Flat-Panel Computed Tomography (DYNA-CT) in Neuroradiology. From High-Resolution Imaging of Implants to One-Stop-Shopping for Acute Stroke

Abstract

Originally aimed at improving standard radiography by providing higher absorption efficiency and a wider dynamic range, flat-panel detector technology has meanwhile got widely accepted in the neuroradiological community. Especially flat-panel detector computed tomography (FD-CT) using rotational C-arm mounted flat-panel detector technology is capable of volumetric imaging with a high spatial resolution. By providing CT-like images of the brain within the angio suite, FD-CT is able to rapidly visualize hemorrhage and may thus improve complication management without the need of patient transfer. As “Angiographic CT” FD-CT may be helpful during many diagnostic and neurointerventional procedures and for noninvasive monitoring and follow-up. In addition, spinal interventions and high-resolution imaging of the temporal bone might also benefit from FD-CT. Finally, using novel dynamic perfusion and angiographic protocols, FD-CT may provide functional information on brain perfusion and vasculature with the potential to replace standard imaging in selected acute stroke patients.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7

References

  1. 1

    Dörfler A, Struffert T, Engelhorn T, Richter G. Rotational flat-panel CT in diagnostic and interventional neuroradiology. Rofo. 2008;180:891–8.

    Article  PubMed  Google Scholar 

  2. 2

    Doelken M, Struffert T, Richter G, Engelhorn T, Nimsky C, Ganslandt O, Hammen T, Doerfler A. Flat-panel detector volumetric CT for visualization of subarachnoid hemorrhage and ventricles: preliminary results compared to conventional CT. Neuroradiology. 2008;50:517–23.

    CAS  Article  PubMed  Google Scholar 

  3. 3

    Struffert T, Richter G, Engelhorn T, Doelken M, Goelitz P, Kalender WA, Ganslandt O, Doerfler A. Visualization of intracerebral hemorrhage with flat-detector CT compared to multislice CT: results in 44 cases. Eur Radiol. 2009;19:619–25.

    Article  PubMed  Google Scholar 

  4. 4

    Struffert T, Eyupoglu IY, Huttner HB, Engelhorn T, Dölken M, Saake M, Ganslandt O, Doerfler A. Clinical evaluation of flat-panel detector compared with multislice computed tomography in 65 patients with acute intracranial hemorrhage: initial results. Clinical article. J Neurosurg. 2010;113:901–7.

    Article  PubMed  Google Scholar 

  5. 5

    Richter G, Engelhorn T, Struffert T, Doelken M, Ganslandt O, Hornegger J, Kalender WA, Doerfler A. Flat panel detector angiographic CT for stent-assisted coil embolization of broad-based cerebral aneurysms. AJNR Am J Neuroradiol. 2007;28:1902–8.

    CAS  Article  PubMed  Google Scholar 

  6. 6

    Richter G, Pfister M, Struffert T, Engelhorn T, Doelken M, Spiegel M, Hornegger J, Doerfler A. Technical feasibility of 2D-3D coregistration for visualization of self-expandable microstents to facilitate coil embolization of broad-based intracranial aneurysms: an in vitro study. Neuroradiology. 2009;51:851–4.

    Article  PubMed  Google Scholar 

  7. 7

    Pfaff J, Struffert T, Gölitz P, Doerfler A. Angiographic CT for intraprocederal monitoring of complex neuroendovascular procedures. AJNR Am J Neuroradiol. 2013;34:77–80.

    Article  Google Scholar 

  8. 8

    Engelhorn T, Struffert T, Richter G, Doelken M, Ganslandt O, Kalender W, Doerfler A. Flat-panel detector angiographic CT in the management of aneurysmal rupture during coil embolization. AJNR Am J Neuroradiol. 2008;29:1581–4.

    CAS  Article  PubMed  Google Scholar 

  9. 9

    Struffert T, Saake M, Ott S, Engelhorn T, Gölitz P, Kloska S, Doelken M, Doerfler A. Intravenous flat detector CT angiography for non-invasive visualisation of intracranial flow diverter: technical feasibility. Eur Radiol. 2011;21:1797–801.

    Article  PubMed  Google Scholar 

  10. 10

    Saake M, Struffert T, Goelitz P, Ott S, Seifert F, Ganslandt O, Doerfler A. Angiographic CT with intervenous contrast agent application for monitoring of intracranial flow diverting stents. Neuroradiology. 2012;54:727–35.

    Article  PubMed  Google Scholar 

  11. 11

    Buhk JH, Lingor P, Knauth M. Angiographic CT with intravenous administration of contrast medium is a noninvasive option for follow-up after intracranial stenting. Neuroradiology. 2008;50:349–54.

