title: CT reconstruction and MRI fusion of 3D rotational angiography in the evaluation of pediatric cerebrovascular lesions.
abstract: OBJECTIVE
  Complex neurovascular lesions in children require precise anatomic understanding for treatment planning. Although 3DRA is commonly employed for volumetric reformation in neurointerventional procedures, the ability to reconstruct this data into CT-like images (3DRA-CT) is not widely utilized. This study demonstrates the feasibility and usefulness of 3DRA-CT and subsequent MRI fusion for problem solving in pediatric neuroangiography.
  
  
  METHODS
  This retrospective study includes 18 3DRA-CT studies in 16 children (age 9.6 ± 3.8 years, range 2-16 years) over 1 year. After biplane 2D-digital subtraction angiography (DSA), 5-second 3DRA was performed with selective vessel injection either with or without subtraction. Images were reconstructed into CT sections which were post-processed to generate multiplanar reformation (MPR) and maximum intensity projection (MIP) images. Fusion was performed with 3D T1 MRI images to precisely demonstrate neurovascular relationships. Quantitative radiation metrics were extracted and compared against those for the entire examination and for corresponding biplane 2D-DSA acquisitions.
  
  
  RESULTS
  In all 18 cases, the 3DRA procedure and MRI fusion were technically successful and provided clinically useful information relevant to management. The unsubtracted and subtracted 3DRA acquisitions were measured to deliver 5.9 and 132.2%, respectively, of the mean radiation dose of corresponding biplane 2D-DSA acquisitions and contributed 1.2 and 12.5%, respectively, to the total procedure dose.
  
  
  CONCLUSIONS
  Lower radiation doses, high spatial resolution, and multiplanar reformatting capability make 3DRA-CT a useful adjunct to evaluate neurovascular lesions in children. Fusing 3DRA-CT data with MRI is an additional capability that can further enhance diagnostic information.
authors.affiliation: Pediatric Neuroradiology and Image Guided Therapy, Department of Diagnostic Imaging, The Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada. prakash.muthusami@sickkids.ca.
authors.forename: Prakash
authors.identifier: http://orcid.org/0000-0002-7062-9571
authors.initials: P
authors.lastname: Muthusami
authors.affiliation: Medical Physics, Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, ON, Canada.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Shkumat
authors.affiliation: Pediatric Neuroradiology and Image Guided Therapy, Department of Diagnostic Imaging, The Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada.
authors.forename: Vanessa
authors.initials: V
authors.lastname: Rea
authors.affiliation: Department of Interventional Neuroradiology, Institute of Neurological Sciences, Prince of Wales Hospital, Randwick, NSW, Australia.
authors.forename: Albert H
authors.initials: AH
authors.lastname: Chiu
authors.affiliation: Pediatric Neuroradiology and Image Guided Therapy, Department of Diagnostic Imaging, The Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada.
authors.forename: Manohar
authors.initials: M
authors.lastname: Shroff
mesh_terms: D000293:Adolescent; D015901:Angiography, Digital Subtraction; D002533:Cerebral Angiography; D002561:Cerebrovascular Disorders / Q000000981:diagnostic imaging*; D002648:Child; D002675:Child, Preschool; D000072226:Computed Tomography Angiography; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional; D007223:Infant; D018810:Magnetic Resonance Angiography; D008297:Male; D064847:Multimodal Imaging; D012189:Retrospective Studies
keywords: Cerebral angiography; Cone-beam computed tomography; Pediatric; Radiation dose; Three-dimensional imaging