Pasquale Mordasini
Flat panel detector (FPD) angiographic systems have been widely introduced into neurointerventional suites. They primarily allow the acquisition of high-quality 3D rotational angiography, but also allow us to obtain CT-like cross-sectional soft tissue imaging with different reconstruction modalities. FPD technology has been shown to permit fast imaging without the need for time-consuming patient transfer to a CT facility, and, therefore, has already become a helpful tool for immediate “on the table” evaluation of treatment results and intraprocedural complications, such as assessment of the extent of subarachnoid or intracerebral hemorrhage and ventricle width.
Technological advances permit FPD parenchymal cerebral blood volume (FPD-CBV) measurements tableside in the neuroangiography suite immediately prior to, during, and just after an interventional procedure, by means of intravenous contrast injection. In our preliminary experience, FPD-CBV measurements provide an attractive and easy-to-use tool for peri-interventional neuroimaging, extending the tableside imaging modalities to the level of tissue perfusion, depicting CBV values comparable with standard multisection CT perfusion.
Adding cerebral perfusion maps as a physiologic parameter to guide treatment decisions and monitor treatment effect may particularly be of interest for endovascular recanalization therapies in patients with acute stroke. Patients may be transferred directly into the neuroangiography suite and undergo diagnostic imaging evaluation on the table. However, in our opinion, current limitations of the technology such as the lack of dynamic perfusion