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Introduction: The use of self-expandable microstents for treatment of broad-based intracranial aneurysms is widely spread. However, poor fluoroscopic visibility of the stents remains disadvantageous during the coiling procedure. Flat detector angiographic computed tomography (ACT) provides high resolution imaging of microstents even though integration of this imaging modality in the neurointerventional workflow has not been widely reported., Methods: An acrylic glass model was used to simulate the situation of a broad-based sidewall aneurysm. After insertion of a self-expandable microstent, ACT was performed. The resulting 3D dataset of the Microstent was subsequently projected into a conventional 2D fluoroscopic roadmap. This 3D visualization of the stent supported the coil embolization procedure of the in vitro aneurysm., Results: In vitro 2D-3D coregistration with integration of 3D ACT data of a self-expandable microstent in a conventional 2D roadmap is feasible., Conclusions: Unsatisfying stent visibility constrains clinical cases with complex parent vessel anatomy and challenging aneurysm geometry; hence, this technique potentially may be useful in such cases. In our opinion, the clinical feasibility and utility of this new technique should be verified in a clinical aneurysm embolization study series using 2D-3D coregistration.

The aim of the study was to test the reliability of intracerebral haemorrhage (ICH) detection with C-arm-mounted flat-detector computed tomography (FD-CT) in the angio suite as compared to multislice CT (MSCT). In this study 44 patients with 45 ICH were included. All patients were investigated with MSCT and FD-CT during angiographic evaluation. As a control group we included 16 patients without ICH. In each haematoma we assessed volumetric data of the ICH and counted the numbers of ICH-positive slices. Using interobserver ratings, we additionally investigated the potential of FD-CT to serve as a diagnostic tool to detect ICH. In FD-CT three haematomas were not detected because of motion and beam-hardening artefacts in the region close to the skull base. The r value for the degree of interobserver agreement for the number of slices was 0.95 for MSCT and 0.94 for FD-CT. Measurements of the area and the calculated volume of the ICH showed high inter- and intraobserver agreement. Our results indicate that FD-CT is a helpful tool in the daily emergency management of ICH patients as detection of ICH was found to be nearly as reliable as in MSCT. Limitations of this technology are motion and beam-hardening artefacts that may mask small haematomas located in the posterior fossa or the skull base.

Though being inferior to magnetic resonance imaging, computed tomography (CT) of the brain is the most frequently applied imaging modality in the diagnostic workup of acute cerebral Ischaemia. We report on a case of a comatose 53-year-old man who was brought to the emergency room after cardiopulmonary resuscitation. The CT of the brain showed a diffuse brain oedema with an explicit hypodense demarcation of all deep nuclei.

Study Design: The technical feasibility of flat panel volumetric computed tomography (FPVCT) for lumbar myelographic imaging was evaluated in 20 patients and compared with multislice computed tomography (MSCT)., Objective: The purpose of this study was to determine the feasibility and sensitivity of FPVCT for myelographic imaging in lumbar spinal stenosis., Summary and Background Data: In the diagnosis of spinal stenosis, myelography and myelo-computed tomography (PCT) have been performed routinely for nearly 30 years. Rotational angiography is a new technique initially developed to visualize vessels but also allowing multiplanar reconstructed (MPR) CT images. The spatial resolution of FPCVT is even higher than in current MSCT. To date, this technique has not been evaluated for use in myelography., Methods: In 20 patients referred for CT for evaluation of low back pain, lumbar myelography was performed on a biplane angiography system equipped with flat panel detectors. FPVCT was provided from a volume data set out of a rotational acquisition and compared with MSCT performed on a 4-slice CT scanner. Hereby, for a total of 100 disc levels (range from L1-L2 to L5-S1), the narrowest dural cross-sectional diameter (D-CSD) and the dural cross-sectional area (D-CSA) referred to MSCT and FPVCT were calculated., Results: Mean D-CSD and C-CSA for all disc levels as measured by MSCT was 9.26 +/- 3.0 mm and 63.2 +/- 10.8 mm, respectively. Compared with D-CSD and C-CSA measured by FPVCT, there was no statistically significant difference (9.48 +/- 2.9 mm and 64.7 +/- 11.2 mm, respectively; P > 0.89). The most pronounced lumbar spinal stenosis was seen on L4/5 level with D-CSD of 6.6 +/- 3.6 mm and 6.8 +/- 3.2 mm and D-CSA of 53.7 +/- 14.7 mm and 55.0 +/- 14.3 mm, respectively., Conclusion: In all patients, the diagnostic quality of the reconstructed FPVCT slice images is comparable to those acquired by MSCT. Using FPVCT, radiographic myelography and postmyelographic computed tomography can be performed with less radiation in a single session at the same imaging system.

Noninvasive diagnostic imaging of the craniocervical and intracranial vasculature is a domain of computed tomography angiography (CTA), magnetic resonance angiography (MRA) and Doppler/duplex ultrasound, the latter not being the topic of this presentation. We give a methodological background for both, CTA and MRA, followed by a critical appraisal of both imaging modalities in the diagnosis of ischemic cerebrovascular disease. The contribution of noninvasive vascular imaging to vascular malformations (including aneurysms, fistulas and cerebral-vein thrombosis) is beyond the scope of this paper and therefore not covered., (Copyright 2007 S. Karger AG, Basel.)