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Kawasaki Y, Izumi T, Nishihori M, Goto S, Araki Y, Yokoyama K, Saito R. Superselective Angiography of Vasa Vasorum Within Partially Thrombosed Vertebral Aneurysm: A Case Report. Neurosurgery 2024:00006123-990000000-01287. [PMID: 39007600 DOI: 10.1227/neu.0000000000003115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Accepted: 06/03/2024] [Indexed: 07/16/2024] Open
Abstract
BACKGROUND AND IMPORTANCE Partially thrombosed vertebral artery aneurysms (PTVAs) are rare, most of which are not easy to treat. Furthermore, endovascular treatment of PTVAs may not have favorable outcomes. The relationship between PTVAs and well-developed vasa vasorum (VV), including the mechanism of aneurysm growth, has been reported, but there are no reports of imaging findings by digital subtraction angiography (DSA). In this case, we successfully performed superselective angiography of well-developed VV and evaluated its imaging characteristics. We present the first DSA report of a well-developed VV of PTVA. CLINICAL PRESENTATION A 54-year-old patient presented with a PTVA that exerted a mass effect on the medulla oblongata. The aneurysm had no cavity due to thrombosis. The 3-dimensional DSA images indicated VV. Superselective angiography of the VV indicated staining of the thrombosed aneurysm and draining into the suboccipital cavernous sinus through the venous VV. Thus, VV embolization with n-butyl cyanoacrylate was performed. After 3 months, the contrast effect of the aneurysm on contrast-enhanced magnetic resonance imaging disappeared and aneurysm shrinkage was observed. CONCLUSION We successfully identified a VV within PTVA. Superselective VV angiography showed staining of the thrombosed component and venous return draining into the suboccipital cavernous sinus. In this case, the embolization of the VV proved to be an effective endovascular treatment of PTVA, but the safety of this method is a challenge. Further case studies are required to validate this method, and we hope it will evolve into a new treatment of PTVA.
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Affiliation(s)
- Yuichi Kawasaki
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Takashi Izumi
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Masahiro Nishihori
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Shunsaku Goto
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yoshio Araki
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
- Department of Neurosurgery, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Nagoya, Japan
| | - Kinya Yokoyama
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Ryuta Saito
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
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Shapiro M, Nossek E, Sharashidze V, Tanaka M, Rutledge C, Chung C, Khawaja A, Riina H, Nelson PK, Raz E. Spinal dural and epidural fistulas: role of cone beam CT in diagnosis and treatment. J Neurointerv Surg 2024; 16:615-623. [PMID: 37673678 DOI: 10.1136/jnis-2022-019950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 08/14/2023] [Indexed: 09/08/2023]
Abstract
Understanding normal spinal arterial and venous anatomy, and spinal vascular disease, is impossible without flow-based methods. Development of practical spinal angiography led to site-specific categorization of spinal vascular conditions, defined by the 'seat of disease' in relation to the cord and its covers. This enabled identification of targets for highly successful surgical and endovascular treatments, and guided interpretation of later cross-sectional imaging.Spinal dural and epidural arteriovenous fistulas represent the most common types of spinal shunts. Although etiology is debated, anatomy provides excellent pathophysiologic correlation. A spectrum of fistulas, from foramen magnum to the sacrum, is now well-characterized.Most recently, use of cone beam CT angiography has yielded new insights into normal and pathologic anatomy, including venous outflow. It provides unrivaled visualization of the fistula and its relationship with spinal cord vessels, and is the first practical method to study normal and pathologic spinal veins in vivo-with multiple implications for both safety and efficacy of treatments. We advocate consistent use of cone beam CT imaging in modern spinal fistula evaluation.The role of open surgery is likely to remain undiminished, with increasing availability and use of hybrid operating rooms for practical intraoperative angiography enhancing safety and efficacy of complex surgery.
