title: Multimodal angiographic assessment of cerebral arteriovenous malformations: a pilot study.
abstract: OBJECTIVE
  We describe our protocol of three-dimensional (3D) Roadmap intracranial navigation and image fusion for analysis of the angioarchitecture and endovascular treatment of brain arteriovenous malformations (AVMs).
  
  
  METHODS
  We performed superselective catheterization of brain AVMs feeders under 3D-Roadmap navigation. Angiograms of each catheterized artery on two registered orthogonal views were transferred to the imaging workstations, and dedicated postprocessing imaging software allowed automated multiple overlays of the arterial supply of the AVM superselective acquisitions on the global angiogram in angiographic or 3D views and on coregistered MRI datasets.
  
  
  RESULTS
  11 untreated brain AVMs (4 with hemorrhagic presentation) were explored. The superselective acquisitions were performed under 3D-Roadmap navigation in 74 arteries, for a total of 79 targeted arteries. Imaging analysis was available at table side or postoperatively for discussion of the therapeutic strategy. No complications occurred during superselective catheterization. The accuracy of the coregistration of angiogram and MRI was submillimetric after automated mutual information coregistration, with manual re-registration by the physicians.
  
  
  CONCLUSIONS
  Superselective angiograms acquired under 3D-Roadmap navigation can be postprocessed with multiple overlays. The fluoroscopic navigation under 3D-Roadmapping and the coregistration of 3D rotational angiography, selective angiography, and 3D MR datasets appears reliable with millimeter accuracy, and could be implemented in the critical brain AVM embolization setting to allow refined analysis of AVM angioarchitecture.
authors.affiliation: Department of Interventional Neuroradiology, Fondation Rothschild Hospital, Paris, France.
authors.forename: Raphaël
authors.initials: R
authors.lastname: Blanc
authors.affiliation: Department of Interventional Neuroradiology, Fondation Rothschild Hospital, Paris, France.
authors.forename: Aude
authors.initials: A
authors.lastname: Seiler
authors.affiliation: Department of Interventional Neuroradiology, Fondation Rothschild Hospital, Paris, France.
authors.forename: Thomas
authors.initials: T
authors.lastname: Robert
authors.affiliation: Neurosurgical Department, Ghaem Hospital-Mashhad University of Medical Sciences, Teheran, Iran.
authors.forename: Humain
authors.initials: H
authors.lastname: Baharvahdat
authors.affiliation: Department of Interventional Neuroradiology, Fondation Rothschild Hospital, Paris, France Institut supérieur des biosciences, Université Paris-Est- Créteil, Paris, France.
authors.forename: Maxime
authors.initials: M
authors.lastname: Lafarge
authors.affiliation: Department of Neuroradiology, Saint Joseph Hospital, Paris, France.
authors.forename: Julien
authors.initials: J
authors.lastname: Savatovsky
authors.affiliation: Department of Neuroradiology, Fondation Rothschild Hospital, Paris, France.
authors.forename: Jérôme
authors.initials: J
authors.lastname: Hodel
authors.affiliation: Department of Interventional Neuroradiology, Fondation Rothschild Hospital, Paris, France.
authors.forename: Gabriele
authors.initials: G
authors.lastname: Ciccio
authors.affiliation: Department of Neurosurgery, Hopital de la Pitié-Salpetrière, Paris, France.
authors.forename: Dorian
authors.initials: D
authors.lastname: Chauvet
authors.affiliation: Department of Interventional Neuroradiology, Fondation Rothschild Hospital, Paris, France.
authors.forename: Silvia
authors.initials: S
authors.lastname: Pistocchi
authors.affiliation: Department of Interventional Neuroradiology, Fondation Rothschild Hospital, Paris, France.
authors.forename: Bruno
authors.initials: B
authors.lastname: Bartolini
authors.affiliation: Department of Interventional Neuroradiology, Fondation Rothschild Hospital, Paris, France.
authors.forename: Hocine
authors.initials: H
authors.lastname: Redjem
authors.affiliation: Department of Interventional Neuroradiology, Fondation Rothschild Hospital, Paris, France.
authors.forename: Michel
authors.initials: M
authors.lastname: Piotin
mesh_terms: D000293:Adolescent; D000328:Adult; D015901:Angiography, Digital Subtraction / Q000379:methods; D002533:Cerebral Angiography / Q000379:methods*; D002648:Child; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000379:methods*; D002538:Intracranial Arteriovenous Malformations / Q000175:diagnosis* / Q000000981:diagnostic imaging; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging; D038361:Neuronavigation / Q000379:methods*; D010865:Pilot Projects; D011300:Preoperative Care; D055815:Young Adult
keywords: Angiography; Arteriovenous Malformation; Vascular Malformation