title: Application of Time-Resolved 3D Digital Subtraction Angiography to Plan Cerebral Arteriovenous Malformation Radiosurgery.
abstract: Time-resolved 3D-DSA (4D-DSA) enables viewing vasculature from any desired angle and time frame. We investigated whether these advantages may facilitate treatment planning and the feasibility of using 4D-DSA as a single imaging technique in AVM/dural arteriovenous fistula radiosurgery.
  
  
  
  Twenty consecutive patients (8 dural arteriovenous fistulas and 12 AVMs; 13 men and 7 women; mean age, 45 years; range, 18-64 years) who were scheduled for gamma knife radiosurgery were recruited (November 2014 to October 2015). An optimal volume of reconstructed time-resolved 3D volumes that defines the AVM nidus/dural arteriovenous fistula was sliced into 2D-CT-like images. The original radiosurgery treatment plan was overlaid retrospectively. The registration errors of stereotactic 4D-DSA were compared with those of integrated stereotactic imaging. AVM/dural arteriovenous fistula volumes were contoured, and disjoint and conjoint components were identified. The Wilcoxon signed rank test and the Wilcoxon rank sum test were adopted to evaluate registration errors and contoured volumes of stereotactic 4D-DSA and integration of stereotactic MR imaging and stereotactic 2D-DSA.
  
  
  
  Sixteen of 20 patients were successfully registered in Advanced Leksell GammaPlan Program. The registration error of stereotactic 4D-DSA was smaller than that of integrated stereotactic imaging (P= .0009). The contoured AVM volume of 4D-DSA was smaller than that contoured on the integration of MR imaging and 2D-DSA, while major inconsistencies existed in cases of dural arteriovenous fistula (P= .042 and 0.039, respectively, for measurements conducted by 2 authors).
  
  
  
  Implementation of stereotactic 4D-DSA data for gamma knife radiosurgery for brain AVM/dural arteriovenous fistula is feasible. The ability of 4D-DSA to demonstrate vascular morphology and hemodynamics in 4 dimensions potentially reduces the target volumes of irradiation in vascular radiosurgery.
authors.affiliation: From the Department of Biomedical Imaging and Radiological Sciences (K.-K.C., Y.-T.W.), National Yang-Ming University, Taipei, Taiwan.
authors.forename: K-K
authors.identifier: 0000-0001-8582-3898
authors.initials: KK
authors.lastname: Chen
authors.affiliation: Departments of Radiology (W.-Y.G., C.-J.L.) wyguo@vghtpe.gov.tw.|School of Medicine (W.-Y.G., C.-J.L.), National Yang-Ming University, Taipei, Taiwan.
authors.forename: W-Y
authors.identifier: 0000-0003-2640-8664
authors.initials: WY
authors.lastname: Guo
authors.affiliation: Neurosurgery (H.-C.Y., W.-Y.C.), Taipei Veterans General Hospital, Taipei, Taiwan.
authors.forename: H-C
authors.identifier: 0000-0002-4949-5417
authors.initials: HC
authors.lastname: Yang
authors.affiliation: Departments of Radiology (W.-Y.G., C.-J.L.).|School of Medicine (W.-Y.G., C.-J.L.), National Yang-Ming University, Taipei, Taiwan.
authors.forename: C-J
authors.identifier: 0000-0003-2370-6316
authors.initials: CJ
authors.lastname: Lin
authors.affiliation: Siemens Healthcare Ltd, Advanced Therapies (C.-H.F.W.), Taipei, Taiwan.
authors.forename: C-H F
authors.identifier: 0000-0001-5201-3311
authors.initials: CF
authors.lastname: Wu
authors.affiliation: Siemens, Advanced Therapies (S.G., M.K.), Forchheim, Germany.
authors.forename: S
authors.identifier: 0000-0002-7962-7804
authors.initials: S
authors.lastname: Gehrisch
authors.affiliation: Siemens, Advanced Therapies (S.G., M.K.), Forchheim, Germany.
authors.forename: M
authors.identifier: 0000-0001-9962-3870
authors.initials: M
authors.lastname: Kowarschik
authors.affiliation: From the Department of Biomedical Imaging and Radiological Sciences (K.-K.C., Y.-T.W.), National Yang-Ming University, Taipei, Taiwan.
authors.forename: Y-T
authors.identifier: 0000-0002-6942-0340
authors.initials: YT
authors.lastname: Wu
authors.affiliation: Neurosurgery (H.-C.Y., W.-Y.C.), Taipei Veterans General Hospital, Taipei, Taiwan.
authors.forename: W-Y
authors.identifier: 0000-0002-9343-6289
authors.initials: WY
authors.lastname: Chung
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D015901:Angiography, Digital Subtraction / Q000379:methods*; D020785:Central Nervous System Vascular Malformations / Q000000981:diagnostic imaging / Q000601:surgery; D002560:Cerebrovascular Circulation; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional; D002538:Intracranial Arteriovenous Malformations / Q000000981:diagnostic imaging* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D016634:Radiosurgery / Q000379:methods*; D012189:Retrospective Studies; D055815:Young Adult