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Affiliation(s)
- Maksim Shapiro
- Department of Radiology, Neurosurgery, and Neurology, New York City Health and Hospitals Bellevue, New York, New York, USA
| | - Erez Nossek
- Department of Neurosurgery, NYU Grossman School of Medicine, New York, New York, USA
- Department of Neurosurgery, NYC Health Hospitals Bellevue, New York, New York, USA
| | - Vera Sharashidze
- Department of Radiology, NYU Grossman School of Medicine, New York, New York, USA
- Department of Radiology, NYC Health Hospitals Bellevue, New York, New York, USA
| | - Michihiro Tanaka
- Department of Neurosurgery, Kameda Medical Center, Kamogawa, Chiba, Japan
| | - Caleb Rutledge
- Department of Neurosurgery, NYU Grossman School of Medicine, New York, New York, USA
- Department of Neurosurgery, NYC Health Hospitals Bellevue, New York, New York, USA
| | - Charlotte Chung
- Department of Radiology, NYU Grossman School of Medicine, New York, New York, USA
- Department of Radiology, NYC Health Hospitals Bellevue, New York, New York, USA
| | - Ayaz Khawaja
- Department of Radiology, NYU Grossman School of Medicine, New York, New York, USA
- Department of Radiology, NYC Health Hospitals Bellevue, New York, New York, USA
| | - Howard Riina
- Department of Neurosurgery, NYU Grossman School of Medicine, New York, New York, USA
| | - Peter Kim Nelson
- Department of Radiology, NYU Grossman School of Medicine, New York, New York, USA
- Department of Radiology, NYC Health Hospitals Bellevue, New York, New York, USA
| | - Eytan Raz
- Department of Radiology, NYU Grossman School of Medicine, New York, New York, USA
- Department of Radiology, NYC Health Hospitals Bellevue, New York, New York, USA
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Raz E, Sharashidze V, Nossek E, Sahlein DH, Rostanski S, Chung CY, Khawaja AM, Nelson PK, Shapiro M. SuperDyna: Unlocking the Potential of Post-Treatment Device Evaluation. J Neurointerv Surg 2024; 16:512-515. [PMID: 37316194 DOI: 10.1136/jnis-2023-020357] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 05/18/2023] [Indexed: 06/16/2023]
Abstract
BACKGROUND Current imaging algorithms for post-device evaluation are limited by either poor representation of the device or poor delineation of the treated vessel. Combining the high-resolution images from a traditional three-dimensional digital subtraction angiography (3D-DSA) protocol with the longer cone-beam computed tomography (CBCT) protocol may provide simultaneous visualization of both the device and the vessel content in a single volume, improving the accuracy and detail of the assessment. We aim here to review our use of this technique which we termed "SuperDyna". METHODS In this retrospective study, patients who underwent an endovascular procedure between February 2022 and January 2023 were identified. We analyzed patients who had both non-contrast CBCT and 3D-DSA post-treatment and collected information on pre-/post-blood urea nitrogen, creatinine, radiation dose, and the intervention type. RESULTS In 1 year, SuperDyna was performed in 52 (of 1935, 2.6%) patients, of which 72% were women, median age 60 years. The most common reason for the addition of the SuperDyna was for post-flow diversion assessment (n=39). Renal function tests showed no changes. The average total procedure radiation dose was 2.8 Gy, with 4% dose and ~20 mL of contrast attributed to the additional 3D-DSA needed to generate the SuperDyna. CONCLUSIONS The SuperDyna is a fusion imaging method that combines high-resolution CBCT and contrasted 3D-DSA to evaluate intracranial vasculature post-treatment. It allows for more comprehensive evaluation of the device position and apposition, aiding in treatment planning and patient education.
