Aortic arch injection with C-arm cone beam CT for radiosurgery treatment planning of cerebral arteriovenous malformations: technical note
- 1The Johns Hopkins University School of Medicine, Division of Interventional Neuroradiology, Baltimore, Maryland, USA
- 2Siemens Corporate Research, Princeton, New Jersey, USA
- 3The Johns Hopkins University School of Medicine, Department of Neurosurgery, Baltimore, Maryland, USA
- 4The Johns Hopkins University School of Medicine, Department of Radiology, Baltimore, Maryland, USA
- Correspondence to Dr Martin G Radvany, The Johns Hopkins University School of Medicine, Division of Interventional Neuroradiology, 600 N Wolfe Street, Radiology B-100, Baltimore, MD 21287, USA;
Contributors MGR drafted the manuscript and participated radiographic image analysis. TE participated in creating and fine tuning the CBCT acquisitions as well as editing the manuscript. JH participated in editing of the manuscript and performed the stereotactic radiosurgery. MM performed the dosimetry measurements and participated in editing the manuscript. PG conceived of the idea and participated in radiographic image analysis and manuscript editing.
- Received 25 July 2011
- Accepted 30 September 2011
- Published Online First 22 October 2011
Background C-arm cone beam CT (CBCT) with selective intra-arterial contrast injection combined with digital subtraction angiography (DSA) is currently used for the evaluation and treatment planning of cerebral arteriovenous malformations (AVMs). In some instances an AVM will derive its blood supply from more than one main cervical artery (carotid and/or vertebral artery) and a single-vessel injection will not adequately demonstrate the entire AVM nidus.
Methods Three patients with cerebral AVM in whom the entire nidus could not be visualized by injection of a single cervical artery are reported. CBCT dataset acquisition was performed by intra-arterial contrast injection in the ascending thoracic aorta through a 5 F pigtail catheter. The injection of diluted iodinated contrast agent (35%) lasted 22 s at a rate of 8 ml/s for a total volume of 176 ml (61.6 ml of contrast agent). The dataset was then processed using standard reconstruction methods.
Results Contrast injection in the ascending aorta during a single CBCT acquisition provided a volumetric dataset adequate for subsequent radiosurgical treatment planning.
Conclusion This is a safe and effective angiographic technique for the acquisition of volumetric datasets using CBCT that are suitable for treatment planning of intracranial AVMs deriving their blood supply from more than one major cervical artery. This technique allows imaging of the entire AVM nidus during a single CBCT acquisition.
Funding Siemens Corporate Research provided research support.
Competing interests None.
Patient consent Local IRB approved consent forms were used for all patients in the study along with standard institutional consent forms for the procedures.
Ethics approval Ethics approval was provided by the Johns Hopkins Investigational Review Board.
Provenance and peer review Not commissioned; externally peer reviewed.