Use of MR angiography for stereotactic planning

With the introduction of MR angiography (MRA) into clinical routine MR protocols, it has become possible now to image flowing as well as stationary tissue with excellent contrast using a single modality. This has opened up new perspectives for planning stereotactic approaches, which are characterized by high risks for damaging intracerebral vessels or vital brain structures. In this article we present an MRA based planning method for the treatment of arteriovenous malformations by stereotactic radiosurgery. It includes flow compensated gradient echo pulse sequences for the acquisition of angiographic MR datasets, a stereotactic MR marker system, an algorithm for the correction of geometric distortion of MR image data, and a three-dimensional workstation system for the creation and evaluation of treatment plans. The latter is based on the concept of simultaneously displaying both MR slice and angiographic projection images. This allows the evaluation of intracerebral vasculature together with brain anatomy. The MRA guided planning approach was tested and compared to a conventional X-ray angiographic technique in a clinical study. Our satisfactory results suggest that MRA is a technique that can be used advantageously for stereotactic planning.