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Affiliation(s)
- Eytan Raz
- Radiology, NYU Langone Health, New York, New York, USA
| | | | - Erez Nossek
- Neurosurgery, NYU Langone Health, New York, New York, USA
| | - Daniel H Sahlein
- Interventional Neuroradiology, Goodman Campbell Brain and Spine, Carmel, Indiana, USA
- Interventional Neuroradiology, Ascension St Vincent's, Indianapolis, Indiana, USA
| | | | | | | | - Peter Kim Nelson
- Radiology, NYU Langone Health, New York, New York, USA
- Neurosurgery, NYU Langone Health, New York, New York, USA
| | - Maksim Shapiro
- Radiology, NYU Langone Health, New York, New York, USA
- Neurology, NYU Langone Health, New York, New York, USA
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Muszynski P, Hak JF, Kerleroux B, Gory B, Anxionnat R, Zhu F. Virtual diluted cone beam CT for device apposition assessment during endovascular treatment of intracranial aneurysm: A technical note. J Neuroradiol 2024; 51:224-229. [PMID: 38262518 DOI: 10.1016/j.neurad.2024.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 12/01/2023] [Accepted: 01/16/2024] [Indexed: 01/25/2024]
Abstract
The increasing use of embolization devices with suboptimal radio-opacity to treat intracranial aneurysm underscores the need for advanced imaging techniques to characterize device-vessel interactions more accurately. Contrast-diluted cone-beam CT is commonly used in neurointervention but requires additional technical refinements to improve endovascular treatment assessment. In this technical note, we describe the virtual dilution cone beam CT (VDCBCT), a technique that synthetizes non-contrast and contrast-enhanced CBCT images to virtually dilute iodinated contrast agents, thereby facilitating a more accurate assessment of embolization device apposition. Through a set of intracranial aneurysms treated with different embolization devices, we describe the VDCBCT protocol and its usefulness for device apposition confidence. VDCBCT may enhance the global understanding of neurovascular embolization treatments by providing improved visualization of target vessels and low-radio-opacity embolization devices, obviating the need for contrast dilution.
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Affiliation(s)
- Patricio Muszynski
- Department of Diagnostic and Interventional Neuroradiology, CHRU Nancy, France
| | - Jean François Hak
- Department of Neuroradiology, APHM La Timone, Marseille, France; LiiE, Aix Marseille University, Marseille, France; CERIMED, Aix Marseille University, 27 Bd Jean Moulin, Marseille 13005, France
| | - Basile Kerleroux
- Department of Neuroradiology, APHM La Timone, Marseille, France; Department of Radiology, Bastia Hospital, France
| | - Benjamin Gory
- Department of Diagnostic and Interventional Neuroradiology, CHRU Nancy, France; IADI, INSERM U1254, Université de Lorraine, Nancy, France
| | - René Anxionnat
- Department of Diagnostic and Interventional Neuroradiology, CHRU Nancy, France; IADI, INSERM U1254, Université de Lorraine, Nancy, France
| | - François Zhu
- Department of Diagnostic and Interventional Neuroradiology, CHRU Nancy, France; IADI, INSERM U1254, Université de Lorraine, Nancy, France.
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Hoover M, Berwanger R, Scott JA, DeNardo A, Amuluru K, Payner T, Kulwin C, Raz E, Gibson D, Sahlein DH. Endovascular intervention for the treatment of epistaxis: cone beam CT review of anatomy, collateral, and treatment implications/efficacy. J Neurointerv Surg 2024; 16:192-196. [PMID: 37019626 DOI: 10.1136/jnis-2022-019966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 03/09/2023] [Indexed: 04/07/2023]
Abstract
Epistaxis is common, impacting more than half the population, and can require procedural intervention in approximately 10% of cases. With an aging population and increasing use of antiplatelets and anticoagulants, severe epistaxis is likely to increase in frequency significantly over the next two decades. Sphenopalatine artery embolization is rapidly becoming the most common type of procedural intervention. The efficacy of endovascular embolization is dependent on a refined understanding of the anatomy and collateral physiology of this circulation as well as the impact of temporizing measures such as nasal packing and inflation of a nasal balloon. Likewise, safety is dependent on a detailed appreciation of collateralization with the internal carotid artery and ophthalmic artery. Cone beam CT imaging has the resolution to enable a clear visualization of the anatomy and collateral circulation associated with the arterial supply to the nasal cavity, in addition to assisting with hemorrhage localization. We present a review of epistaxis treatment, a detailed description of anatomic and physiologic considerations informed by cone beam CT imaging, and a proposed protocol for sphenopalatine embolization for which there is currently no standard.
