A phantom for targeted endomyocardial biopsy training.

Endomyocardial biopsy (EMB) of the right ventricular (RV) septal surface during cardiac catheterization is the standard method to assess cardiac allograft rejection, heart failure, or inflammatory cardiomyopathies. We developed methodology using a three-dimensional (3D) printed phantom to provide proof of concept for using biplane overlay technology for targeted EMB. A standard bioptome and steerable sheath were used to discern feasibility of biopsy for seven regions of the RV septum guided by 3D overlay. This novel biopsy phantom can help train operators in biopsy techniques, and biplane overlay technology has the potential to advance targeted EMB in transplant and cardiomyopathy populations.

Angiographic Revascularization after Bariatric Embolization in a Swine Model.

This study evaluated fundal arteriole angiographic revascularization after embolization with embolic microspheres of 3 different diameters in a swine model (16 swine, 31 arterioles). In the 50-µm group, 7 of 11 (64%) arterioles recanalized completely, 3 of 11 (27%) arterioles recanalized partially, and 1 of 11 (9%) arterioles had collateralization (no recanalization). In the 100- to 300-µm group, 7 of 10 (70%) arterioles recanalized completely and 3 of 10 (30%) arterioles) recanalized partially. In the 300- to 500-µm group, 7 of 10 (70%) arterioles recanalized completely, 1 of 10 (10%) arterioles recanalized partially, and 2 of 10 (20%) arterioles had collateralization. No difference was found between the groups in the degree of recanalization (P = .64). All embolized arterioles exhibited some degree of angiographic revascularization, irrespective of the microsphere size.

Fused X-ray and MR imaging guidance of intrapericardial delivery of microencapsulated human mesenchymal stem cells in immunocompetent swine.

PURPOSE: To assess intrapericardial delivery of microencapsulated, xenogeneic human mesenchymal stem cells (hMSCs) by using x-ray fused with magnetic resonance (MR) imaging (x-ray/MR imaging) guidance as a potential treatment for ischemic cardiovascular disease in an immunocompetent swine model. MATERIALS AND METHODS: All animal experiments were approved by the institutional animal care and use committee. Stem cell microencapsulation was performed by using a modified alginate-poly-l-lysine-alginate encapsulation method to include 10% (wt/vol) barium sulfate to create barium-alginate microcapsules (BaCaps) that contained hMSCs. With x-ray/MR imaging guidance, eight female pigs (approximately 25 kg) were randomized to receive either BaCaps with hMSCs, empty BaCaps, naked hMSCs, or saline by using a percutaneous subxiphoid approach and were compared with animals that received empty BaCaps (n = 1) or BaCaps with hMSCs (n = 2) by using standard fluoroscopic delivery only. MR images and C-arm computed tomographic (CT) images were acquired before injection and 1 week after delivery. Animals were sacrificed immediately or at 1 week for histopathologic validation. Cardiac function between baseline and 1 week after delivery was evaluated by using a paired Student t test. RESULTS: hMSCs remained highly viable (94.8% ± 6) 2 days after encapsulation in vitro. With x-ray/MR imaging, successful intrapericardial access and delivery were achieved in all animals. BaCaps were visible fluoroscopically and at C-arm CT immediately and 1 week after delivery. Whereas BaCaps were free floating immediately after delivery, they consolidated into a pseudoepicardial tissue patch at 1 week, with hMSCs remaining highly viable within BaCaps; naked hMSCs were poorly retained. Follow-up imaging 1 week after x-ray/MR imaging-guided intrapericardial delivery showed no evidence of pericardial adhesion and/or effusion or adverse effect on cardiac function. In contradistinction, BaCaps delivery with x-ray fluoroscopy without x-ray/MR imaging (n = 3) resulted in pericardial adhesions and poor hMSC viability after 1 week. CONCLUSION: Intrapericardial delivery of BaCaps with hMSCs leads to high cell retention and survival. With x-ray/MR imaging guidance, intrapericardial delivery can be performed safely in the absence of preexisting pericardial effusion to provide a novel route for cardiac cellular regenerative therapy.

