Helical 3D DSA for Whole-Head-and-Neck Vascular Imaging: Technical Development and First-in-Human Application

Background Conventional three-dimensional (3D) digital subtraction angiography (DSA) has limited longitudinal coverage, requiring multiple selective injections and acquisitions for head-and-neck vascular assessment, increasing procedural complexity and contrast material use. Purpose To develop and evaluate the feasibility of a helical 3D DSA technique for panoramic 3D angiography of the entire head-and-neck vasculature using a single contrast material injection and a single acquisition. Materials and Methods A continuous helical scanning trajectory was implemented on a robotic C-arm system using 400° rotation with simultaneous axial translation. The technique was evaluated in phantom experiments to assess geometric accuracy and imaging performance, in vivo imaging in two swine to optimize contrast material injection protocols, and a feasibility study in a human patient with bilateral carotid disease. Results The helical scan achieved a longitudinal coverage of 419.4 mm within 7.6 seconds (conventional 3D DSA: 174.0 mm within 5.0 seconds). Spatial resolution was preserved at 11 line pairs per centimeter on Catphan 700 testing, equivalent to that of conventional 3D DSA. In a simulated head-and-neck vascular phantom, the mean absolute percentage error in contrast to noise ratio between the two techniques was 2.18% ± 0.68 (SD). In two swine, undiluted contrast agent injected at 10 mL/sec produced diagnostically adequate image quality, with high interreader agreement among three readers (intraclass correlation coefficient > 0.90). In the human case, helical 3D DSA enabled continuous 3D angiography from the aortic arch to the cranial vertex in a single acquisition. Stenosis rate measurements in the ophthalmic segment of the left internal carotid artery showed strong agreement between methods, with a mean absolute error of 2.57% ± 0.90. Conclusion This study demonstrated the feasibility of a helical scanning trajectory in 3D DSA, achieving panoramic 3D angiography from the aortic arch to the cranial vertex in a single acquisition while preserving high spatial resolution and contrast fidelity. © The Author(s) 2026. Published by the Radiological Society of North America under a CC BY 4.0 license. Supplemental material is available for this article.