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Affiliation(s)
- Madeline Hoover
- Neurosurgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Robert Berwanger
- Neurosurgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - John A Scott
- Goodman Campbell Brain and Spine, Carmel, Indiana, USA
- Neurointerventional Radiology, Ascension St. Vincent Hospital, Indianapolis, IN, USA
| | - Andrew DeNardo
- Goodman Campbell Brain and Spine, Carmel, Indiana, USA
- Neurointerventional Radiology, Ascension St. Vincent Hospital, Indianapolis, IN, USA
| | - Krishna Amuluru
- Goodman Campbell Brain and Spine, Carmel, Indiana, USA
- Neurointerventional Radiology, Ascension St. Vincent Hospital, Indianapolis, IN, USA
| | - Troy Payner
- Goodman Campbell Brain and Spine, Carmel, Indiana, USA
| | | | - Eytan Raz
- Radiology, NYU Grossman School of Medicine, New York, New York, USA
| | - Daniel Gibson
- Neurointerventional Surgery, Ascension Columbia St. Mary's Hospital, Milwaukee, Wisconsin, USA
| | - Daniel H Sahlein
- Goodman Campbell Brain and Spine, Carmel, Indiana, USA
- Neurointerventional Radiology, Ascension St. Vincent Hospital, Indianapolis, IN, USA
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Shapiro M, Sharashidze V, Nossek E, Sen C, Rutledge C, Chung C, Khawaja A, Kvint S, Riina H, Nelson PK, Raz E. Superior hypophyseal arteries: angiographic re-discovery, comprehensive assessment, and embryologic implications. J Neurointerv Surg 2023:jnis-2023-020922. [PMID: 37875341 DOI: 10.1136/jnis-2023-020922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 10/10/2023] [Indexed: 10/26/2023]
Abstract
The superior hypophyseal arteries (SHAs) are well known in anatomical and surgical literature, with a well-established role in supply of the anterior hypophysis and superjacent optic apparatus. However, due to small size and overlap with other vessels, in vivo imaging by any modality has been essentially non-existent. Advances in high resolution cone beam CT angiography (CBCTA) now enables this deficiency to be addressed. This paper presents, to the best of our knowledge, the first comprehensive in vivo imaging evaluation of the SHAs. METHODS Twenty-five CBCTA studies of common or internal carotid arteries were obtained for a variety of clinical reasons. Dedicated secondary reconstructions of the siphon were performed, recording the presence, number, and supply territory of SHAs. A spectrum approach, emphasizing balance with adjacent territories (inferior hypophyseal, ophthalmic, posterior and communicating region arteries) was investigated. RESULTS The SHAs were present in all cases. Supply of the anterior pituitary was nearly universal (96%) and almost half (44%) originated from the 'cave' region, in excellent agreement with surgical literature. Optic apparatus supply was more difficult to adjudicate, but appeared present in most cases. The relationship with superior hypophyseal aneurysms was consistent. Patency following flow diverter placement was typical, despite a presumably rich collateral network. Embryologic implications with respect to the ophthalmic artery and infraoptic course of the anterior cerebral artery are intriguing. CONCLUSIONS SHAs are consistently seen with CBCTA, allowing for correlation with existing anatomical and surgical literature, laying the groundwork for future in vivo investigation.
