Fusion Technique Using Three-Dimensional Digital Subtraction Angiography in the Evaluation of Complex Cerebral and Spinal Vascular Malformations.
OBJECTIVE
The authors introduce a new fusion technique using 2 three-dimensional digital subtraction angiography images acquired by a flat-panel detector angiographic system to understand the detailed angioarchitecture of complex cerebral and spinal vascular malformations.


METHODS
Eleven consecutive cases of arteriovenous fistula or arteriovenous malformation with lesions that involved 2 major vessels (i.e., internal carotid arteries, external carotid arteries, vertebral arteries, or spinal arteries) were included. Three-dimensional rotational angiography was performed in each affected vessel after conventional cerebral or spinal angiography. Subsequently, the 2 three-dimensional digital subtraction angiography images were fused.


RESULTS
The fused images provided the accurate three-dimensional angioarchitecture of complex vascular malformations clearly with high spatial resolution. In particular, the relationship between the nidus/fistulous point, the feeding arteries from each major vessel, and the draining veins could be easily delineated from different directions and multiple angles. Surgical or endovascular treatment was performed in all cases based on the information from these fused three-dimensional images.


CONCLUSIONS
A fusion technique using two three-dimensional digital subtraction angiography is beneficial for preoperative planning and successful treatment in cases of complex cerebral and spinal vascular malformations.
Department of Neurosurgery, Fukuoka University Hospital, and School of Medicine, Fukuoka University, Fukuoka, Japan.
Kenji
K
Fukuda
Department of Neurosurgery, Fukuoka University Hospital, and School of Medicine, Fukuoka University, Fukuoka, Japan. Electronic address: toshi-higashi@pop13.odn.ne.jp.
Toshio
T
Higashi
Department of Neurosurgery, Fukuoka University Hospital, and School of Medicine, Fukuoka University, Fukuoka, Japan.
Masakazu
M
Okawa
Department of Neurosurgery, Fukuoka University Hospital, and School of Medicine, Fukuoka University, Fukuoka, Japan.
Mitsutoshi
M
Iwaasa
Department of Neurosurgery, Fukuoka University Hospital, and School of Medicine, Fukuoka University, Fukuoka, Japan.
Hiroshi
H
Abe
Department of Neurosurgery, Fukuoka University Hospital, and School of Medicine, Fukuoka University, Fukuoka, Japan.
Tooru
T
Inoue
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015901:Angiography, Digital Subtraction / Q000379:methods; D002339:Carotid Arteries / Q000000981:diagnostic imaging / Q000473:pathology; D020785:Central Nervous System Vascular Malformations / Q000150:complications / Q000000981:diagnostic imaging*; D002533:Cerebral Angiography / Q000379:methods; D002543:Cerebral Hemorrhage / Q000209:etiology; D004172:Diplopia / Q000209:etiology; D005260:Female; D006423:Hemianopsia / Q000209:etiology; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000379:methods; D002538:Intracranial Arteriovenous Malformations / Q000150:complications / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D010264:Paraplegia / Q000209:etiology; D013131:Spine / Q000098:blood supply*; D016055:Urinary Retention / Q000209:etiology; D014711:Vertebral Artery / Q000000981:diagnostic imaging / Q000473:pathology
Arteriovenous fistula; Arteriovenous malformation; Fusion technique; Three-dimensional digital subtraction angiography