title: 4D DSA a new technique for arteriovenous malformation evaluation: a feasibility study.
abstract: BACKGROUND
  The angioarchitectural features of an arteriovenous malformation (AVM) provide key information regarding natural history and treatment planning. Because of rapid filling and vascular overlap, two-dimensional (2D) and three-dimensional (3D) digital subtraction angiography (DSA) are often suboptimal for evaluation of these features. We have developed an algorithm that derives a series of fully time-resolved 3D DSA volumes (four-dimensional (4D) DSA) at up to 30 frames/s from a conventional 3D DSA. The temporal/spatial resolution of 4D reconstructions is significantly higher than that provided by current MR angiography and CT angiography techniques. 4D reconstruction allows viewing of an AVM from any angle at any time during its opacification. This feasibility study investigated the potential of 4D DSA to improve the ability to analyze angioarchitectural features compared with conventional 2D and 3D DSA.
  
  
  METHODS
  2D, 3D, and 4D DSA reconstructions of angiographic studies of six AVMs were evaluated by three cerebrovascular neurosurgeons and one interventional neuroradiologist. These observers evaluated the ability of each modality to visualize the angioarchitectural features of the AVMs. They also compared the information provided using the combination of 2D and 3D DSA with that provided by a 4D DSA reconstruction.
  
  
  RESULTS
  By consensus, 4D DSA provided the best ability to visualize the internal features of the AVM including intranidal aneurysms, fistulae, venous obstructions, and sequence of filling and draining. 2D and 3D images in comparison were limited because of overlap of the vasculature.
  
  
  CONCLUSIONS
  In this small series, 4D DSA provided better ability to visualize the angioarchitecture of an AVM than conventional methods. Further experience is required to determine the ultimate utility of this technique.
authors.affiliation: Department of Neurological Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA.
authors.forename: Carolina
authors.initials: C
authors.lastname: Sandoval-Garcia
authors.affiliation: Department of Biomedical Engineering, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA Siemens Medical Solutions, USA, Inc, Hoffman Estates, Illinois, USA.
authors.forename: Kevin
authors.initials: K
authors.lastname: Royalty
authors.affiliation: Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA Department of Neurosurgery, Changhai Hospital, Second Military Medical University, Shanghai, China.
authors.forename: Pengfei
authors.initials: P
authors.lastname: Yang
authors.affiliation: Department of Neurological Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA.
authors.forename: David
authors.initials: D
authors.lastname: Niemann
authors.affiliation: Department of Neurological Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA.
authors.forename: Azam
authors.initials: A
authors.lastname: Ahmed
authors.affiliation: Department of Neurological Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA.
authors.forename: Beverly
authors.initials: B
authors.lastname: Aagaard-Kienitz
authors.affiliation: Department of Neurological Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA.
authors.forename: Mustafa K
authors.initials: MK
authors.lastname: Başkaya
authors.affiliation: Siemens Medical Solutions, USA, Inc, Hoffman Estates, Illinois, USA.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Schafer
authors.affiliation: Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA.
authors.forename: Charles
authors.initials: C
authors.lastname: Strother
mesh_terms: D000328:Adult; D000368:Aged; D000465:Algorithms; D015901:Angiography, Digital Subtraction / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000379:methods*; D002538:Intracranial Arteriovenous Malformations / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged
keywords: Angiography; Arteriovenous Malformation; Technique; Vascular Malformation