    Article  PubMed Central  PubMed  Google Scholar 

  12. 12

    Struffert T, Deuerling-Zheng Y, Kloska S, Engelhorn T, Strother CM, Kalender WA, Köhrmann M, Schwab S, Doerfler A. Flat detector CT in the evaluation of brain parenchyma, intracranial vasculature, and cerebral blood volume: a pilot study in patients with acute symptoms of cerebral ischemia. AJNR Am J Neuroradiol. 2010;31:1462–9.

    CAS  Article  PubMed  Google Scholar 

  13. 13

    Struffert T, Deuerling-Zheng Y, Kloska S, Engelhorn T, Boese J, Zellerhof M, Schwab S, Doerfler A. Cerebral blood volume imaging by flat detector computed tomography in comparison to conventional multislice CT. Eur Radiol. 2011;21:882–9.

    Article  PubMed  Google Scholar 

  14. 14

    Struffert T, Deuerling-Zheng Y, Engelhorn T, Kloska S, Gölitz P, Köhrmann M, Schwab S, Strother CM, Doerfler A. Feasibility of cerebral blood volume mapping by flat detector computed tomography in the angio suite: first experience in patients with acute middle cerebral artery occlusions. AJNR Am J Neuroradiol. 2012;33:618–25.

    CAS  Article  PubMed  Google Scholar 

  15. 15

    Saake M, Breuer L, Goelitz P, Ott S, Struffert T, Doerfler A. Detector computed tomography angiography with intravenous contrast application: feasibility for visualization of cerebral arterial vasculature. J Neuroimaging. 2013;23:414–20.

    Article  PubMed  Google Scholar 

  16. 16

    Engelhorn T, Rennert J, Richter G, Struffert T, Ganslandt O, Doerfler A. Myelography using flat panel volumetric computed tomography: a comparative study in patients with lumbar spinal stenosis. Spine (Phila Pa 1976). 2007;32(18):E523-7.

    Article  Google Scholar 

  17. 17

    Struffert T, Hertel V, Kyriakou Y, Krause J, Engelhorn T, Schick B, Iro H, Hornung J, Doerfler A. Imaging of cochlear implant electrode array with flat-detector CT and conventional multislice CT: comparison of image quality and radiation dose. Acta Otolaryngol. 2010;130:443–52.

    Article  PubMed  Google Scholar 

  18. 18

    Bozzato A, Struffert T, Hertel V, Iro H, Hornung J. Analysis of the accuracy of high-resolution computed tomography techniques for the measurement of stapes prostheses. Eur Radiol. 2010;20:566–71.

    Article  PubMed  Google Scholar 

  19. 19

    Kalender WA, Kyriakou Y. Flat-detector computed tomography (FD-CT). Eur Radiol. 2007;17:2767–79.

    Article  PubMed  Google Scholar 

  20. 20

    Akpek S, Brunner T, Benndorf G, Strother C. Three-dimensional imaging and cone beam volume CT in C-arm angiography with flat panel detector. Diagn Interv Radiol. 2005;11:10–3.

    PubMed  Google Scholar 

  21. 21

    Doerfler A, Wanke I, Egelhof T, Dietrich U, Asgari S, Stolke D, Forsting M. Aneurysmal rupture during embolization with Guglielmi detachable coils: causes, management, and outcome. AJNR Am J Neuroradiol. 2001;22:1825–32.

    CAS  PubMed  Google Scholar 

  22. 22

    Ogilvy CS, Stieg PE, Awad I, Brown RD Jr, Kondziolka D, Rosenwasser R, Young WL, Hademenos G; Special Writing Group of the Stroke Council, American Stroke Association. AHA Scientific Statement: recommendations for the management of intracranial arteriovenous malformations: a statement for healthcare professionals from a special writing group of the Stroke Council, American Stroke Association. Stroke. 2001;32:1458–71.

    CAS  Article  PubMed  Google Scholar 

  23. 23

    Gölitz P, Struffert T, Knossalla F, Saake M, Ott S, Ganslandt O, Doerfler A. Angiographic CT with intravenous contrast injection compared with rotational angiography in the diagnostic work-up of cerebral aneurysms. AJNR Am J Neuroradiol. 2012;33:982–7.

    Article  PubMed  Google Scholar 

  24. 24

    Gölitz P, Struffert T, Ganslandt O, Saake M, Lücking H, Rösch J, Knossalla F, Doerfler A. Optimized angiographic computed tomography with intravenous contrast injection: an alternative to conventional angiography in the follow-up of clipped aneurysms? J Neurosurg. 2012;117:29–36.

    Article  PubMed  Google Scholar 

  25. 25

    Gölitz P, Struffert T, Ganslandt O, Lang S, Knossalla F, Doerfler A. Contrast-enhanced angiographic computed tomography for detection of aneurysm remnants after clipping: a comparison with digital subtraction angiography in 112 clipped aneurysms. Neurosurgery. 2014;74:606–14.