Fully automatic online geometric calibration for non-circular cone-beam CT orbits using fiducials with unknown placement.

BACKGROUND: Cone-beam CT (CBCT) with non-circular scanning orbits can improve image quality for 3D intraoperative image guidance. However, geometric calibration of such scans can be challenging. Existing methods typically require a prior image, specialized phantoms, presumed repeatable orbits, or long computation time. PURPOSE: We propose a novel fully automatic online geometric calibration algorithm that does not require prior knowledge of fiducial configuration. The algorithm is fast, accurate, and can accommodate arbitrary scanning orbits and fiducial configurations. METHODS: The algorithm uses an automatic initialization process to eliminate human intervention in fiducial localization and an iterative refinement process to ensure robustness and accuracy. We provide a detailed explanation and implementation of the proposed algorithm. Physical experiments on a lab test bench and a clinical robotic C-arm scanner were conducted to evaluate spatial resolution performance and robustness under realistic constraints. RESULTS: Qualitative and quantitative results from the physical experiments demonstrate high accuracy, efficiency, and robustness of the proposed method. The spatial resolution performance matched that of our existing benchmark method, which used a 3D-2D registration-based geometric calibration algorithm. CONCLUSIONS: We have demonstrated an automatic online geometric calibration method that delivers high spatial resolution and robustness performance. This methodology enables arbitrary scan trajectories and should facilitate translation of such acquisition methods in a clinical setting.

Non-circular CBCT orbit design and realization on a clinical robotic C-arm for metal artifact reduction.

Metal artifacts have been a difficult challenge for cone-beam CT (CBCT), especially for intraoperative imaging. Metal surgical tools and implants are often present in the field of view and can attenuate X-rays so heavily that they essentially create a missing-data problem. Recently, an increasing number of intra-operative imaging systems such as robotic C-arms are capable of non-circular orbits for data acquisition. Such trajectories can potentially improve sampling and the degree of data completeness to solve the metal-induced missing-data problem, thereby reducing or eliminating the associated image artifacts. In this work, we extend our prior theoretical and experimental work and implement non-circular orbits for metal artifact reduction on a clinical robotic C-arm (Siemens Artis zeego). To maximize the potential for clinical translation, we restrict our implementation to standard built-in motion and data collection functions, also available on other zeego systems, and work within the physical constraints and limitations on positioning and motion. Customized software tools for data extraction, processing, calibration, and reconstruction are used. We demonstrate example non-circular orbits and the resulting image quality using a phantom containing pedicle screws for spine fixation. As compared with a standard circular CBCT orbit, these non-circular orbits exhibit significantly reduced metal artifacts. These results suggest a high potential for image quality improvements for intraoperative CBCT imaging when metal tools or implants are present in the field-of-view.

Practical workflow for arbitrary non-circular orbits for CT with clinical robotic C-arms.

Non-circular orbits in cone-beam CT (CBCT) imaging are increasingly being studied for potential benefits in field-of-view, dose reduction, improved image quality, minimal interference in guided procedures, metal artifact reduction, and more. While modern imaging systems such as robotic C-arms are enabling more freedom in potential orbit designs, practical implementation on such clinical systems remains challenging due to obstacles in critical stages of the workflow, including orbit realization, geometric calibration, and reconstruction. In this work, we build upon previous successes in clinical implementation and address key challenges in the geometric calibration stage with a novel calibration method. The resulting workflow eliminates the need for prior patient scans or dedicated calibration phantoms, and can be conducted in clinically relevant processing times.

Extended Intraoperative Longitudinal 3-Dimensional Cone Beam Computed Tomography Imaging With a Continuous Multi-Turn Reverse Helical Scan.

