Optimization of the Surgical Approach in AVMs Using MRI and 4D DSA Fusion Technique : A technical note.

Area of Science:

• Neuroradiology
• Medical Imaging
• Interventional Neurology

Background:

• Time-resolved 3D digital subtraction angiography (4D DSA) visualizes intracranial vascular malformations.
• Accurate anatomical display of arteriovenous malformations (AVMs) is crucial for treatment planning.

Purpose of the Study:

• To assess the technical feasibility of fusing time-resolved 3D DSA with MPRAGE MRI data.
• To evaluate the reliability of fused images for displaying the AVM nidus and venous drainage.

Main Methods:

• 20 patients with intracranial AVMs underwent pretherapeutic DSA, time-resolved 3D DSA, and MRI (MPRAGE sequences).
• Image fusion was performed using semi-automatic co-registration software followed by manual refinement.
• Co-registered DSA/MRI datasets were evaluated by two independent reviewers.

Main Results:

• Image fusion was successful in all 20 cases with minimal additional setup time.
• Reviewers highly scored the fused images for congruency and accurate anatomical localization.
• The merged images precisely depicted the nidus, feeding arteries, and draining veins.

Conclusions:

• Fusing time-resolved 3D DSA and contrast-enhanced T1-weighted MPRAGE MRI is beneficial for preoperative and intrasurgical workflows in AVM patients.
• The software tool provides the required quality and accuracy for merged images.
• Further studies are needed for clinical validation.