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CT reconstruction and MRI fusion of 3D rotational angiography in the evaluation of pediatric cerebrovascular lesions

  • Paediatric Neuroradiology
  • Published:
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Abstract

Purpose

Complex neurovascular lesions in children require precise anatomic understanding for treatment planning. Although 3DRA is commonly employed for volumetric reformation in neurointerventional procedures, the ability to reconstruct this data into CT-like images (3DRA-CT) is not widely utilized. This study demonstrates the feasibility and usefulness of 3DRA-CT and subsequent MRI fusion for problem solving in pediatric neuroangiography.

Methods

This retrospective study includes 18 3DRA-CT studies in 16 children (age 9.6 ± 3.8 years, range 2–16 years) over 1 year. After biplane 2D-digital subtraction angiography (DSA), 5-second 3DRA was performed with selective vessel injection either with or without subtraction. Images were reconstructed into CT sections which were post-processed to generate multiplanar reformation (MPR) and maximum intensity projection (MIP) images. Fusion was performed with 3D T1 MRI images to precisely demonstrate neurovascular relationships. Quantitative radiation metrics were extracted and compared against those for the entire examination and for corresponding biplane 2D-DSA acquisitions.

Results

In all 18 cases, the 3DRA procedure and MRI fusion were technically successful and provided clinically useful information relevant to management. The unsubtracted and subtracted 3DRA acquisitions were measured to deliver 5.9 and 132.2%, respectively, of the mean radiation dose of corresponding biplane 2D-DSA acquisitions and contributed 1.2 and 12.5%, respectively, to the total procedure dose.

Conclusion

Lower radiation doses, high spatial resolution, and multiplanar reformatting capability make 3DRA-CT a useful adjunct to evaluate neurovascular lesions in children. Fusing 3DRA-CT data with MRI is an additional capability that can further enhance diagnostic information.

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Authors and Affiliations

  1. Pediatric Neuroradiology and Image Guided Therapy, Department of Diagnostic Imaging, The Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada

    Prakash Muthusami, Vanessa Rea & Manohar Shroff

  2. Medical Physics, Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, ON, Canada

    Nicholas Shkumat

  3. Department of Interventional Neuroradiology, Institute of Neurological Sciences, Prince of Wales Hospital, Randwick, NSW, Australia

    Albert H. Chiu

Authors
  1. Prakash Muthusami
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  2. Nicholas Shkumat
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  3. Vanessa Rea
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  4. Albert H. Chiu
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Corresponding author

Correspondence to Prakash Muthusami.

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Funding

No funding was received for this study.

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in the studies involving human participants were in accordance with the ethical standards of the institutional Research Ethics Board (REB) with REB#1000 055502 and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. For this type of study formal consent is not required.

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Muthusami, P., Shkumat, N., Rea, V. et al. CT reconstruction and MRI fusion of 3D rotational angiography in the evaluation of pediatric cerebrovascular lesions. Neuroradiology 59, 625–633 (2017). https://doi.org/10.1007/s00234-017-1818-y

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  • DOI: https://doi.org/10.1007/s00234-017-1818-y

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