Toward the Era of a One-Stop Imaging Service Using an Angiography Suite for Neurovascular Disorders

Abstract

Transportation of patients requiring multiple diagnostic and imaging-guided therapeutic modalities is unavoidable in current radiological practice. This clinical scenario causes time delays and increased risk in the management of stroke and other neurovascular emergencies. Since the emergence of flat-detector technology in imaging practice in recent decades, studies have proven that flat-detector X-ray angiography in conjunction with contrast medium injection and specialized reconstruction algorithms can provide not only high-quality and high-resolution CT-like images but also functional information. This improvement in imaging technology allows quantitative assessment of intracranial hemodynamics and, subsequently in the same imaging session, provides treatment guidance for patients with neurovascular disorders by using only a flat-detector angiographic suite—a so-called one-stop quantitative imaging service (OSIS). In this paper, we review the recent developments in the field of flat-detector imaging and share our experience of applying this technology in neurovascular disorders such as acute ischemic stroke, cerebral aneurysm, and stenoocclusive carotid diseases.

Radiation Doses of Cerebral Blood Volume Measurements Using C-Arm CT: A Phantom Study

“…In addition to PBV, in-room assessment of the ischemic core and thrombus condition was feasible, thus reducing the door-to-puncture time and improving recanalization rates. 10,32 Further reduction of the radiation dose is possible by lowering tube currents in CTP. 33 A similar strategy might be applied in PBV.…”

“…Due to the versatile applications, C-arm CT equipped with a flat detector has gained wide popularity in current imaging practice. [8][9][10] C-arm CT also allows functional imaging of parenchymal blood volume (PBV) with either intravenous or intra-arterial contrast injection. 11,12 It is highly correlated with CBV from CTP and has shown promising initial results in treating acute middle cerebral artery occlusions.…”

“…13 It can be used to access the extent of the ischemic core and detect hyperperfusion phenomena peritherapeutically in the angiography suite, facilitating endovascular therapy without the transfer of patients to the CT room. [10][11][12][13][14][15] In a recent study, Royalty et al 16 showed the feasibility of using C-arm CT to measure perfusion parameters in an animal model. Nevertheless, the combination of DSA and flat panel parenchymal blood volume raises concerns related to radiation exposure.…”

Application of Time-Resolved 3D Digital Subtraction Angiography to Plan Cerebral Arteriovenous Malformation Radiosurgery

“…The ability of 4D-DSA to demonstrate vascular morphology and hemodynamics in 4 dimensions potentially reduces the need and dependence of stereotactic MR imaging and shows its potential for 1-stop DSA in radiosurgery. 33 Moreover, the 4D feature is not exclusive to a single manufacturer. Potentially, the 4D-DSA may be used in conjunction with conebeam CT angiography for both superior spatial resolution images and temporal information integrated into a single environment to achieve the best target delineation in radiosurgery.…”

Artifact Reduction of Different Metallic Implants in Flat Detector C-Arm CT

“…Today, the term "flat detector CT" (FDCT) refers to CT images with a series of projection data using a C-arm-based flat detector system, known as angiographic CT. 4 This technology has gained popularity and provided a number of important clinical applications. 5 As a crucial tool for follow-up examinations in the angiographic suite, FDCT detects most intraparenchymal hemorrhages in emergency situations 6,7 and can recognize intracranial complications early during endovascular surgery, such as coiling of an intracranial aneurysm, stent placement, or other interventional procedures. 7 However, severe artifacts stemming from metallic objects remarkably degrade the image quality of FDCT and prevent visualization of the adjacent brain parenchyma or hemorrhage.…”