Fig. 1

Use of virtual injection software in neurointerventional radiology. Patient with an AVM the left medial frontal lobe with subjacent flow-related aneurysm. The vascular tree was automatically extracted, and the bones removed (a). The neuro interventionalist used the virtual microcatheter (the red trace) to review the potential AVM feeders on both the 3D volume rendering (b) and the cross-sectional views (c). On initial glance, apparent primary feeder to the AVM seems to be the anterior cerebral artery (c, blue arrow). However, the software accurately identified this as an en passage vessel supplying the flow-related aneurysm, with subsequent correct identification of the true AVM feeders arising from small caliber lenticulostriate vessels (c-d, red line). Even though it was also possible to simulate injections from the same points (additional distal contrast flow is simulated past the red line in green, d-e), the interventionalist were less interested by this feature as the software prediction are unreliable inside the AVM. The simulated catheterizations were saved as 3D model (f), which could be used in addition to the full vascular in augmented fluoroscopy (g- full vascular tree; h- targeted vessel; i – example of catheterization guidance)