Arterial bolus contrast medium enhancement for computed tomographically guided stereotactic biopsy

Stereotactic biopsy of deep-seated brain lesions by computed tomography guidance with intravenous contrast medium enhancement is now a well-recognized technique. However, arteriography continues to be the best method for studying the vasculature of such lesions. A method is described here in which a limited arteriography can be incorporated into the computed tomographic technique especially for the purpose of avoiding injury to vessels in stereotactic biopsy procedures. The technique requires that a single 4-mL bolus of contrast medium be injected intraarterially as the computed tomography scan for stereotactic localization is performed. The vessels are thereby seen in the same computed tomographic image as that used for stereotactic localization. The method has these additional advantages: it provides more pronounced contrast medium enhancement; it requires only 4 mL of contrast medium and can therefore be used in patients with renal failure; it can often distinguish crude arterial and venous phases; and lastly, it can be performed with routinely available equipment.