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Affiliation(s)
- Maksim Shapiro
- Neurosurgery, NYU Grossman School of Medicine, New York, NY, USA
- Radiology, NYU Grossman School of Medicine, New York, NY, USA
- Neurology, NYU Grossman School of Medicine, New York, NY, USA
- Radiology, NYC Health Hospitals Bellevue, New York, NY, USA
| | - Vera Sharashidze
- Neurosurgery, NYU Grossman School of Medicine, New York, NY, USA
- Radiology, NYU Grossman School of Medicine, New York, NY, USA
- Neurology, NYU Grossman School of Medicine, New York, NY, USA
- Radiology, NYC Health Hospitals Bellevue, New York, NY, USA
| | - Erez Nossek
- Neurosurgery, NYU Grossman School of Medicine, New York, NY, USA
- Radiology, NYC Health Hospitals Bellevue, New York, NY, USA
- Neurosurgery, NYC Health Hospitals Bellevue, New York, NY, USA
| | - Chandra Sen
- Neurosurgery, NYU Grossman School of Medicine, New York, NY, USA
| | - Caleb Rutledge
- Neurosurgery, NYU Grossman School of Medicine, New York, NY, USA
- Neurosurgery, NYC Health Hospitals Bellevue, New York, NY, USA
| | - Charlotte Chung
- Radiology, NYU Grossman School of Medicine, New York, NY, USA
- Radiology, NYC Health Hospitals Bellevue, New York, NY, USA
| | - Ayaz Khawaja
- Radiology, NYU Grossman School of Medicine, New York, NY, USA
- Radiology, NYC Health Hospitals Bellevue, New York, NY, USA
| | - Svetlana Kvint
- Radiology, NYU Grossman School of Medicine, New York, NY, USA
- Radiology, NYC Health Hospitals Bellevue, New York, NY, USA
| | - Howard Riina
- Neurosurgery, NYU Grossman School of Medicine, New York, NY, USA
- Radiology, NYU Grossman School of Medicine, New York, NY, USA
- Neurology, NYU Grossman School of Medicine, New York, NY, USA
| | - Peter Kim Nelson
- Neurosurgery, NYU Grossman School of Medicine, New York, NY, USA
- Radiology, NYU Grossman School of Medicine, New York, NY, USA
- Radiology, NYC Health Hospitals Bellevue, New York, NY, USA
| | - Eytan Raz
- Neurosurgery, NYU Grossman School of Medicine, New York, NY, USA
- Radiology, NYU Grossman School of Medicine, New York, NY, USA
- Radiology, NYC Health Hospitals Bellevue, New York, NY, USA
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Alzate JD, Mashiach E, Raz E, Shapiro M, Riina H, Kondziolka D. Advances in Radiosurgical Planning: High-Resolution Imaging and Objective Hemodynamic Measurements for Arteriovenous Malformations. World Neurosurg 2023; 178:264-265. [PMID: 37573234 DOI: 10.1016/j.wneu.2023.07.071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/14/2023]
Affiliation(s)
- Juan Diego Alzate
- Departments of Neurological Surgery, NYU Langone Health, New York University, New York, New York, USA
| | - Elad Mashiach
- Departments of Neurological Surgery, NYU Langone Health, New York University, New York, New York, USA
| | - Eytan Raz
- Department of Interventional Neuroradiology, NYU Langone Health, New York University, New York, New York, USA
| | - Maksim Shapiro
- Department of Interventional Neuroradiology, NYU Langone Health, New York University, New York, New York, USA
| | - Howard Riina
- Departments of Neurological Surgery, NYU Langone Health, New York University, New York, New York, USA; Department of Interventional Neuroradiology, NYU Langone Health, New York University, New York, New York, USA
| | - Douglas Kondziolka
- Departments of Neurological Surgery, NYU Langone Health, New York University, New York, New York, USA
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Kawauchi S, Chida K, Hamada Y, Tsuruta W. Image Quality and Radiation Dose of Conventional and Wide-Field High-Resolution Cone-Beam Computed Tomography for Cerebral Angiography: A Phantom Study. Tomography 2023; 9:1683-1693. [PMID: 37736987 PMCID: PMC10514806 DOI: 10.3390/tomography9050134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 08/24/2023] [Accepted: 08/29/2023] [Indexed: 09/23/2023] Open
Abstract
There has been an increase in the use of interventional neuroradiology procedures because of their non-invasiveness compared to surgeries and the improved image quality of fluoroscopy, digital subtraction angiography, and rotational angiography. Although cone-beam computed tomography (CBCT) images are inferior to multi-detector CT images in terms of low-contrast detectability and lower radiation doses, CBCT scans are frequently performed because of their accessibility. This study aimed to evaluate the image quality and radiation dose of two different high-resolution CBCTs (HR CBCT): conventional (C-HR CBCT) and wide-field HR CBCT (W-HR CBCT). The modulation transfer function (MTF), noise power spectrum (NPS), and contrast-to-noise ratio (CNR) were used to evaluate the image quality. On comparing the MTF of C-HR CBCT with a 256 × 256 matrix and that of W-HR CBCT with a 384 × 384 matrix, the MTF of W-HR CBCT with the 384 × 384 matrix was larger. A comparison of the NPS and CNR of C-HR CBCT with a 256 × 256 matrix and W-HR CBCT with a 384 × 384 matrix showed that both values were comparable. The reference air kerma values were equal for C-HR CBCT and W-HR CBCT; however, the value of the kerma area product was 1.44 times higher for W-HR CBCT compared to C-HR CBCT. The W-HR CBCT allowed for improved spatial resolution while maintaining the image noise and low-contrast detectability by changing the number of image matrices from 256 × 256 to 384 × 384. Our study revealed the image characteristics and radiation dose of W-HR CBCT. Given its advantages of low-contrast detectability and wide-area imaging with high spatial resolution, W-HR CBCT may be useful in interventional neuroradiology for acute ischemic stroke.