OBJECTIVES: Cone beam computed tomography (CBCT) imaging is becoming an indispensable intraoperative tool; however, the current field of view prevents visualization of long anatomical sites, limiting clinical utility. Here, we demonstrate the longitudinal extension of the intraoperative CBCT field of view using a multi-turn reverse helical scan and assess potential clinical utility in interventional procedures. MATERIALS AND METHODS: A fixed-room robotic CBCT imaging system, with additional real-time control, was used to implement a multi-turn reverse helical scan. The scan consists of C-arm rotation, through a series of clockwise and anticlockwise rotations, combined with simultaneous programmed table translation. The motion properties and geometric accuracy of the multi-turn reverse helical imaging trajectory were examined using a simple geometric phantom. To assess potential clinical utility, a pedicle screw posterior fixation procedure in the thoracic spine from T1 to T12 was performed on an ovine cadaver. The multi-turn reverse helical scan was used to provide postoperative assessment of the screw insertion via cortical breach grading and mean screw angle error measurements (axial and sagittal) from 2 observers. For all screw angle measurements, the intraclass correlation coefficient was calculated to determine observer reliability. RESULTS: The multi-turn reverse helical scans took 100 seconds to complete and increased the longitudinal coverage by 370% from 17 cm to 80 cm. Geometric accuracy was examined by comparing the measured to actual dimensions (0.2 ± 0.1 mm) and angles (0.2 ± 0.1 degrees) of a simple geometric phantom, indicating that the multi-turn reverse helical scan provided submillimeter and degree accuracy with no distortion. During the pedicle screw procedure in an ovine cadaver, the multi-turn reverse helical scan identified 4 cortical breaches, confirmed via the postoperative CT scan. Directly comparing the screw insertion angles (n = 22) measured in the postoperative multi-turn reverse helical and CT scans revealed an average difference of 3.3 ± 2.6 degrees in axial angle and 1.9 ± 1.5 degrees in the sagittal angle from 2 expert observers. The intraclass correlation coefficient was above 0.900 for all measurements (axial and sagittal) across all scan types (conventional CT, multi-turn reverse helical, and conventional CBCT), indicating excellent reliability between observers. CONCLUSIONS: Extended longitudinal field-of-view intraoperative 3-dimensional imaging with a multi-turn reverse helical scan is feasible on a clinical robotic CBCT imaging system, enabling long anatomical sites to be visualized in a single image, including in the presence of metal hardware.

Task-driven source-detector trajectories in cone-beam computed tomography: II. Application to neuroradiology.

We apply the methodology detailed in "Task-driven source-detector trajectories in cone-beam computed tomography: I. Theory and methods" by Stayman et al. for task-driven optimization of source-detector orbits in cone-beam computed tomography (CBCT) to scenarios emulating imaging tasks in interventional neuroradiology. The task-driven imaging framework is used to optimize the CBCT source-detector trajectory by maximizing the detectability index, d ' . The approach was applied to simulated cases of endovascular embolization of an aneurysm and arteriovenous malformation and was translated to real data first using a CBCT test bench followed by implementation on an interventional robotic C-arm. Task-driven trajectories were found to generally favor higher fidelity (i.e., less noisy) views, with an average increase in d ' ranging from 7% to 28%. Visually, this resulted in improved conspicuity of particular stimuli by reducing the noise and altering the noise correlation to a form distinct from the spatial frequencies associated with the imaging task. The improvements in detectability and the demonstration of the task-driven workflow using a real interventional imaging system show the potential of the task-driven imaging framework to improve imaging performance on motorized, multiaxis C-arms in neuroradiology.

Noninvasive Monitoring of Allogeneic Stem Cell Delivery with Dual-Modality Imaging-Visible Microcapsules in a Rabbit Model of Peripheral Arterial Disease.

