Clinical experience of cone-beam computed tomography in interventional neuroradiology

Abstract

Objective ‒ to analyze the experience of using cone-beam computed tomography (CBCT) angiography during diagnostic and interventional procedures in the SO «Scientific-Practical Center of Endovascular Neuroradiology NAMS of Ukraine». Materials and methods. Informed consent was obtained from each patient (parent or guardian) enrolled in the study and the study protocol conforms to the ethical guidelines of the Declaration of Helsinki as reflected in a priori approval by the Institutional Ethical Review Board (Institution's Human Research Committee). Since January 2024 in the SO «Scientific-Practical Center of Endovascular Neuroradiology NAMS of Ukraine» used in practical work a modern angio machine «Siemens Artis Q.zen» (Siemens, Erlangen, Germany), equipped with a set of various techniques and programs, in particular CBCT, syngo Aneurysm Guidance Neuro, 3D Roadmap. We analysed 36 diagnostic and interventional procedures was conducted from January 2024 to March 2024, during which CBCT was used. Among the procedures, 29 cases of brain aneurysms, 4 arteriovenous malformations and 3 cases of dural arteriovenous fistulas. Results. CBCT is useful for understanding vascular anatomy and allows for more detailed visualization of the curvilinear course of vessels in 3D space along any plane with the possibility of their correlation with bone structures compared to traditional angiography, and also has a higher resolution compared to more common 3D digital subtraction angiography. CBCT images are also a valuable source of information for further understanding of both pathological and normal neurovascular anatomy. Our center has implemented rotation 3D images with contrast of the CBCT at the stage of preparation and planning of the interventional procedure, rotation with subtraction (3D-DSA) ‒ to control implanted devices and its relationship to the vessels and long-term rotation of the CBCT without contrast ‒ to control the straightening and positioning of the stent. To control the position of the stent and its relations to the vessels, the «fusion» mode was used, providing additional information about the vascular structures imposed during conventional angiography, as well as the ability to rotate the volume at any angle regardless of the mechanical capabilities. Conclusions. CBCT is an accessible and unique function of modern angiomachines and helps to improve the understanding of anatomical features in various pathologies of cerebral vessels and helps in making clinical decisions.

Keywords

• interventional neuroradiology; cone-beam computed tomography; endovas­cular treatment; angiography.