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Affiliation(s)
- Satoru Kawauchi
- Department of Radiology, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo 105-8470, Japan; (S.K.); (Y.H.)
- Department of Radiological Technology, Tohoku University Graduate School of Medicine, 2-1 Seiryo, Aoba-ku, Sendai 980-8575, Miyagi, Japan
- Okinaka Memorial Institute for Medical Research, 2-2-2 Toranomon, Minato-ku, Tokyo 105-8470, Japan
| | - Koichi Chida
- Department of Radiological Technology, Tohoku University Graduate School of Medicine, 2-1 Seiryo, Aoba-ku, Sendai 980-8575, Miyagi, Japan
- Department of Radiation Disaster Medicine, International Research Institute of Disaster Science, Tohoku University, 468-1 Aramaki Aza-Aoba, Aoba-ku, Sendai 980-0845, Miyagi, Japan
| | - Yusuke Hamada
- Department of Radiology, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo 105-8470, Japan; (S.K.); (Y.H.)
| | - Wataro Tsuruta
- Department of Endovascular Neurosurgery, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo 105-8470, Japan;
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Raz E, Nayak G, Sharashidze V, Nossek E, Malak W, Bueno H, Komiyama M, Nelson PK, Shapiro M. An unusual anatomical variant: A transclival artery supplying the vertebrobasilar circulation. Interv Neuroradiol 2023:15910199231165613. [PMID: 37032452 DOI: 10.1177/15910199231165613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/11/2023] Open
Abstract
The persistent carotid-vertebrobasilar anastomoses are arterial communications between the anterior and posterior circulations due to the persistence of embryological connections. We here present an extremely rare instance of a transclival persistent carotid-vertebrobasilar anastomosis in a 10-month-old infant, which does not fit into any of the traditionally described categories, such as the trigeminal artery, hypoglossal artery, or proatlantal artery.
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Affiliation(s)
- Eytan Raz
- Neurointerventional section, Department of Radiology, NYU Langone Health, New York, NY, USA
- Department of Radiology, 12297NYU Langone Health, New York, NY, USA
| | - Gopi Nayak
- Department of Radiology, 12297NYU Langone Health, New York, NY, USA
| | - Vera Sharashidze
- Neurointerventional section, Department of Radiology, NYU Langone Health, New York, NY, USA
| | - Erez Nossek
- Neurointerventional section, Department of Radiology, NYU Langone Health, New York, NY, USA
| | - Wassim Malak
- Department of Radiology, 12297NYU Langone Health, New York, NY, USA
| | - Hugo Bueno
- Department of Radiology, 12297NYU Langone Health, New York, NY, USA
| | | | - Peter Kim Nelson
- Neurointerventional section, Department of Radiology, NYU Langone Health, New York, NY, USA
| | - Maksim Shapiro
- Neurointerventional section, Department of Radiology, NYU Langone Health, New York, NY, USA
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10
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Chen M. JNIS spotlight: commissioned reviews. J Neurointerv Surg 2023; 15:jnis-2022-020019. [PMID: 36593117 DOI: 10.1136/jnis-2022-020019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/20/2022] [Indexed: 01/04/2023]
Affiliation(s)
- Michael Chen
- Neurological Sciences, Rush University Medical Center, Chicago, Illinois, USA
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11
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Treb K, Ji X, Feng M, Zhang R, Periyasamy S, Laeseke PF, Dingle AM, Brace CL, Li K. A C-arm photon counting CT prototype with volumetric coverage using multi-sweep step-and-shoot acquisitions. Phys Med Biol 2022; 67:10.1088/1361-6560/ac950d. [PMID: 36162399 PMCID: PMC9623602 DOI: 10.1088/1361-6560/ac950d] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 09/26/2022] [Indexed: 11/12/2022]
