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Three-Dimensional Rotational Angiography of Neurovascular Lesions in Pediatric Patients

¹ Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., Cincinnati, OH 45229-3039.

View larger version (99K): [in a new window]   Fig. 1A —Vein of Galen aneurysmal malformation in 8-month-old female infant. Anteroposterior angiogram with injection in left vertebral artery shows vein of Galen aneurysmal malformation (arrows) with primary supply from left posterior choroidal artery (arrowheads).

View larger version (65K): [in a new window]   Fig. 1B —Vein of Galen aneurysmal malformation in 8-month-old female infant. Anteroposterior gradient-rendered view of 3D rotational angiography (RA) shows precise location and orientation of feeding artery (arrows) to malformation.

View larger version (114K): [in a new window]   Fig. 1C —Vein of Galen aneurysmal malformation in 8-month-old female infant. Two views of shaded-surface cut-away 3D RA show flow into aneurysmal malformation through feeding vessel (arrows) and precise diameter of feeding vessel in preparation for coil embolization.

View larger version (92K): [in a new window]   Fig. 1D —Vein of Galen aneurysmal malformation in 8-month-old female infant. Two views from volume-rendered 3D RA obtained 16 months after partial embolization. Note previous area of embolization (arrows), as determined with conventional angiography, and new vessel (arrowheads) feeding aneurysmal malformation. Cut-away feature of 3D RA workstation used to locate exact site of feeding vessel enters aneurysmal malformation from the left.

View larger version (66K): [in a new window]   Fig. 1E —Vein of Galen aneurysmal malformation in 8-month-old female infant. Oblique view of shaded-surface reconstruction from left vertebral artery injection after second embolization. Previously placed embolization coils (arrows) are gray with residual right-sided posterior choroidal arterial feeder (arrowheads) inferior and lateral to coil mass.

View larger version (158K): [in a new window]   Fig. 2A —2-month-old female infant with arteriovenous fistula from middle cerebral artery to vein of Labbé. Axial T2-weighted MR image shows enlarged transverse sinus (arrows) secondary to arteriovenous fistula.

View larger version (169K): [in a new window]   Fig. 2B —2-month-old female infant with arteriovenous fistula from middle cerebral artery to vein of Labbé. Anteroposterior conventional angiogram shows dilated transverse sinus (arrows).

View larger version (100K): [in a new window]   Fig. 2C —2-month-old female infant with arteriovenous fistula from middle cerebral artery to vein of Labbé. Anteroposterior gradient-rendered view of 3D rotational angiography (RA) shows arteriovenous fistula from middle cerebral artery (arrows) to vein of Labbé (arrowheads). Three-dimensional RA was performed immediately before coil embolization.

View larger version (109K): [in a new window]   Fig. 2D —2-month-old female infant with arteriovenous fistula from middle cerebral artery to vein of Labbé. Medial gradient-rendered view of 3D RA shows arteriovenous fistula from middle cerebral artery (arrows) to vein of Labbé (arrowheads).

View larger version (109K): [in a new window]   Fig. 2E —2-month-old female infant with arteriovenous fistula from middle cerebral artery to vein of Labbé. Posterior craniocaudal oblique volume-rendered view of 3D RA shows arteriovenous fistula from middle cerebral artery (arrows) to vein of Labbé (arrowheads). On the basis of 3D RA images, chronology of coil embolization was planned; patient underwent two scheduled rounds of embolization with obliteration of arteriovenous fistula.

View larger version (159K): [in a new window]   Fig. 3A —Arteriovenous malformation (AVM) of mandible in 10-year-old girl who presented with massive hemorrhage after attempted extraction of impacted molar tooth. Coronal contrast-enhanced T1-weighted MR image shows enhancement within left mandible (arrows) and enlarged draining vein (arrowheads), indicating high-flow AVM.

View larger version (109K): [in a new window]   Fig. 3B —Arteriovenous malformation (AVM) of mandible in 10-year-old girl who presented with massive hemorrhage after attempted extraction of impacted molar tooth. Lateral oblique projection of volume-rendered MR angiography shows dilated vein draining from AVM (arrows) in mandible, with arterial supply from internal maxillary artery (M) and lingual and facial arteries (arrowheads).

