P-007 Initial experience with a combined multi-detector row CT and a biplane angiography suite with a single interactive table for the evaluation and treatment of vascular disease involving the head and neck
Authors: Gemmete J , Chaudhary N , Pandey A , Thompson B , Maher C , Ansari S 
Published: December 2010

Introduction and purpose

The purpose of this study is to present our initial experience with the usefulness of a combined multi-detector row CT and biplane angiographic system with a single interactive table for the evaluation and treatment of vascular disease involving the head and neck.

Materials and methods

Between June 2009 and January 2010, 29 patients (17 women, 12 men, mean age 44 years, range 11–81) at our institution were studied utilizing this combined multi-detector row CT and biplane angiography suite with a single interactive table. Direct intra-arterial injection of contrast with CT imaging (IA-CTA) was performed in nine vascular tumors, three intracranial arteriovenous malformations, four spinal vascular lesions and one aneurysm. CT perfusion imaging was obtained in five temporary balloon occlusion tests. CT perfusion imaging was also performed in two ischemic stroke and two vasospasm cases prior to angiography. In addition, a high quality CT scan of the head was readily obtained in two patients during aneurysm coiling with acute elevation of intracranial pressure. Finally, CT venography of the skull base was performed through contrast injection into the inferior petrosal sinus in two inferior petrosal sinus sampling cases.

Results

All studies were technically successful and there were no complications. IA-CTA provided better definition of architecture and true extent of the tumor when compared with conventional MRI and CT imaging. This was particularly striking in two glomus jugulare tumors invading the jugular foramen and middle ear cavity. Small cerebral arteriovenous malformations were mapped easily on high resolution IA-CTA images, enabling microsurgical resection or stereotactic radiosurgery. The exact site of fistula communication in four spinal dural arteriovenous fistulas was accurately defined on cross section imaging enabling microsurgical resection or endovascular treatment. A 1.5 mm left P3 aneurysm was more readily apparent on the IA-CTA images. CT perfusion imaging was easily performed during five temporary balloon occlusion tests providing additional prognostic information about the patient's stroke risk prior to carotid sacrifice. CT perfusion imaging was also easily performed prior to two stroke and vasospasm cases providing immediate information prior to intervention. The single interactive table allowed angiography to be immediately performed after physiological imaging expediting treatment. CT head was obtained immediately after acute elevation of intracranial pressure in two patients being worked up for subarachnoid hemorrhage. The single interactive table allowed the patient to be scanned without transfer, ruling out rebleeding from the aneurysm, hydrocephalus and intracranial herniation. Finally, the exact location of the catheter was confirmed in two patients referred for inferior petrosal sinus sampling. Contrast injection through the catheter exquisitely defined the venous sinuses of the skull base.

Conclusion

In combining a multi-detector row CT system and a biplane angiographic unit with a single interactive table, this hybrid system improves the diagnostic and therapeutic capabilities of treating vascular disease involving the head and neck.