Abstract
Objective.Existing clinical C-arm interventional systems use scintillator-based energy-integrating flat panel detectors (FPDs) to generate cone-beam CT (CBCT) images. Despite its volumetric coverage, FPD-CBCT does not provide sufficient low-contrast detectability desired for certain interventional procedures. The purpose of this work was to develop a C-arm photon counting detector (PCD) CT system with a step-and-shoot data acquisition method to further improve the tomographic imaging performance of interventional systems.Approach.As a proof-of-concept, a cadmium telluride-based 51 cm × 0.6 cm PCD was mounted in front of a FPD in an Artis Zee biplane system. A total of 10 C-arm sweeps (5 forward and 5 backward) were prescribed. A motorized patient table prototype was synchronized with the C-arm system such that it translates the object by a designated distance during the sub-second rest time in between gantry sweeps. To evaluate whether this multi-sweep step-and-shoot acquisition strategy can generate high-quality and volumetric PCD-CT images without geometric distortion artifacts, experiments were performed using physical phantoms, a human cadaver head, and anin vivoswine subject. Comparison with FPD-CT was made under matched narrow beam collimation and radiation dose conditions.Main results.Compared with FPD-CT images, PCD-CT images had lower noise and improved visualization of low-contrast lesion models, as well as improved visibility of small iodinated blood vessels. Fine structures were visualized more clearly by the PCD-CT than the highest-available resolution provided by FPD-CBCT and MDCT. No perceivable geometric distortion artifacts were observed in the multi-planar PCD-CT images.Significance.This work is the first demonstration of the feasibility of high-quality and multi-planar (volumetric) PCD-CT imaging with a rotating C-arm gantry.
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Affiliation(s)
- Kevin Treb
- Department of Medical Physics, School of Medicine and Public Health, University of Wisconsin-Madison, 1111 Highland Avenue, Madison, WI 53705, USA
| | - Xu Ji
- Department of Medical Physics, School of Medicine and Public Health, University of Wisconsin-Madison, 1111 Highland Avenue, Madison, WI 53705, USA
| | - Mang Feng
- Department of Medical Physics, School of Medicine and Public Health, University of Wisconsin-Madison, 1111 Highland Avenue, Madison, WI 53705, USA
| | - Ran Zhang
- Department of Medical Physics, School of Medicine and Public Health, University of Wisconsin-Madison, 1111 Highland Avenue, Madison, WI 53705, USA
| | - Sarvesh Periyasamy
- Department of Radiology, School of Medicine and Public Health, University of Wisconsin-Madison, 600 Highland Avenue, Madison, WI 53792, USA
| | - Paul F. Laeseke
- Department of Radiology, School of Medicine and Public Health, University of Wisconsin-Madison, 600 Highland Avenue, Madison, WI 53792, USA
| | - Aaron M. Dingle
- Department of Surgery, School of Medicine and Public Health, University of Wisconsin-Madison, 600 Highland Avenue, Madison, WI 53792, USA
| | - Christopher L. Brace
- Department of Biomedical Engineering, University of Wisconsin-Madison, 1415 Engineering Drive, Madison, WI, 53706, USA
| | - Ke Li
- Department of Medical Physics, School of Medicine and Public Health, University of Wisconsin-Madison, 1111 Highland Avenue, Madison, WI 53705, USA
- Department of Radiology, School of Medicine and Public Health, University of Wisconsin-Madison, 600 Highland Avenue, Madison, WI 53792, USA
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