Four-dimensional multifusion imaging for assessment of meningioma hemodynamics

We introduce our new image analysis method, 4-dimensional (4D)-multifusion imaging (four-phase 4D-multifusion image and dynamic 4D-multifusion image), and its clinical value in four illustrative cases of surgically treated meningiomas. In 4D-multifusion imaging, hemodynamic information from 4D-CTA was incorporated into advanced 3D images. Bone subtracted 4D-CTA volume data were divided into four phases: early arterial, late arterial, early venous, and late venous. Four-phase 4D-multifusion image was created by combining integrated vascular phase images with advanced 3D image. By subdividing the integrated vascular phase image into 10 dynamic images with gradation colors, a series of dynamic 4D-multifusion images from the initial early arterial to the last late venous phase image were displayed sequentially to simulate blood flow through the cerebral vessels. With this method, it was possible to identify the arterial feeders and their entry points into a meningioma, the pattern and distribution of tumor stain, and the drainage routes. Complicated anatomical and hemodynamic information was obtained simultaneously on freely rotated images, and pre-surgical simulation with 4D-multifusion imaging was useful for intracranial meningiomas in planning the surgical strategy and procedures including indication of a presurgical feeding artery embolization, selecting an appropriated approach route. In addition, 4D-multifusion imaging could be applicable to other hypervascular tumors and vascular lesions with arteriovenous shunts or collaterals.