title: Dynamic CT angiography for cyberknife radiosurgery planning of intracranial arteriovenous malformations: a technical/feasibility report.
abstract: BACKGROUND
  Successful radiosurgery for arteriovenous malformations (AVMs) requires accurate nidus delineation in the 3D treatment planning system (TPS). The catheter biplane digital subtraction angiogram (DSA) has traditionally been the gold standard for evaluation of the AVM nidus, but its 2D nature limits its value for contouring and it cannot be imported into the Cyberknife TPS. We describe a technique for acquisition and integration of 3D dynamic CT angiograms (dCTA) into the Cyberknife TPS for intracranial AVMs and review the feasibility of using this technique in the first patient cohort.
  
  
  METHODS
  Dynamic continuous whole brain CT images were acquired in a Toshiba 320 volume CT scanner with data reconstruction every 0.5 sec. This multi-time-point acquisition enabled us to choose the CT data-set with the clearest nidus without significant enhancement of surrounding blood vessels. This was imported to the Cyberknife TPS and co-registered with planning CT and T2 MRI (2D DSA adjacent for reference). The feasibility of using dCTA was evaluated in the first thirteen patients with outcome evaluation from patient records.
  
  
  RESULTS
  dCTA data was accurately co-registered in the Cyberknife TPS and appeared to assist in nidus contouring for all patients. Imaging modalities were complementary. 85% of patients had complete (6/13) or continuing partial nidus obliteration (5/13) at 37 months median follow-up.
  
  
  CONCLUSIONS
  dCTA is a promising imaging technique that can be successfully imported into the Cyberknife TPS and appears to assist in radiosurgery nidus definition. Further study to validate its role is warranted.
authors.affiliation: The Ottawa Hospital, Ottawa, Ontario, Canada.
authors.forename: Anoop
authors.initials: A
authors.lastname: Haridass
authors.affiliation: The Ottawa Hospital, Ottawa, Ontario, Canada.
authors.forename: Jillian
authors.initials: J
authors.lastname: Maclean
authors.affiliation: The Ottawa Hospital, Ottawa, Ontario, Canada.
authors.forename: Santanu
authors.initials: S
authors.lastname: Chakraborty
authors.affiliation: The Ottawa Hospital, Ottawa, Ontario, Canada.
authors.forename: John
authors.initials: J
authors.lastname: Sinclair
authors.affiliation: The Ottawa Hospital, Ottawa, Ontario, Canada.
authors.forename: Janos
authors.initials: J
authors.lastname: Szanto
authors.affiliation: The Ottawa Hospital, Ottawa, Ontario, Canada.
authors.forename: Daniela
authors.initials: D
authors.lastname: Iancu
authors.affiliation: The Ottawa Hospital, Ottawa, Ontario, Canada.
authors.forename: Shawn
authors.initials: S
authors.lastname: Malone
keywords: Cyberknife; arteriovenous malformation; dynamic CT angiogram; radiosurgery