Preliminary experience of three-dimensional computed tomography angiography (3D-CTA) in the diagnosis and preoperative evaluation of cerebral arteriovenous malformations(AVMs)

Objective To assess the role of 3D CTA in the diagnosis and preoperative evaluation of cerebral AVMs.Methods Twenty five consecutive cases of cerebral AVM were studied with both 3D CTA and digital subtraction angiography (DSA). 3D CTA images were reconstructed by surface shaded display(SSD), maximum intensity projection (MIP), color SSD and transparent SSD methods. Results 3D CTA images demonstrated 24 AVMs whereas DSA showed 25 AVMs. 3D CTA is superior to DSA for depicting the 3D angioarchitecture of the feeding arteries, nidus and draining veins as well as surrounding bony structures. In a patient with small cerebellar AVM associated one aneurysm of feeding artery, 3D CTA did not reveal the small AVM but clearly revealed the coexisting aneurysm of distal posterior inferior cerebellar artery (PICA) which can not demonstrated clearly by DSA. 3D CTA reconstruction in an operative view were useful in identification of feeding arteries, nidus and draining veins during the operation. Conclusions 3D CTA has its own unique features not present in DSA. It is suitable for large AVMs, AVM associated aneurysm and giant intracranial hematoma highly suspicion of AVM bleeding. However, 3D CTA can not replace DSA. DSA is still the golden standard for evaluation of AVMs.