3D Cone Beam CT Applications in Neurointerventional Radiology

With Eytan Raz MD PhD

The role of advanced imaging (3D imaging) continues to evolve — from early applications in identifying the right projections for aneurysm coiling to the wealth of information leading to safer and more effective treatments for essentially everything in neurointerventional arena.  One of important educational frontiers in neurovascular space is to facilitate utilization of these readily available capabilities.  This work is being spearheaded at our institution by Dr. Eytan Raz.  The following represent examples of DYNA CT (This is Siemens Q).  These are continuously improving and will be obsolete soon enough.  So we will keep updating them.

We emphasize these contributions in multiple publications

Below are some examples.  These, and many more, in context of interventions / treatments, are found on the Case Library page

Ophthalmic Artery DYNA VR

Cavernous Sinus Inferior Petrosal Sinus Sampling
Ruptured Dorsal Wall Pseudoaneurysm Pipeline Shield Embolization
DYNA ACOM Aneurysm Post WEB and Pipeline Shield Embolization

Moya Moya Fusion

Fusion same case vert and right ICA

Stereo ICA vert fusion

Superior Hypophyseal Aneurysm Pipeline Embolization

Giant Cavernous Aneurysm


Pre-WEB embolization complex ruptured ACOM aneurysm
Ruptured PCOM Aneurysm DYNA CT VR
Difference between 3D-DSA and “DYNA” versions — the higher resolution DYNA images (bottom row) definitively show the subcallosal branch (arrows) not be arising from the ruptured ACOM aneurysm, as strongly suggested by 3D-DSA (top row). The DYNA also identifies the point of rupture (dashed arrow in inset)
Same without arrows
Post coil

Supraclinoid Occlusion Vasa Vasorum
Posterior Cerebral Artery Page VR
Vertebrobasilar Circulation DYNA MIPs — 3 Planes
Venous VR
Spinal Angiography Conus Basket
Spinal Angiography Conus Arterial MIPs
Spinal AVM Pre-Surgical Angiogram VR DYNA
Spinal AVM Pre-Surgical Angiogram VR DYNA
Spinal DYNA CT Dural Fistula
Spinal DYNA CT Dural Fistula
Spinal DYNA CT dural fistula
C1 Lateral Mass Jugular Relationship Normal
C1 Jugular Compression Symptomatic
Petrous Apex Fistula
Stereos Petrous Apex Dural Fistula
Tectal AVM-related pseudoaneurysm — cured by embolization
Example of Superselective Transvenous Dural Fistula Embolization Strategy — these are best seen on DYNA MIPs
Advanced DYNA imaging of “cryptogenic” hemorrhage — pseudoaneurysms
Middle Meningeal Artery Angioarchitecture Prior to MMA Embolization
Superior Sagittal Sinus Wall Meningeal Vasculature
Subdural Membranes Pre-MMA Embolization
Subdural Membranes DYNA MIP
Skull Metastasis Preoperative Embolization
C2 Transoral Vertebral Augmentation
Access Post Fusion Rescue Vertebral Augmentation
Post Augmentation