Introduction: Rotational C-arm Flat Detector CT Angiography (fdCTA) is an imaging technique with evolving technological capabilities and clinical applications.
Methods: Systematic literature review.
Results: 52 research articles were included. Algorithms that initially constrain fdCTA source data to a preliminary reconstruction mask and then intensely process the constrained data within that mask can display cerebrovascular anatomy with spatial resolution and conspicuity superior to DSA, CTA, and MRA. fdCTA can display coil and stent shape and structure in greater detail than DSA, aiding device positioning, deployment, and follow-up imaging. Temporal fdCTA data quantitatively describes intravascular flow parameters that can be visually depicted with color-coding. Dedicated fdCTA C-arm rotation protocols and data processing methods can generate quantitative parenchymal perfusion results. fdCTA reliably displays intracerebral and subarachnoid hemorrhage, though it is inferior to conventional multi-slice CT in this regard. Novel fdCTA algorithms reduce metallic artifacts. The optimization of arterial and venous contrast injection protocols is ongoing.
Conclusions: fdCTA displays peri- and intra-procedural anatomical and physiological cerebrovascular information that may guide diagnosis, patient selection, treatment, complication management, and follow-up. It is an increasingly comprehensive and sophisticated tool in the neurendovascular suite.
Patient Care: fdCTA is a rapidly-evolving tool in the neuroendovascularist’s armamentarium. Awareness and utilization of its current technological capabilities and clinical applications may improve the diagnosis, patient selection, treatment, complication management, and follow-up of patients with a variety of cerebravoascular pathologies.
Learning Objectives: By the conclusion of this session, participants should be able to: 1) Understand the fundamental principles of fdCTA imaging; 2) Describe fdCTA evolving technological capabilities; and 3) Consider novel clinical applications of fdCTA in the neuroendovascular suite.