Visualization of the Intracisternal Angioarchitecture at the Posterior Fossa by Use of Image Fusion

OBJECTIVE:Magnetic resonance (MR) images most clearly visualize intracranial tissues but have some limitations in terms of detailed analysis of the intracisternal vasculature. To compensate for these shortcomings, an image fusion of three-dimensional digital subtraction angiography (DSA) and MR images, DSA-MR fusion, has been developed. The goal of this study was to evaluate the usefulness of DSA-MR fusion for the visualization of the intracisternal arteries and veins at the posterior fossa. METHODS:Ten consecutive patients (five with neurovascular compression syndrome and five with brain tumors) underwent preoperative DSA-MR fusion. The DSA-MR fusion images were compared with intraoperative findings. RESULTS:Image fusion was performed within 20 minutes, and the registration error was insignificant in all cases. Image fusion successfully visualized the clear three-dimensional relationships among the intracisternal arteries and veins, cranial nerves, brain tissues, and a lesion, and a specific vessel was easily identified. The findings of the DSA-MR fusion images were surgically confirmed in all patients. CONCLUSION:Using this advanced image fusion technique coupled with its reasonable postprocessing time, neurosurgeons may more easily and precisely understand the surgical anatomy before surgery than analyzing three-dimensional DSA and MR images separately.