Fused magnetic resonance angiography and 2D fluoroscopic visualization for endovascular intracranial neuronavigation

Technical note

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Advanced transluminal neurovascular navigation is an indispensable image-guided method that allows for real-time navigation of endovascular material in critical neurovascular settings. Thus far, it has been primarily based on 2D and 3D angiography, burdening the patient with a relatively high level of iodinated contrast. However, in the patients with renal insufficiency, this method is no longer tolerable due to the contrast load. The authors present a novel image guidance technique based on periprocedural fluoroscopic images fused with a preinterventionally acquired MRI data set. The technique is illustrated in a case in which the fused image combination was used for endovascular treatment of a giant cerebral aneurysm.

Abbreviations used in this paper:FDCT = flat detector CT; MRA = MR angiography.

Article Information

Address correspondence to: Naci Kocer, M.D., Department of Radiology, Division of Neuroradiology, Cerrahpasa Medical School, University of Istanbul, Kocamustafapasa, Istanbul 34098, Turkey. email: nkocer@istanbul.edu.tr.

Please include this information when citing this paper: published online December 14, 2012; DOI: 10.3171/2012.11.JNS111355.

© AANS, except where prohibited by US copyright law.

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    The previously acquired MR image (purple) is fused with the live fluoroscopic images (gray).

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    The MRI overlay is updated in real time to capture any change in C-arm viewing incidence and table movement.

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    The stent deployment is checked by acquiring a high-resolution FDCT reconstruction.

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