Abstract 021: Comparative Evaluation of Micro DynaCT and CT Head Angiography for Preoperative Perforator Mapping

Introduction/Purpose This study assessed the utility of preoperative Micro Dynamic Computed Tomography (Micro‐DynaCT) in visualizing cerebral perforator vessels and compared its performance with conventional Computed Tomography Angiography (CTA).Accurate delineation of perforator vessels is critical for guiding neurovascular interventions and minimizing ischemic complications. While CTA remains the clinical standard for vascular mapping, its limited spatial resolution often restricts detection of small‐caliber perforators. Micro‐DynaCT, a flat‐panel detector‐based rotational angiographic modality, enables high‐resolution, intra‐angiographic 3D imaging with potential to enhance visualization of fine vascular anatomy and improve surgical planning. Materials and Methods Preoperative Micro‐DynaCT and CTA scans were retrospectively reviewed for 20 patients who underwent endovascular treatment at the Department of Neurosurgery, Hospital of the University of Pennsylvania (July 2022‐November 2024). Five perforator vessels—recurrent artery of Heubner (RAH), anterior choroidal artery (AChA), lateral lenticulostriate artery (LSA), basilar artery perforators (BAP), and posterior cerebral artery perforators (PCAP)—were independently assessed by four neuroradiologists using a 3‐point scale (3 = visible; 2 = not visible due to field of view; 1 = not visible due to resolution). Statistical analysis was performed using R. Results All values are reported as Micro‐DynaCT vs. CTA. Patient demographics were similar across modalities median age: 64 vs. 57 years (p = 0.51); male: 36% vs. 29% (p = 1). Diagnostic distributions were comparable aneurysm: 55% vs. 57%; AVM: 36% vs. 29%; dAVF: 9.1% vs. 14% (p = 1). Micro‐DynaCT demonstrated superior perforator visualization, with all non‐visualization attributed to resolution limits RAH: 75% vs. 7% (p < 0.0001); AChA: 100% vs. 40% (p < 0.0001); LSA: 100% vs. 48% (p < 0.0001); BAP: 100% vs. 0% (p = 0.11); PCAP: 100% vs. 0% (p = 0.11). Conclusion Micro‐DynaCT demonstrated superior visualization of cerebral perforators compared to CTA and may serve as a valuable adjunct in preoperative endovascular planning. image image