Stem cell therapies, although promising for treating peripheral arterial disease (PAD), often suffer from low engraftment rates and the inability to confirm the delivery success and track cell distribution and engraftment. Stem cell microencapsulation combined with imaging contrast agents may provide a means to simultaneously enhance cell survival and enable cell tracking with noninvasive imaging. Here, we have evaluated a novel MRI- and X-ray-visible microcapsule formulation for allogeneic mesenchymal stem cell (MSC) delivery and tracking in a large animal model. Bone marrow-derived MSCs from male New Zealand White rabbits were encapsulated using a modified cell encapsulation method to incorporate a dual-modality imaging contrast agent, perfluorooctyl bromide (PFOB). PFOB microcapsules (PFOBCaps) were then transplanted into the medial thigh of normal or PAD female rabbits. In vitro MSC viability remained high (79 ± 5% at 4 weeks of postencapsulation), and as few as two and ten PFOBCaps could be detected in phantoms using clinical C-arm CT and 19F MRI, respectively. Successful injections of PFOBCaps in the medial thigh of normal (n = 15) and PAD (n = 16) rabbits were demonstrated on C-arm CT at 1-14 days of postinjection. Using 19F MRI, transplanted PFOBCaps were clearly identified as "hot spots" and showed one-to-one correspondence to the radiopacities on C-arm CT. Concordance of 19F MRI and C-arm CT locations of PFOBCaps with postmortem locations was high (95%). Immunohistological analysis revealed high MSC survival in PFOBCaps (>56%) two weeks after transplantation while naked MSCs were no longer viable beyond three days after delivery. These findings demonstrate that PFOBCaps could maintain cell viability even in the ischemic tissue and provide a means to monitor cell delivery and track engraftment using clinical noninvasive imaging systems.

Task-driven image acquisition and reconstruction in cone-beam CT.

This work introduces a task-driven imaging framework that incorporates a mathematical definition of the imaging task, a model of the imaging system, and a patient-specific anatomical model to prospectively design image acquisition and reconstruction techniques to optimize task performance. The framework is applied to joint optimization of tube current modulation, view-dependent reconstruction kernel, and orbital tilt in cone-beam CT. The system model considers a cone-beam CT system incorporating a flat-panel detector and 3D filtered backprojection and accurately describes the spatially varying noise and resolution over a wide range of imaging parameters in the presence of a realistic anatomical model. Task-based detectability index (d') is incorporated as the objective function in a task-driven optimization of image acquisition and reconstruction techniques. The orbital tilt was optimized through an exhaustive search across tilt angles ranging ± 30°. For each tilt angle, the view-dependent tube current and reconstruction kernel (i.e. the modulation profiles) that maximized detectability were identified via an alternating optimization. The task-driven approach was compared with conventional unmodulated and automatic exposure control (AEC) strategies for a variety of imaging tasks and anthropomorphic phantoms. The task-driven strategy outperformed the unmodulated and AEC cases for all tasks. For example, d' for a sphere detection task in a head phantom was improved by 30% compared to the unmodulated case by using smoother kernels for noisy views and distributing mAs across less noisy views (at fixed total mAs) in a manner that was beneficial to task performance. Similarly for detection of a line-pair pattern, the task-driven approach increased d' by 80% compared to no modulation by means of view-dependent mA and kernel selection that yields modulation transfer function and noise-power spectrum optimal to the task. Optimization of orbital tilt identified the tilt angle that reduced quantum noise in the region of the stimulus by avoiding highly attenuating anatomical structures. The task-driven imaging framework offers a potentially valuable paradigm for prospective definition of acquisition and reconstruction protocols that improve task performance without increase in dose.

Diagnostic quality and accuracy of low dose 3D-DSA protocols in the evaluation of intracranial aneurysms.

BACKGROUND: 3D-DSA is the 'gold standard' imaging technique for the diagnosis and characterization of intracranial aneurysms. OBJECTIVE: To compare the image quality and accuracy of low dose 3D-DSA protocols in patients with unruptured intracranial aneurysms. MATERIALS AND METHODS: The standard manufacturer 5 s 0.36 µGy/f protocol and one of three low dose 3D-DSA protocols (5 s 0.10 µGy/f, 5 s 0.17 µGy/f, 5 s 0.24 µGy/f) were performed in 12 patients with unruptured intracranial aneurysms. Three interventional neuroradiologists, two neurosurgeons, and two neurologists rated the image quality of all 3D reconstructions as good, acceptable, or poor. Three interventional neuroradiologists measured two dimensions of each aneurysm for all protocols. The radiation dose metric Ka,r (reference point air kerma, in mGy) was recorded for each 3D-DSA protocol. RESULTS: The standard 5 s 0.36 µGy/f protocol earned the highest average subjective rating of 2.76, followed by the 5 s 0.24 µGy/f (2.72), and 5 s 0.17 µGy/f (2.59) protocols. The ranges of differences in aneurysm measurements between the 5 s 0.24 µGy/f protocol and the standard were <0.5 mm. The median Ka,r metrics for each protocol were as follows: 5 s 0.36 µGy/f (89.0 mGy), 5 s 0.24 µGy/f (57.7 mGy), 5 s 0.17 µGy/f (45.9 mGy), and 5 s 0.10 µGy/f (27.6 mGy). CONCLUSIONS: Low dose 3D-DSA protocols with preserved image quality are achievable, and can help reduce exposure of patients and operators to unnecessary radiation. The 5 s 0.24 µGy/f protocol generates one-third smaller radiation dose than the standard 5 s 0.36 µGy/f protocol without compromising diagnostic image quality or accuracy.

A novel method of 3D image analysis of high-resolution cone beam CT and multi slice CT for the detection of semicircular canal dehiscence.

HYPOTHESIS: We investigated if current-generation computed tomographic (CT) scanners have the resolution required to objectively detect bone structure defects as small as 0.1 mm. In addition, we propose that our method is able to predict a possible dehiscence in a semicircular canal. BACKGROUND: In semicircular canal dehiscence (SCD), the bone overlying the superior canal (SC) is partially absent, causing vertigo, autophony, hyperacusis or hearing loss. Diagnosis of SCD is typically based on multi-slice computed tomography (MSCT) images combined with the consideration of clinical signs and symptoms. Recent studies have shown that MSCT tends to overestimate the size of dehiscences and may skew the diagnosis towards dehiscence when a thin bone layer remains. Evaluations of CT scans for clinical application are typically observer based. METHODS: We developed a method of objectively evaluating the resolution of CT scanners. We did this for 2 types of computed tomography: MSCT, and cone beam computed tomography (CBCT), which have been reported to have a higher resolution for temporal bone scans. For the evaluation and comparison of image accuracy between different CT scanners and protocols, we built a bone cement phantom containing small, well-defined structural defects (diameter, 0.1-0.4 mm). These small inhomogeneities could reliably be detected by comparing the variances of radiodensities of a region of interest (i.e., a region containing a hole) with a homogenous region. The Fligner-Killeen test was used to predict the presence or absence of a hole (p ≥ 0.05). For our second goal, that is, to see how this technique could be applied to the detection of a possible dehiscence in a SC, a cadaveric head specimen was used to create an anatomic model for a borderline SCD; the SC was drilled to the point of translucency. After semi-automatically fitting the location of the canal, our variance-based approach allowed a clear, significant detection of the thin remaining bone layer. RESULTS: Our approach of statistical noise analysis on bone cement phantoms allowed us to distinguish real irregularities from measured image noise or reconstruction errors. We have shown that with computed tomography, an approach comparing radiodensity variance in regions of interest is capable of detecting inhomogeneities down to 0.1 mm (p ≤ 0.0001). CONCLUSION: Our analysis of data from the cadaveric head specimen demonstrates that this approach can be used to objectively detect thin layers of bone overlying an SC. This should provide the basis for using this approach for a semi-automated, objective detection of SCD.

Reducing radiation dose while maintaining diagnostic image quality of cerebral three-dimensional digital subtraction angiography: an in vivo study in swine.

BACKGROUND: Three-dimensional digital subtraction angiography (3D-DSA) is a modern technique that allows for better appreciation of complex vascular lesions. This study evaluates the impact of various dose reduction strategies on 3D-DSA image quality. METHODS: The standard manufacturer 5 s 0.36 µGy/frame setting was modified to create lower dose 3D-DSA protocols by varying the acquisition time (5 or 3 s) and/or dose per frame (0.36, 0.24, 0.17, and 0.10 µGy/f). All protocols were evaluated in three swine. Four raters measured a segment of the external carotid artery on two-dimensional multiplanar reconstruction images. The raters were also presented with three-dimensional volume rendered images from all protocols in a blinded manner and asked to choose the superior image. A full model analysis of variance with repeated measure factors was performed to compare mean differences in measurements between protocols. RESULTS: Measurement differences between the standard and low dose protocols were not clinically significant (<0.5 mm). All raters demonstrated high inter-rater reliability. The 5 s protocols were considered as qualitatively superior to the 3 s protocols. Delivered system doses ranged from 43.8 to 6.5 mGy. The 5 s 0.10 µGy/frame protocols generated 65-68% less delivered dose compared with the 5 s 0.36 µGy/frame setting. CONCLUSIONS: Low dose 3D-DSA protocols with preserved image quality are achievable, and can help reduce unnecessary radiation exposure to both patients and operators. The 5 s low dose protocols generated clinically acceptable and superior images compared with the 3 s protocols, suggesting a more important role for acquisition time than dose per frame to maintain image quality.

Planning evaluation of C-arm cone beam CT angiography for target delineation in stereotactic radiation surgery of brain arteriovenous malformations.

PURPOSE: Stereotactic radiation surgery (SRS) is one of the therapeutic modalities currently available to treat cerebral arteriovenous malformations (AVM). Conventionally, magnetic resonance imaging (MRI) and MR angiography (MRA) and digital subtraction angiography (DSA) are used in combination to identify the target volume for SRS treatment. The purpose of this study was to evaluate the use of C-arm cone beam computed tomography (CBCT) in the treatment planning of SRS for cerebral AVMs. METHODS AND MATERIALS: Sixteen consecutive patients treated for brain AVMs at our institution were included in this retrospective study. Prior to treatment, all patients underwent MRA, DSA, and C-arm CBCT. All images were coregistered using the GammaPlan planning system. AVM regions were delineated independently by 2 physicians using either C-arm CBCT or MRA, resulting in 2 volumes: a CBCT volume (VCBCT) and an MRA volume (VMRA). SRS plans were generated based on the delineated regions. RESULTS: The average volume of treatment targets delineated using C-arm CBCT and MRA were similar, 6.40 cm(3) and 6.98 cm(3), respectively (P=.82). However, significant regions of nonoverlap existed. On average, the overlap of the MRA with the C-arm CBCT was only 52.8% of the total volume. In most cases, radiation plans based on VMRA did not provide adequate dose to the region identified on C-arm CBCT; the mean minimum dose to VCBCT was 29.5%, whereas the intended goal was 45% (P<.001). The mean volume of normal brain receiving 12 Gy or more in C-arm CBCT-based plans was not greater than in the MRA-based plans. CONCLUSIONS: Use of C-arm CBCT images significantly alters the delineated regions of AVMs for SRS planning, compared to that of MRA/MRI images. CT-based planning can be accomplished without increasing the dose to normal brain and may represent a more accurate definition of the nidus, increasing the chances for successful obliteration.

Comparison of aortic arch and intravenous contrast injection techniques for C-arm cone beam CT: implications for cerebral perfusion imaging in the angiography suite.

RATIONALE AND OBJECTIVES: The ability to perform cerebral perfusion imaging (CPI) in the angiography suite has provided a new tool for diagnosis and treatment of neurovascular patients but requires comparable contrast perfusion to each cerebral hemisphere. In the angiography suite, contrast injection may be performed via an intra-arterial or intravenous (IV) route. The purpose of this study was to investigate whether a difference exists between contrast injection in the aortic arch (AA) and a peripheral vein (IV), particularly in the setting of stroke. MATERIALS AND METHODS: Using three canines, both AA and IV injection protocols compatible with CPI were performed prospectively at three time points after creation of a stroke. The common carotid arteries in the resulting image data sets were segmented and the means and distributions of corresponding pixel intensities analyzed with Student's t-test. Using similar techniques, the internal carotid arteries of three patients (one female, two males, ages 69, 29, and 20) undergoing AA contrast injection with cone beam computed tomography (CBCT) cerebral imaging were analyzed and compared retrospectively with those of three random patients (one female, two males, ages 19, 57, and 35) undergoing standard head CT scans using IV contrast administration. All acquisitions followed institutionally approved protocols and informed consent. RESULTS: No statistical significance (P < .05) was found when mean values for the right and left carotid artery pixel intensities were compared in the canine model or the clinical studies in which patients underwent imaging after AA or IV contrast administration. CONCLUSIONS: No statistically significant difference exists between right and left carotid artery filling density using either AA or IV contrast injection methods, making both suitable for CPI in the angiography suite.

Using C-arm x-ray imaging to guide local reporter probe delivery for tracking stem cell engraftment.

Poor cell survival and difficulties with visualization of cell delivery are major problems with current cell transplantation methods. To protect cells from early destruction, microencapsulation methods have been developed. The addition of a contrast agent to the microcapsule also could enable tracking by MR, ultrasound, and X-ray imaging. However, determining the cell viability within the microcapsule still remains an issue. Reporter gene imaging provides a way to determine cell viability, but delivery of the reporter probe by systemic injection may be hindered in ischemic diseases. In the present study, mesenchymal stem cells (MSCs) were transfected with triple fusion reporter gene containing red fluorescent protein, truncated thymidine kinase (SPECT/PET reporter) and firefly luciferase (bioluminescence reporter). Transfected cells were microencapsulated in either unlabeled or perfluorooctylbromide (PFOB) impregnated alginate. The addition of PFOB provided radiopacity to enable visualization of the microcapsules by X-ray imaging. Before intramuscular transplantation in rabbit thigh muscle, the microcapsules were incubated with D-luciferin, and bioluminescence imaging (BLI) was performed immediately. Twenty-four and forty-eight hours post transplantation, c-arm CT was used to target the luciferin to the X-ray-visible microcapsules for BLI cell viability assessment, rather than systemic reporter probe injections. Not only was the bioluminescent signal emission from the PFOB-encapsulated MSCs confirmed as compared to non-encapsulated, naked MSCs, but over 90% of injection sites of PFOB-encapsulated MSCs were visible on c-arm CT. The latter aided in successful targeting of the reporter probe to injection sites using conventional X-ray imaging to determine cell viability at 1-2 days post transplantation. Blind luciferin injections to the approximate location of unlabeled microcapsules resulted in successful BLI signal detection in only 18% of injections. In conclusion, reporter gene probes can be more precisely targeted using c-arm CT for in vivo transplant viability assessment, thereby avoiding large and costly systemic injections of a reporter probe.

Aortic arch injection with C-arm cone beam CT for radiosurgery treatment planning of cerebral arteriovenous malformations: technical note.

BACKGROUND: C-arm cone beam CT (CBCT) with selective intra-arterial contrast injection combined with digital subtraction angiography (DSA) is currently used for the evaluation and treatment planning of cerebral arteriovenous malformations (AVMs). In some instances an AVM will derive its blood supply from more than one main cervical artery (carotid and/or vertebral artery) and a single-vessel injection will not adequately demonstrate the entire AVM nidus. METHODS: Three patients with cerebral AVM in whom the entire nidus could not be visualized by injection of a single cervical artery are reported. CBCT dataset acquisition was performed by intra-arterial contrast injection in the ascending thoracic aorta through a 5 F pigtail catheter. The injection of diluted iodinated contrast agent (35%) lasted 22 s at a rate of 8 ml/s for a total volume of 176 ml (61.6 ml of contrast agent). The dataset was then processed using standard reconstruction methods. RESULTS: Contrast injection in the ascending aorta during a single CBCT acquisition provided a volumetric dataset adequate for subsequent radiosurgical treatment planning. CONCLUSION: This is a safe and effective angiographic technique for the acquisition of volumetric datasets using CBCT that are suitable for treatment planning of intracranial AVMs deriving their blood supply from more than one major cervical artery. This technique allows imaging of the entire AVM nidus during a single CBCT acquisition.