Purpose To evaluate the potential advantages and limitations of 4D-DSA image acquisition, the acquired images on the patients with arteriovenous malformations (AVMs) and aneurysms were reviewed and analyzed.
Methods Brain arteriovenous malformation (AVM) and brain aneurysm patients who underwent 4D-DSA during the pre and post assessment for the endovascular / surgical treatment were included. The obtained source image information of the 4D-DSA was transferred to a dedicated workstation and reconstructed using a software, “Syngo Dyna4D©”. The results were reviewed and interpretation of each image finding was evaluated. The radiation dose required for each examination was calculated, and compared with that required for conventional 5-second 3D-DSA acquisitions.
Results 10 aneurysm patients and 4 AVM patients underwent 4D-DSA. One patient had both an intracranial aneurysm and an AVM. 6 aneurysm patients underwent 6-second acquisition protocol. 12-second acquisition was used for all AVM patients as well as 4 aneurysm patients. For aneurysm evaluation, with a temporal sampling of 28.7-volumes/sec and a region of interest (ROI) of 42 cm x× 42 cm, the quality of the image was not sufficient to evaluate contrast flow patterns in the aneurysm although the sizes of all aneurysms were less than 10 mm in the largest diameter. With 12-second acquisition, anatomical information of both arteries and veins were simultaneously obtained in one scan, which was useful for the pre-operative evaluation of surgical clipping. For AVMs, temporal change in the appearance of each feeding artery clearly differentiated the different feeding patterns of each artery to the nidus component. Detailed anatomical structures, e.g. a stenosis in the main drainer which was not detected in the 2D-DSA and difficult to see in the conventional 3D angiogram, were better depicted in the 4D-DSA images. Average surface dose of the radiation was 115 mGy in the 6-second acquisition, 225 mGy in the 12-second acquisition and 105 mGy in the conventional 3D angiogram.
Conclusions 4D-DSA provides useful information for the treatment planning of AVM patients by depicting the temporal change in the 3D-DSA. Current temporal resolution was not sufficient for the evaluation of contrast flow patterns in the small aneurysms. The 12-second acquisition which covers the entire arterial phase to the venous phase required approximately double the radiation dose of the conventional 5-second 3D-DSA. However, the dose required for the 6-second acquisition, which mainly covers the arterial phase, was similar to the conventional 3D-DSA.
Disclosures I. Yuki: 1; C; Siemens Grant. T. Ishibashi: None. A. Ikemura: 1; C; Siemens Grant. Y. Kambayashi: None. I. Kan: None. Y. Abe: None. C. Dahmani: 5; C; Siemens K. K.. S. Kaku: None. K. Nishimura: None. Y. Murayama: 1; C; Siemens Grant.
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