title: Novel application of 3-dimensional rotational C-arm conebeam computed tomography angiography for metastatic hypervascular tumor mass in the spine.
abstract: METHODS
  This is a case report.
  
  
  OBJECTIVE
  To report a 3-dimensional (3D) rotational C-arm conebeam computed tomography (CT) (DynaCT) angiography generating computed tomographic data concurrently with spinal angiographic datasets. This technology allowed 3D modeling of the anterior spinal arterial supply in juxtaposition to a hypervascular tumor mass, thus affording unprecedented guidance in presurgical planning.
  
  
  BACKGROUND
  An enhanced demonstration of spatial relationships between the vascular elements and their adjacent soft-tissue structures is needed to visualize the minute anterior spinal artery optimally.
  
  
  METHODS
  A 76-year-old male with a history of renal cell carcinoma metastasis to the T6 vertebra 1 year prior, presented with worsening myelopathy caused by severe spinal cord compression at T6 level, and a plan for surgical decompression was established. Because of the hypervascular nature of this renal cell carcinoma metastasis, preoperative embolization was requested to minimize blood loss during the operation. A digital subtraction angiogram identified the major arterial contribution to the tumor to also supply the radiculomedullary branch to the anterior spinal artery. To further characterize this blood supply, a rotational DynaCT angiography was performed.
  
  
  RESULTS
  The rotationally acquired data were processed generating volumetric CT datasets demonstrating the 3D relationships of the anterior spinal artery, the blood supply to the tumor and the adjacent soft-tissue and bony structures. A shared blood supply to both the tumor mass and the anterior spinal artery from the left T6 segmental artery was confirmed. The dual nature of this blood supply presented increased risk of ischemic spinal cord injury by possible nontarget embolization. Therefore, the embolization was deferred.
  
  
  CONCLUSIONS
  The DynaCT angiography precisely characterized the complex blood supply of a hypervascular vertebral tumor mass in relation to a shared arterial supply to the thoracic spinal cord. The optimal visualization properly aided presurgical planning.
  
  
  METHODS
  N/A.
authors.affiliation: *Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, CA †Department of Pathology, Hartford Hospital, Hartford, CT ‡Department of Diagnostic Imaging and Therapeutics, University of Connecticut School of Medicine, Farmington, CT; and Departments of §Radiology and ¶Neurosurgery, Hartford Hospital, Hartford, CT.
authors.forename: Jilin
authors.initials: J
authors.lastname: Bai
authors.forename: Aneta
authors.initials: A
authors.lastname: Bakula
authors.forename: Douglas W
authors.initials: DW
authors.lastname: Fellows
authors.forename: Martin D
authors.initials: MD
authors.lastname: Ollenschleger
authors.forename: Inam U
authors.initials: IU
authors.lastname: Kureshi
authors.forename: Gary R
authors.initials: GR
authors.lastname: Spiegel
mesh_terms: D000368:Aged; D015901:Angiography, Digital Subtraction; D002292:Carcinoma, Renal Cell / Q000000981:diagnostic imaging* / Q000556:secondary / Q000601:surgery; D019299:Decompression, Surgical; D006801:Humans; D007680:Kidney Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D008297:Male; D013125:Spinal Neoplasms / Q000000981:diagnostic imaging* / Q000556:secondary / Q000601:surgery; D013904:Thoracic Vertebrae / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery