Fusion imaging using subtracted and unsubtracted rotational angiography for pretherapeutic evaluation of dural arteriovenous fistulas

Purpose We describe the clinical utility of an imaging technique that combines 3D subtracted and unsubtracted rotational angiography for evaluation of the angioarchitecture of dural arteriovenous fistulas (DAVFs). Methods From May 2010 to June 2013, 21 consecutive patients with intracranial DAVFs (22 lesions) underwent 3D angiography for pretherapeutic evaluation. 3D fusion angiography (3DFA) images were semiautomatically obtained from a dataset of unsubtracted and subtracted rotational angiographs. Multiplanar reformatted images and partial MIP images from unsubtracted rotational angiography and fusion images were evaluated by two radiologists, with particular focus on visualization of feeding arteries, shunted pouches, and drainage veins of DAVFs by use of a 3-point scale. The referring neuroradiologists were asked whether the information provided by 3DFA was helpful for treatment decisions. Results For 21 of 22 lesions, all evaluated items were well depicted on the 3DFA. The visualization rating score for feeding arteries and shunted pouches on 3DFA were significantly higher than those of 3D digital angiography ( p