Toward the era of a one-stop imaging service using an angiography suite for neurovascular disorders

Abstract

Transportation of patients requiring multiple diagnostic and imaging-guided therapeutic modalities is unavoidable in current radiological practice. This clinical scenario causes time delays and increased risk in the management of stroke and other neurovascular emergencies. Since the emergence of flat-detector technology in imaging practice in recent decades, studies have proven that flat-detector X-ray angiography in conjunction with contrast medium injection and specialized reconstruction algorithms can provide not only high-quality and high-resolution CT-like images but also functional information. This improvement in imaging technology allows quantitative assessment of intracranial hemodynamics and, subsequently in the same imaging session, provides treatment guidance for patients with neurovascular disorders by using only a flat-detector angiographic suite-a so-called one-stop quantitative imaging service (OSIS). In this paper, we review the recent developments in the field of flat-detector imaging and share our experience of applying this technology in neurovascular disorders such as acute ischemic stroke, cerebral aneurysm, and stenoocclusive carotid diseases.

Figure 1

Shift of clinical paradigm in stroke management by employing flat-detector angiographic suite.

Figure 2

A 67-year-old man with left middle cerebral artery (MCA) occlusion. (a) Noncontrast computed tomography (CT) demonstrated a hyperdense MCA sign (arrow) and excluded intracranial hemorrhage. (b) Flat-detector CT (FDCT) angiography demonstrated the total occlusion of left MCA (arrow). (c) A parenchymal cerebral blood volume (FDCT-PBV) map depicted a large area of hypoperfusion in the corresponding left MCA territory, which was similar to the results of multidetector CT perfusion imaging (not shown). (d) After intra-arterial mechanical thrombectomy, recanalization of the left MCA was demonstrated by FDCT angiography. (e) An FDCT-PBV map depicted the recovery of CBV values (circle) in part of the hypoperfused parenchyma after revascularization.

Figure 3

Intraprocedural DynaCT showed the relationship between stent struts (arrowheads) and coil mass (arrow) of a 50-year-old woman who received stent-assisted embolization for a left posterior inferior cerebellar artery aneurysm.

Figure 4

A 77-year-old man who underwent carotid artery stenting for left internal carotid artery high-grade stenosis. Prestenting (a) and poststenting (b) parenchymal cerebral blood volume (FDCT-PBV) maps in conjunction with selective intra-arterial contrast medium injection demonstrated increased CBV values and arterial territorial shifting (arrows).