Early clinical experience with a dedicated portable computed tomography scanner in a biplane neuroangiography suite: assessment of feasibility and utility in neurointerventional practice.

SUMMARY: The ability to have on-site access to cross-sectional imaging in a biplane neuroangiography suite has tremendous potential for enhancing current neurointerventional practice.Although a few prototypical multimodality suites have been created, several problems/limitations have prevented widespread implementation. Recently, a portable CT scanner has been developed, which may overcome previous shortcomings. We review our recent clinical experience with this new modality, exploring numerous adjunctive diagnostic and therapeutic applications. Forty-one patients underwent periprocedural CT using the Tomoscan M/EG portable CT (Philips). The portable CT scanner is kept at the "head-end" of the biplane neuroangiography suite, being moved into position as needed before, after, or during a procedure. A pivoting angiographic table permits excellent z-plane mobility for rapid gantry to fluoroscopy positioning. Five mm slices at five mm increments were obtained. High quality images were obtained in all cases. The portable CT scanner could be quickly positioned and activated within five min. Total scanning time for a typical case, including initial positioning and set-up was 10-12 min. Twelve of 41 cases were performed adjunctively during diagnostic angiography; 29/41 were performed in an interventional setting.Twenty of 29 scan evaluated baseline or post-therapeutic status of the brain (e.g., Guglielmi detachable coil aneurysm obliteration, arteriovenous malformation (AVM) embolisation, local thrombolysis); 9/29 provided cross-sectional guidance to various interventions (direct puncture embolisation, percutaneous vertebroplasty, spinal biopsy, discography). Use of the portable CT scanner permitted rapidly accessible high quality cross sectional imaging within the biplane neuroangiography suite, which augmented diagnostic and therapeutic decision-making, and therapeutic intervention.