Abstract
Novel 320-section CT scanning equipment enables dynamic noninvasive angiographic imaging of the entire cranial vasculature (4D-CTA). We describe this technique and demonstrate its potential in arteriovenous shunting lesions. 4D-CTA imaging resulted in a correct diagnosis, lesion classification, and treatment-strategy selection in 3 patients, compared with CA. We think that 4D-CTA can further reduce the need for CA, sparing the patient the discomfort and risk associated with an invasive procedure.
Highlights
ABBREVIATIONS: AVM ϭ arteriovenous malformation; CTA ϭ CT angiography; CA ϭ conventional angiography; DAVF ϭ dural arteriovenous fistula; MIP ϭ maximum intensity projection; MRA ϭ MR angiography; VR ϭ volume-rendering
We describe 4D-CTA, adding temporal resolution as the fourth dimension
The cases demonstrate the potential of 4D-CTA to follow a benign DAVF, recognize cortical venous reflux, and visualize a small AVM with equivocal planar imaging findings
Summary
4D-CTA All 4D-CTA examinations were performed by using the Aquilion ONE (Toshiba Medical Systems, Tokyo, Japan), equipped with 320 detector rows, each 0.5 mm in width, covering 16 cm of volume per rotation. The first acquisition in this sequence consisted of a single rotation (80 kVp, 300 mAs) to generate a noncontrast scan, because the contrast medium had not yet arrived in the area of interest. This would be used as a mask for all subsequent volumes (80 kVp, 120mAs), which allowed visualization of the passage of contrast through the vascular bed. CA Diagnostic intra-arterial digital subtraction angiography was performed by using standard biplanar fluoroscopy equipment (Toshiba Medical System; or GE Healthcare, Little Chalfont, Buckinghamshire, UK).
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