New Techniques in CT Angiography

Computed tomographic (CT) angiography has been improved significantly with the introduction of four- to 64-section spiral CT scanners, which offer rapid acquisition of isotropic data sets. A variety of techniques have been proposed for postprocessing of the resulting images. The most widely used techniques are multiplanar reformation (MPR), thin-slab maximum intensity projection, and volume rendering. Sophisticated segmentation algorithms, vessel analysis tools based on a centerline approach, and automatic lumen boundary definition are emerging techniques; bone removal with thresholding or subtraction algorithms has been introduced. These techniques increasingly provide a quality of vessel analysis comparable to that achieved with intraarterial three-dimensional rotational angiography. Neurovascular applications for these various image postprocessing methods include steno-occlusive disease, dural sinus thrombosis, vascular malformations, and cerebral aneurysms. However, one should keep in mind the potential pitfalls of these techniques and always double-check the final results with source or MPR imaging.