View larger version (133K): [in a new window]   Fig. 3C —Arteriovenous malformation (AVM) of mandible in 10-year-old girl who presented with massive hemorrhage after attempted extraction of impacted molar tooth. Medial view of volume color-rendered 3D rotational angiography from injection of left external carotid artery shows supply to AVM from lingual and facial arteries (arrows) and from palatal branches of internal maxillary artery (arrowheads).

View larger version (102K): [in a new window]   Fig. 3D —Arteriovenous malformation (AVM) of mandible in 10-year-old girl who presented with massive hemorrhage after attempted extraction of impacted molar tooth. Lateral view of same reconstruction as C shows AVM (arrows) and markedly dilated draining vein (arrowheads).

View larger version (104K): [in a new window]   Fig. 4A —Meningioma in 7-year-old boy. Axial contrast-enhanced T1-weighted MR image shows meningioma (arrows) in left parietal lobe is impinging on branches of middle cerebral artery in sylvian fissure.

View larger version (110K): [in a new window]   Fig. 4B —Meningioma in 7-year-old boy. Lateral oblique volume-rendered view of 3D rotational angiography (RA) from left common carotid arterial injection shows external carotid artery (arrowheads), internal carotid artery (I), and vessel paucity (arrows) in area of meningioma.

View larger version (107K): [in a new window]   Fig. 4C —Meningioma in 7-year-old boy. Anteroposterior shaded-surface views of 3D RA without (left image) and with (right image) spherical volume measurement of tumor (green) show location and mass effect of meningioma. Internal carotid artery (arrows) and superficial temporal branch of external carotid artery (arrowheads) are shown.

View larger version (89K): [in a new window]   Fig. 4D —Meningioma in 7-year-old boy. Lateral oblique shaded-surface view of 3D RA depicts spherical volume measurement of tumor (green). Internal carotid artery (arrows) and superficial temporal branch of external carotid artery (arrowheads) are shown.

View larger version (68K): [in a new window]   Fig. 4E —Meningioma in 7-year-old boy. Lateral shaded-surface view of 3D RA with spherical volume measurement (green). Internal carotid artery (arrows) and superficial temporal branch of external carotid artery (arrowheads) are shown. Three-dimensional RA enables neurosurgical team to delineate ideal surgical approach that would identify middle cerebral artery branches at risk before encountering them in operating suite.

View larger version (159K): [in a new window]   Fig. 5A —10-year-old boy with gunshot injury to neck. Axial CT image shows left common carotid artery (arrows) near bullet.

View larger version (163K): [in a new window]   Fig. 5B —10-year-old boy with gunshot injury to neck. Axial CT image illustrates that visualization of left common carotid artery is compromised by metallic artifact secondary to bullet.

View larger version (29K): [in a new window]   Fig. 5C —10-year-old boy with gunshot injury to neck. Medial posterior oblique shaded-surface view of 3D rotational angiography (RA) shows bullet near common carotid artery. Note artifactual defect suggesting spasm or stenosis of common carotid artery adjacent to bullet.

View larger version (167K): [in a new window]   Fig. 5D —10-year-old boy with gunshot injury to neck. Medial anterior oblique view from 2D RA shows bullet does not contact common carotid artery, which is intact. Surgical exploration and anticoagulation therapy were withheld, and patient recovered.

View larger version (130K): [in a new window]   Fig. 6A —Calcified lesion near vertebral artery in 15-year-old boy who underwent CT for evaluation of football injury. Axial CT image shows incidental calcified lesion (arrows) near left vertebral artery (arrowheads).

View larger version (64K): [in a new window]   Fig. 6B —Calcified lesion near vertebral artery in 15-year-old boy who underwent CT for evaluation of football injury. MR angiography image shows left vertebral artery (arrows) but does not exclude vessel injury secondary to artifact and irregular appearance of vessel wall.

View larger version (34K): [in a new window]   Fig. 6C —Calcified lesion near vertebral artery in 15-year-old boy who underwent CT for evaluation of football injury. Anteroposterior shaded-surface view of 3D rotational angiography (RA) shows vertebral artery (arrows) without evidence of vascular lesion.

View larger version (31K): [in a new window]   Fig. 6D —Calcified lesion near vertebral artery in 15-year-old boy who underwent CT for evaluation of football injury. Medial shaded-surface view of 3D RA shows intact vertebral artery (arrows). Three-dimensional RA was performed and showed no evidence for dissection or pseudoaneurysm. Lesion has remained stable and is presumed unrelated to trauma at presentation.

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