Type:
Educational Exhibit
Keywords:
Neuroradiology brain, Interventional vascular, Vascular, Catheter arteriography, Fluoroscopy, MR, Angioplasty, Stents, Catheters, Arteriovenous malformations, Aneurysms, Embolism / Thrombosis
Authors:
D. Ruijters, R. Homan, P. Mielekamp, D. Babic; Best/NL
DOI:
10.1594/ecr2012/C-1183
Conclusion
In this poster the steps that need to be taken to perform multi-modality 3D roadmapping have been explained.
The fused visualization may be used to improve the localization of arterial feeders and drainage veins of the AVM (see figures 5 and 9),
hemorrhage,
hematoma cavities,
and fistula.
Furthermore,
contrast medium induced nephropathy (CIN) has been reported to occur in approximately 10%–30% of patients with preexisting renal insufficiency [6-9].
Therefore,
for those patients image guidance based on previously acquired CTA or MRA data fusion with fluoroscopy (see figure 8) may become tremendously helpful.
Clinical results have been described by Levitt et al [10].
They successfully combined pre-interventional CTA and MRA with real-time imaging at the time of angiography,
and reported that the technique can reduce radiation and iodinated contrast exposure,
and expands the application of angiographic technology in cerebrovascular and other neurosurgical diseases.
Clinically relevant potential to lower contrast media use and a reduction of the risk of thromboembolic events is reported by Lin et al [1],
when the multimodality roadmapping method is used for navigation in areas ranging from the aortic arch level to the proximal internal carotid arteries.
Outside the neurological field,
Gupta and Radaelli [11] have described how the presented method can also be applied in transarterial chemoembolization (TACE).
The fusion of the 3DRA with diagnostic CT or MR angiography enables valuable multimodal visualizations of feeding vessels and tumors.
The 3D roadmapping,
using the live 2D fluoroscopy,
allows a smooth catheter placement into the feeding vessels.
Kobeiter et al.
have used the described multi-modal roadmap to perform thoracic endovascular aortic repair without any contrast injection at all [12].
Overall,
it can be concluded that the 3D roadmapping technique is considered a valuable method for accurate navigation and helps to reduce x-ray dose and use of a harmful iodine contrast agent [1,2,11].