    Article  PubMed  Google Scholar 

  26. 26

    Gölitz P, Struffert T, Kaschka I, Roessler K, Knossalla F, Doerfler A. Optimized angiographic CT using intravenous contrast injection: a noninvasive imaging option for the follow-up of coiled aneurysms? AJNR Am J Neuroradiol. 2014;35:2341–7.

    Article  PubMed  Google Scholar 

  27. 27

    Prell D, Kyriakou Y, Struffert T, Dörfler A, Kalender WA. Metal artifact reduction for clipping and coiling in interventional C-arm CT. AJNR Am J Neuroradiol. 2010;31:634–9.

    CAS  Article  PubMed  Google Scholar 

  28. 28

    Levy E, Turk A, Albuquerque F, Niemann DB, Aagaard-Kienitz B, Pride L, Purdy P, Welch B, Woo H, Rasmussen PA, Hopkins LN, Masaryk TJ, McDougall CG, Fiorella DJ. Wingspan in-stent restenosis and thrombosis. Incidence, clinical presentation, and management. Neurosurgery. 2007;61:644–51.

    Article  PubMed  Google Scholar 

  29. 29

    Struffert T, Kloska S, Engelhorn T, Deuerling-Zheng Y, Ott S, Doelken M, Saake M, Köhrmann M, Doerfler A. Optimized intravenous Flat Detector CT for non-invasive visualisation of intracranial stents: first results. Eur Radiol. 2011;21:411–8.

    Article  PubMed  Google Scholar 

  30. 30

    Davis B, Royalty K, Kowarschik M, Rohkohl C, Oberstar E, Aagaard-Kienitz B, Niemann D, Ozkan O, Strother C, Mistretta C. 4D digital subtraction angiography: implementation and demonstration of feasibility. AJNR Am J Neuroradiol. 2013;34:1914–21.

    CAS  Article  PubMed  Google Scholar 

  31. 31

    Lang S, Gölitz P, Rösch J, Dietzel M, Kowarschik M, Banckwitz R, Royalty K, Struffert T, Dörfler A. 4-D DSA: Ein neues FD-CT Verfahren zur zeitlich aufgelösten dreidimensionalen Darstellung der cerebralen Gefäßanatomie. Clin Neuroradiol. 2014;2014:(Suppl. 24):9.

    Google Scholar 

  32. 32

    Royalty K, Manhart M, Pulfer K, Deuerling-Zheng Y, Strother C, Fieselmann A, Consigny D. C-arm CT measurement of cerebral blood volume and cerebral blood flow using a novel high-speed acquisition and a single intravenous contrast injection. AJNR Am J Neuroradiol. 2013;34:2131–8.

    CAS  Article  PubMed  Google Scholar 

  33. 33

    Jürgens JH, Schulz N, Wybranski C, Seidensticker M, Streit S, Brauner J, Wohlgemuth WA, Deuerling-Zheng Y, Ricke J, Dudeck O. Time-resolved perfusion imaging at the angiography suite: preclinical comparison of a new flat-detector application to computed tomography perfusion. Invest Radiol. 2015;50(2):108–13.

    Article  PubMed  Google Scholar 

  34. 34

    Struffert T, Deuerling-Zheng Y, Kloska S, Engelhorn T, Lang S, Mennecke A, Manhart M, Strother CM, Schwab S, Doerfler A.Dynamic Angiography and Perfusion Imaging Using Flat Detector CT in the Angiography Suite: A Pilot Study in Patients with AcuteMiddle Cerebral Artery Occlusions. AJNR Am J Neuroradiol. 2015. doi:10.3174/ajnr.A4383.

  35. 35

    Hung SC, Lin CJ, Guo WY, Chang FC, Luo CB, Teng MM, Chang CY. Toward the era of a one-stop imaging service using an angiography suite for neurovascular disorders. Biomed Res Int. 2013;2013:873614.

    PubMed Central  PubMed  Google Scholar 

  36. 36

    Struffert T, Hauer M, Banckwitz R, Köhler C, Royalty K, Doerfler A. Effective dose to patient measurements in flat-detector and multislice computed tomography: a comparison of applications in neuroradiology. Eur Radiol. 2014;24:1257–65.

    Article  PubMed  Google Scholar 

Download references

Author information

Affiliations

Authors

Corresponding author

Correspondence to A. Doerfler MD, PhD.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Doerfler, A., Gölitz, P., Engelhorn, T. et al. Flat-Panel Computed Tomography (DYNA-CT) in Neuroradiology. From High-Resolution Imaging of Implants to One-Stop-Shopping for Acute Stroke. Clin Neuroradiol 25, 291–297 (2015). https://doi.org/10.1007/s00062-015-0423-x

Download citation

Keywords

  • Angiography
  • Flat-panel detector computed tomography
  • Neurovascular
  • Perfusion imaging, high spatial resolution imaging