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

S Lang; P Gölitz; T Struffert; J Rösch; K Rössler; M Kowarschik; C Strother; A Doerfler

doi:10.3174/ajnr.A5161

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

AJNR Am J Neuroradiol. 2017 Jun;38(6):1169-1176. doi: 10.3174/ajnr.A5161. Epub 2017 Apr 13.

Authors

S Lang¹, P Gölitz², T Struffert², J Rösch², K Rössler³, M Kowarschik⁴, C Strother⁵, A Doerfler²

Affiliations

¹ From the Departments of Neuroradiology (S.L., P.G., T.S., J.R., A.D.) [email protected].
² From the Departments of Neuroradiology (S.L., P.G., T.S., J.R., A.D.).
³ Neurosurgery (K.R.), University of Erlangen-Nuremberg, Erlangen, Germany.
⁴ Angiography & Interventional X-Ray Systems (M.K.), Siemens Healthcare GmbH, Forchheim, Germany.
⁵ Department of Radiology (C.S.), University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin.

Abstract

Background and purpose: 4D DSA allows acquisition of time-resolved 3D reconstructions of cerebral vessels by using C-arm conebeam CT systems. The aim of our study was to evaluate this new method by qualitative and quantitative means.

Materials and methods: 2D and 4D DSA datasets were acquired in patients presenting with AVMs, dural arteriovenous fistulas, and cerebral aneurysms. 4D DSA was compared with 2D DSA in a consensus reading of qualitative and quantitative parameters of AVMs (eg, location, feeder, associated aneurysms, nidus size, drainage, Martin-Spetzler Score), dural arteriovenous fistulas (eg, fistulous point, main feeder, diameter of the main feeder, drainage), and cerebral aneurysms (location, neck configuration, aneurysmal size). Identifiability of perforators and diameters of the injection vessel (ICA, vertebral artery) were analyzed in 2D and 4D DSA. Correlation coefficients and a paired t test were calculated for quantitative parameters. The effective patient dose of the 4D DSA protocol was evaluated with an anthropomorphic phantom.

Results: In 26 patients, datasets were acquired successfully (AVM = 10, cerebral aneurysm = 10, dural arteriovenous fistula = 6). Qualitative and quantitative evaluations of 4D DSA in AVMs (nidus size: r = 0.99, P = .001), dural arteriovenous fistulas (diameter of the main feeder: r = 0.954, P = .03), and cerebral aneurysms (aneurysmal size: r = 1, P = .001) revealed nearly complete accordance with 2D DSA. Perforators were comparably visualized with 4D DSA. Measurement of the diameter of the injection vessel in 4D DSA was equivalent to that in 2D DSA (P = .039). The effective patient dose of 4D DSA was 1.2 mSv.

Conclusions: 4D DSA is feasible for imaging of AVMs, dural arteriovenous fistulas, and cerebral aneurysms. 4D DSA offers reliable visualization of the cerebral vasculature and may improve the understanding and treatment of AVMs and dural arteriovenous fistulas. The number of 2D DSA acquisitions required for an examination may be reduced through 4D DSA.

MeSH terms

Adult
Angiography, Digital Subtraction / methods*
Brain / diagnostic imaging*
Central Nervous System Vascular Malformations / diagnostic imaging*
Female
Humans
Intracranial Aneurysm / diagnostic imaging*
Intracranial Arteriovenous Malformations / diagnostic imaging*
Male
Middle Aged
Neuroimaging / methods*

Grants and funding

R01 HL116567/HL/NHLBI NIH HHS/United States