Dynamic CT Angiography for Cyberknife Radiosurgery Planning of Intracranial Arteriovenous Malformations: A Technical/ Feasibility Report
Successful radiosurgery for arteriovenous malformations (AVM) requires accurate nidus delineation in the treatment planning system (TPS). The catheter biplane digital subtraction angiogram (DSA) has traditionally been the gold standard for evaluation of the AVM nidus, but its 2D nature limits its value for contouring and it cannot be imported into the Cyberknife TPS. We describe a technique for acquisition and integration of 3D dyamic CT angiograms (dCTA) into the Cyberknife TPS for intracranial AVMs and review the feasibility of using this technique in the first patient cohort.
Dynamic continuous CT whole brain images were acquired in a Toshiba 320 volume CT scanner with data reconstruction every 0.5 sec. This multi time-point acquisition enabled us to chose the CT dataset with the clearest nidus without significant enhancement of surrounding blood vessels. This was imported into the Cyberknife TPS and co-registered with planning CT and T2 MRI (2D DSA adjacent for reference). The feasibility of using dCTA was evaluated in the first 13 patients with outcome evaluation from patient records.
dCTA was accurately co-registered in the Cyberknife TPS and appeared to assist in nidus contouring for all patients. Imaging modalities were complementary. 85% of patients had complete (6/13) or continuing partial (5/13) nidus obliteration at 37 months median follow-up.
dCTA is a promising imaging technique that can be successfully imported into the Cyberknife TPS and appears to assist in radiosurgery nidus definition. Further study to validate its role is warranted.