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Original research
Three-dimensional image fusion of CTA and angiography for real-time guidance during neurointerventional procedures
  1. Qiang Zhang1,
  2. Qi Sun2,
  3. Yiqi Zhang3,
  4. Hao Zhang1,
  5. Tonghui Shan1,
  6. Jingfeng Han2,
  7. Wenlong Pan1,
  8. Chuanqi Gu1,
  9. Ruxiang Xu1
  1. 1Beijing PLA Military General Hospital Affiliated Bayi Brain Hospital, Beijing, China
  2. 2Siemens Ltd China, Healthcare Sector, Beijing, China
  3. 3Hebei Cangzhou Cang Xian hospital, Cangzhou, Hebei, China
  1. Correspondence to Professor Xu Ruxiang, Beijing PLA Military General Hospital Affiliated Bayi Brain Hospital, No 5, Nanmencang, Dongcheng District, Beijing 100700, China; xuruxiang_bjjz{at}


Aim To evaluate the accuracy of three-dimensional (3D) images from two modalities—CT angiography (CTA) and digital subtraction angiography (DSA). Additionally, to explore the value of using preprocedural CTA for real-time guidance during neurointerventional procedures.

Materials and methods 25 patients with CTA-confirmed cerebral arterial lesions were enrolled. For 12 of these patients, 3D DSA images of the contrast medium-enhanced target vessel were acquired during the intervention and registered with the preprocedurally acquired CTA images for evaluation of the accuracy of image fusion, focusing on the target vessel and the lesion. For the other 13 patients, a low-dose non-contrast 3D angiographic scan was performed. The preprocedurally acquired CTA image was then registered with the coordinate of angiography and overlaid onto the live fluoroscopic image to provide interventional guidance.

Results Based on visual inspection by two experienced physicians and quantitative evaluation, excellent accuracy in the 3D registration of the CTA and DSA was achieved for all 12 patients examined. Additionally, CTA could be used successfully to guide the interventional procedures, including both diagnostic DSA and stent treatment. The radiation dose and contrast medium use were compared with those used by conventional interventional procedures and both were found to be significantly reduced.

Conclusions 3D CTA and angiographic image fusion was approved as highly accurate for neurovasculature. Additionally, using the fusion technique to guide interventional procedures enhanced the workflow, and required much less radiation exposure and contrast medium use, thus helping to reduce potential risks and increase treatment safety.

  • Angiography
  • CT Angiography
  • Intervention

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  • Contributors We certify that all coauthors have contributed sufficiently in the work to take public responsibility for the appropriateness of the research design, method, and the collection, analysis, and interpretation of the data. Specific responsibilities are listed below: guarantor of integrity of the entire study: ZQ, SQ, XR; study concepts and design: ZQ, SQ, ZY, HJ, XR; literature research: SQ, ZH, ST, PW, GC; clinical studies: ZQ, ZY, ZH, ST, PW, GC; statistical analysis/data analysis: ZQ, SQ, XR, ZH, ST, PW, GC, ZY; manuscript preparation: ZQ, SQ, ZY, HJ, XR; manuscript editing: ZQ, QQS ZY, HJ, XR.

  • Competing interests None declared.

  • Ethics approval Ethics committee, Beijing PLA Military General Hospital.

  • Provenance and peer review Not commissioned; externally peer reviewed.