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Optimization of the Surgical Approach in AVMs Using MRI and 4D DSA Fusion Technique

A technical note

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Abstract

Purpose

Previously published data demonstrated the possibility of displaying the angioarchitecture of intracranial vascular malformations using time-resolved 3D imaging (4D digital subtraction angiography [DSA]). The purpose of our study was to prove the technical feasibility of creating fused images of time-resolved 3D reconstructions and MPRAGE MRI data sets and to check the reliability of the correct anatomical display of the angioma nidus and the venous drainage in the fused images of patients with intracranial arteriovenous malformations (AVM).

Patients and Methods

In this study 20 patients with intracranial AVM underwent pretherapeutic DSA and time-resolved 3D DSA in addition to MRI including MPRAGE sequences. The images were post-processed with the fusion software tool on a dedicated research workstation. The fusion of both imaging modalities was done semi-automatically with automatic co-registration software followed by a manual co-registration.

Results

Co-registered DSA/MRI data sets of 20 untreated AVMs were evaluated independently by two reviewers. Image fusion was successful in all 20 cases with an acceptable additional set-up time. The fused images were highly scored by the two raters in respect to their congruency of the dedicated regions. Precise anatomical localization of the nidus, the feeding arteries and the draining veins were possible with the merged images.

Conclusion

Creating fused images of time-resolved 3D DSA and contrast-enhanced T1-weighted MPRAGE MR images might be beneficial for the preoperative and intrasurgical workflow in patients with AVMs. This new software tool fulfils the required quality and accuracy of the merged images. The clinical validation has to be proven in further studies.

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Authors and Affiliations

  1. Institute of Neuroradiology, Hospital of Goethe University, Schleusenweg 2–16, 60528, Frankfurt am Main, Germany

    S. Tritt, B. Ommer & J. Berkefeld

  2. Siemens Healthcare GmbH, Forchheim, Germany

    S. Gehrisch & S. Klein

  3. Department of Neurosurgery, Hospital of Goethe University, Frankfurt am Main, Germany

    V. Seifert & J. Konczalla

Authors
  1. S. Tritt
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  2. B. Ommer
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  3. S. Gehrisch
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  4. S. Klein
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  5. V. Seifert
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  6. J. Berkefeld
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  7. J. Konczalla
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Corresponding author

Correspondence to S. Tritt.

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Conflict of interest

B. Ommer, V. Seifert and J. Konczalla declare that they have no competing interests. J. Berkefeld: Consulting Fee or Honorarium: proctor for WEB, Sequent Medical and member of the scientific advisory board of Acandis. J. Berkefeld and S. Tritt: The project is part of a permanent scientific cooperation between Siemens and the Institute of Neuroradiology at the University Frankfurt, Germany, and travel expenses for presentation of the project are covered by Siemens. Our institution will receive a honorarium related to the publication of the study from Siemens. S. Gehrisch and S. Klein: Employee of Siemens Healthcare GmbH, BU Advanced Therapies, Forchheim, Germany.

Ethical standards

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study.

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Tritt, S., Ommer, B., Gehrisch, S. et al. Optimization of the Surgical Approach in AVMs Using MRI and 4D DSA Fusion Technique. Clin Neuroradiol 27, 443–450 (2017). https://doi.org/10.1007/s00062-017-0571-2

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  • DOI: https://doi.org/10.1007/s00062-017-0571-2

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