Aortic arch injection with C-arm cone beam CT for radiosurgery treatment planning of cerebral arteriovenous malformations: Technical note

Background: C-arm cone beam CT (CBCT) with selective intra-arterial contrast injection combined with digital subtraction angiography (DSA) is currently used for the evaluation and treatment planning of cerebral arteriovenous malformations (AVMs). In some instances an AVM will derive its blood supply from more than one main cervical artery (carotid and/or vertebral artery) and a single-vessel injection will not adequately demonstrate the entire AVM nidus. Methods: Three patients with cerebral AVM in whom the entire nidus could not be visualized by injection of a single cervical artery are reported. CBCT dataset acquisition was performed by intra-arterial contrast injection in the ascending thoracic aorta through a 5 F pigtail catheter. The injection of diluted iodinated contrast agent (35%) lasted 22 s at a rate of 8 ml/s for a total volume of 176 ml (61.6 ml of contrast agent). The dataset was then processed using standard reconstruction methods. Results: Contrast injection in the ascending aorta during a single CBCT acquisition provided a volumetric dataset adequate for subsequent radiosurgical treatment planning. Conclusion: This is a safe and effective angiographic technique for the acquisition of volumetric datasets using CBCT that are suitable for treatment planning of intracranial AVMs deriving their blood supply from more than one major cervical artery. This technique allows imaging of the entire AVM nidus during a single CBCT acquisition.