional neuroangiographic approaches.

4D DSA for Dynamic Visualization of Cerebral Vasculature: A Single-Center Experience in 26 Cases

“…In line with recent literature, qualitative parameters obtained from 4D DSA also demonstrated excellent agreement with 2D DSA in our series regarding image quality and arteriovenous visualization of the angioarchitecture of the pathology. Sandoval-Garcia et al 8 and Lescher et al 9 observed a superior visualization of intranidal structures and the fistulous point of a dAVF, respectively, with 4D DSA because time-resolved 3D imaging enables easy differentiation of arterial and venous structures. We fully agree with the hypothesis of Sandoval-Garcia et al that 4D DSA might simplify the understanding of complex vascular malformations and provides valuable support in risk assessment and therapeutic strategies.…”

“…Meanwhile, Sandoval-Garcia et al 7,8 have shown the clinical feasibility of 4D DSA both in a canine model and in patients, with promising results. Recently, the detailed analysis of dAVFs and AVMs with 4D DSA of Lescher et al 9 demonstrated a significantly improved visualization of a fistulous point of the dAVF or a nidus of the AVM by using 4D DSA; in many cases, 4D DSA even came close to superselective angiography.…”

Comparison of the Diagnostic Utility of 4D-DSA with Conventional 2D- and 3D-DSA in the Diagnosis of Cerebrovascular Abnormalities

“…While experience with this application is still limited, early evaluations have shown some advantages over conventional 3D DSA in evaluation of complex AVMs and AVFs. 9,10,11,12 In our experience and in previous reports, the 4D studies have been particularly helpful in assessment of the angioarchitecture of the nidus of AVMs and the location of the fistula connections in AVFs. 10 11.…”

Comment on “Aneurysms Associated with Brain Arteriovenous Malformations”

“…The review of Rammos et al 1 is lacking a discussion on advanced imaging tools that may help to demonstrate these aneurysms and further our understanding of their origin. Indeed, high-rate (6 frames per second or more) DSA acquisitions, 3D rotational angiography (RA), 4D-RA technology, 11 and ultraselective angiography, or even more recent algorithms used on 3D-RA such as segmentation algorithms 12 or anamorphosis algorithm, 13 may help to depict these aneurysms more accurately. Wall enhancement of the intranidal aneurysm on MR imaging has also been proposed as a radiologic feature that may help to confirm the bleeding site.…”