Background: Dynamic CT angiography (dCTA) provides augments traditional CTA with temporal resolution
and has been demonstrated to influence operative planning in skull base surgery.
Methods: 325 dynamic CTA cases from Brigham and Women’s Hospital were reviewed for indication
of study, findings, and comparison to other modalities of imaging.
Results: The Department of Neurosurgery ordered the majority of dCTA tests (72.6%). The most
frequent indication to obtain a dCTA was pre-operative planning (60%); resection of
skull base tumors comprised the majority of these pre-operative orders (92.3%). It
was also used to evaluate new neurological symptoms (20.6%). Of these, the most common
symptoms prompting dCTA orders included headaches (14.9%), visual field deficits (11.9%),
altered mental status (9%), and seizures (9%). The most commonly visualized vascular
lesions were partial (20.9%) and full vascular occlusions (9%). Another indication
for dCTA was for post-operative imaging for vascular malformations (9.2%) and tumors
(2.5%). Finally, dCTA was used to evaluate ambiguous abnormal findings observed on
other imaging modalities (7.7%). Cerebral dCTA ruled out abnormal findings visualized
on other imaging modalities (68%) more frequently than it confirmed them (32%); these
findings included vascular malformations such as arteriovenous malformation and arteriovenous
fistulas (43.8%) and aneurysms (31.2%).
Conclusions: Cerebral dCTA is an evolving new technology with a diverse spectrum of potential
applications. In addition to its role in guiding preoperative planning for skull base
surgical cases, dynamic CTA offers excellent spatial and temporal resolution for assessment
of vascular lesions.
