Article Figures & Data
Figures
- Fig 1.
Schematic diagram of 4D-CTA imaging techniques. The x-axis represents the time domain. The y-axis represents the z-dimension. The light-gray horizontal bar represents the area that needs to be covered in the z-dimension. A, Shuttle mode: the sinus represents continuous table movement back and forth in the z-axis dimension to provide adequate coverage of the region of interest at multiple points in time. Notice that the temporal resolution is a function of the speed of table movement, typically 2–4 seconds depending on coverage. B, Toggling-table technique: the bars represent table repositioning in the z-axis dimension to provide adequate coverage of the region of interest at multiple points in time. Notice that the temporal resolution is a function of the speed of table repositioning, typically 3–4 seconds. C, Volume scanning: complete coverage of the region of interest (horizontal bar) with 1 gantry rotation. Notice that the temporal resolution is a function of the scanning interval settings because each rotation provides full coverage. Volume CT scanning enables (D) continuous volume scanning. Temporal resolution is limited by the gantry rotation speed.
- Fig 2.
4D-CTA demonstrating a Borden type I dural arteriovenous fistula of the left sigmoid sinus. Selected 4D-CTA subtraction MIP images of a continuous 4D-CTA volume acquisition (320–detector row CT) in lateral (A) and oblique (B) projections in a patient presenting with left-sided tinnitus. Branches of the occipital artery are identified as arterial feeders of the dAVF. There is normal antegrade venous return. The 3D image (C) demonstrates the advantage of 4D-CTA to study vessels in relation to surrounding structures.
- Fig 3.
Timing-invariant CTA better estimates the extent of collateral circulation in a patient with right middle cerebral artery occlusion. The left image is a conventional CTA showing poor collateral circulation and suggests a poor prognosis. The right image is a TI-CTA image from a 4D-CTA acquisition (ie, temporal MIP), which shows good collateral filling and suggests a good prognosis. In this case, the patient had a good recovery.
- Fig 4.
4D-CTA image demonstrating recurrence of an arteriovenous malformation. The arrow indicates the nidus, which is fed by arterial feeders from the anterior cerebral artery. There is cortical venous drainage toward the rostral superior sagittal sinus.
Tables
Classification of arteriovenous malformations and arteriovenous fistulas
Pathology AVM AVF Distinguishing feature Presence of a nidus No nidus Grading system Spetzler-Martin classification Cognard classification Borden classification Classification Spetzler-Martin AVM grading scale Cognard classification: Size Grade I: in sinus wall; normal antegrade venous drainage Small (<3 cm) = 1 Grade IIa: in sinus; reflux to sinus, not cortical veins Medium (3–6 cm) = 2 Grade IIb: retrograde drainage (reflux) to cortical veins Large (>6 cm) = 3 Grade III: direct cortical venous drainage; no venous ectasia Eloquence of adjacent brain Grade IV: direct cortical venous drainage and venous ectasia Noneloquent = 0 Grade V: Spinal perimedullary venous drainage Eloquent = 1 Borden classification: Venous drainage Type I: dural arterial supply with antegrade venous drainage Superficial only = 0 Type Ia: simple dAVF with single meningeal arterial supply Deep component = 1 Type Ib: complex dAVF with multiple meningeal arteries Type II: retrograde cortical venous drainage Type III: dural arteries drain into cortical veins
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