Arterial and Venous 3D Fusion AV-3D-DSA: A Novel Approach to Cerebrovascular Neuroimaging

Abstract

DSA is the standard imaging technique for evaluation of cerebrovascular conditions. However, One drawback is its limitation in depicting a single angiographic phase at a time. We describe a new 3D-DSA algorithm, which we call arterial and venous-3D-DSA, which allows the concurrent yet distinct display of the arterial and venous structures, which may be useful for different clinical and educational purposes.

FIG 1.

A, Frontal view arterial 3D-DSA of the right internal carotid artery injection demonstrating a multilobulated carotid terminus aneurysm. B, Frontal view venous 3D-DSA of the right internal carotid artery injection showing the venous outflow of the right hemisphere using mainly a deep middle cerebral vein draining toward the pterygoid plexus through the foramen ovale. C, Fused AV-3D-DSA demonstrating the relationship between the arteries and the veins. Specifically, note the presence of a vein running adjacent to the anterior aneurysm dome (arrow) better demonstrated in the insert (D).

FIG 2.

Left lateral (A), right anterior oblique (B), and right lateral (C) views of AV-3D-DSA of the left internal carotid artery injection demonstrating a large developmental venous anomaly draining most of the left frontal hemisphere toward the left internal cerebral vein, which likely developed in association with atretic anterior superior sagittal sinus. Notice also the hypertrophied right inferior petrosal sinus and the plexus of Rektorzik surrounding the left ICA.

FIG 3.

Frontal (A) and lateral (B) fused AV-3D-DSA of left vertebral artery injection demonstrating well the relationship between the petrosal veins and the vertebrobasilar system.