Identification of the central artery using three-dimensional digital subtraction angiography-magnetic resonance fusion image

Purpose: Conventionally, identification of the central artery involves invasive techniques. This study aimed to evaluate the identification of the central artery on three-dimensional (3D)- and two-dimensional (2D)- digital subtraction angiography (DSA) images based on fusion images created using 3D-DSA and magnetic resonance image (MRI) as a less invasive technique. Methods: We retrospectively reviewed 65 cases in which the central sulcus could be detected among the cases that underwent 3D-DSA and high-resolution MRI. We fused 3D-DSA and MRI to identify the central artery on 3D- and 2D-DSA images. To devise an index to identify the central artery using only the 2D-DSA lateral view, we traced each central artery and calculated the distance from several anatomical landmarks. Using the created index, we evaluated the identification rate using or not using the index for three neurosurgical fellows. Results: We succeeded in fusing 3D-DSA and MRI for all 65 cases. We were able to detect the central artery in 64 (98%) cases in 3D- and 2D-DSA. We created the index of the central artery in the 2D-DSA lateral view in the range of 12 to 60 mm dorsally from the intersection of the straight line connecting the anterior skull base and the internal occipital prominence with the vertical line drawn down from the coronal suture. Comparing using and not using this index, the identification rate of the central artery improved using the index. Conclusion: 3DDSA-MR fusion images are useful for identifying the central artery with less invasiveness compared to conventional methods.