3D Image Fusion to Localise Intercostal Arteries During TEVAR

Abstract

PurposePreservation of intercostal arteries during thoracic aortic procedures reduces the risk of post-operative paraparesis. The origins of the intercostal arteries are visible on pre-operative computed tomography angiography (CTA), but rarely on intra-operative angiography. The purpose of this report is to suggest an image fusion technique for intra-operative localisation of the intercostal arteries during thoracic endovascular repair (TEVAR).TechniqueThe ostia of the intercostal arteries are identified and manually marked with rings on the pre-operative CTA. The optimal distal landing site in the descending aorta is determined and marked, allowing enough length for an adequate seal and attachment without covering more intercostal arteries than necessary. After 3D/3D fusion of the pre-operative CTA with an intra-operative cone-beam CT (CBCT), the markings are overlaid on the live fluoroscopy screen for guidance. The accuracy of the overlay is confirmed with digital subtraction angiography (DSA) and the overlay is adjusted when needed. Stent graft deployment is guided by the markings. The initial experience of this technique in seven patients is presented.Results3D image fusion was feasible in all cases. Follow-up CTA after 1 month revealed that all intercostal arteries planned for preservation, were patent. None of the patients developed signs of spinal cord ischaemia.Conclusion3D image fusion can be used to localise the intercostal arteries during TEVAR. This may preserve some intercostal arteries and reduce the risk of post-operative spinal cord ischaemia.

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Intercostal artery incorporation to prevent spinal cord ischemia during total endovascular thoracoabdominal aortic repair

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Elevated 18F-NaF uptake in cricoid cartilage in a patient with laryngeal carcinoma

“…Our case illustrates that there is a high uptake of 18 F-FDG in the region near the bone, which is uncertain whether there is any skeletal invasion, so 18 F-NaF PET/CT is critical for the diagnosis of skeletal invasion and 3D PET-CT images are helpful in locating invasion lesions and observing the scope of invasion visually at complex anatomic sites, resulting in further appropriate management [ 11 , 12 ] and that 18 F-NaF PET-CT and 3D PET-CT fusion may be useful to detect occult lesions, such as bone metastases, which have no bone changes. Therefore, 18 F-NaF PET-CT and 3D PET-CT fusion should be kept in mind for differential diagnosis of skeletal invasion.…”