# Contents : 3D Rotational DSA (3D RA) with Dual Volume Visualization
- Basics and Radiation Dose
- Clinical application
- Intracranial aneurysm
- bAVM and dAVF
- spinal Vascular malformation
# 3D Rotational Angiography (3D RA)
- Performed using C-arm with rotation around the patient in a few seconds
- Provides better understanding of vessel architecture of
1) Aneurysm :
- Pretreatment: evaluating the potential for EVT,
finding a good working view,
performing accurate measurement1,
depict more aneurysms2…
- During treatment: enable accurately determine stent position during stent assisted-coiling3,
evaluation of SAH in the angiographic suite4 …
- Posttreatment: status after clipping/coiling & baseline data for long term FU5 …
2) Arteriovenous shunts including bAVM / dAVF / Spinal VM :
- Easier identification of shunted venous pouch for dAVF6
- Easy to recognize relationship between the feeding artery / draining vein and adjacent bony structures
1.
Anxlonnat et al.,
Radiology 2001;218:799-808
2.
Van Rooij et al.,
AJNR 2008;29:976-979
3.
Richter et al.
AJNR 2007;28:1902-1908
4.
Doelken et al.,
Neuroradiology 2008;50:517-523
5.
Kang et al.,
AJNR 2004;25:1463-1469,
6.
Kiyosue et al.,
AJNR 2013; DOI:10.3174/ajnr.A3428
# 2D vs 3D DSA
- 3D DSA,
especially VR images,
tends to depict ruptured intracranial aneurysms bigger than 2D,
for aneurysm <5mm in size and are located in the anterior ciculation,
especially ICA and ACA territories.
Masatou et al.,
Neurology India 2005;53:287-289
- 3DRA showed significantly lower dome-to-neck ratios and significantly larger proportions of aneurysms defined as “wide-neck” .
Brinjikji et al.,
AJNR 2009;30:831-834
# 3D RA with DUAL VOLUME VISUALIZATION
- Performed using two rotational acquisition
- Easy to differentiate between contrast-filled vessels and bones,
calcifications,
stents and coils
- Combined soft tissue information and anatomical land marks with contrast-filled vessels in a single image
- Differentiate clearly details in the ROI of almost the same contrast
- Fade bones or contrast-filled vessel out
# 3D RA : Dual Volume Visualization
- Need two or more 3D volumes : Volume A & B (Figure 1)
- Merging tools
- Addition ,
Subtraction,
Embedded MRP (B + A MPR)
- Side by side,
A only,
B only
- Windowing the two volumes seperately
- Addition (A+C) (Figure 2)
two volume sets of subtracted vessels (ie,
both ICAs / VAs/ ICA & VA...)
- Addition (C+C') (Figure 3)
- Embedded MPR (Figure 4)
# Radiation dose
- Dose-Area-Product (DAP) for DSA in the evaluation of intracranial aneurysm at our institute
Procedure |
DAP (Gy-cm2) |
Diagnostic only (N=439) |
136.6 +/- 44.8 |
Therapeutic only (N=111) |
226.0 +/- 129.2 |
Both at same session (n=38) |
334.5 +/- 393.8 |
- Rotational Angiography
- Mean DAP : 19.2 ± 3.2 Gy-cm2
- --> about 14% of total DAP for diagnostic DSA
- 1.4 ± 0.6 times / session (range,
1~4; n=580)
Park et al.,
KCR2013 #SS262
# Radiation Dose for Bi-Plane DSA
- KAP for a single vessel DSA run : 20 ± 4 Gy-cm2
- --> approximately 80% delivered by the frontal plane
- KAP for a 3 vessel DSA examination : 60 Gy-cm2
- -- > with two planes per vessel
- KAP for head CTA : 19 - 24 Gy-cm2
Rumboldt et al.,
RSNA 2008