Evidence map›Paper›PMID 42234016›Full record

ArticleNeuroradiology2026

High-resolution cone-beam CT (DynaCT Micro) enhances preoperative and intraoperative visualization of intracranial perforator arteries.

Mikaeel A Habib, Jaeha Kim, William J Lee, Luis O Tierradentro-Garcia, Om H Gandhi, Robert Romano, Suehyb G Alkhatib, Daniel Gewolb, Colbey Freeman, Sarah A Hamimi and 4 more

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Article in Neuroradiology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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14 authors.

Mikaeel A HabibDepartment of Neurosurgery, University of Pennsylvania, Philadelphia, PA, USA.
Jaeha KimDepartment of Neurosurgery, University of Pennsylvania, Philadelphia, PA, USA.
William J LeeDepartment of Neurosurgery, University of Pennsylvania, Philadelphia, PA, USA.
Luis O Tierradentro-GarciaRadiology, University of Pennsylvania, Philadelphia, PA, USA.
Om H GandhiDepartment of Neurosurgery, University of Pennsylvania, Philadelphia, PA, USA.
Robert RomanoRadiology, University of Pennsylvania, Philadelphia, PA, USA.
Suehyb G AlkhatibRadiology, University of Pennsylvania, Philadelphia, PA, USA.
Daniel GewolbDepartment of Radiology, University of Miami, Coral Gables, FL, USA.
Colbey FreemanRadiology, University of Pennsylvania, Philadelphia, PA, USA.
Sarah A HamimiDepartment of Neurosurgery, University of Pennsylvania, Philadelphia, PA, USA.
Mackenzie CastellanosDepartment of Neurosurgery, University of Pennsylvania, Philadelphia, PA, USA.
Sami AlmasriDepartment of Neurosurgery, University of Pennsylvania, Philadelphia, PA, USA.
Linda J BagleyRadiology, University of Pennsylvania, Philadelphia, PA, USA.
Omar A ChoudhriRadiology, University of Pennsylvania, Philadelphia, PA, USA. choudhrilab@gmail.com.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

background and purposePreservation of perforator arteries during cerebrovascular interventions remains challenging due to their submillimeter caliber and variable anatomy. High-resolution cone-beam computed tomography (HR-CBCT) offers improved resolution compared with conventional CT angiography (CTA), yet its utility for perforator assessment has not been systematically evaluated. This study assessed HR-CBCT for visualization of intracranial perforators in both preoperative and intraoperative contexts.

methodsImaging from 20 patients who underwent aneurysm clipping, arteriovenous malformation resection, or dural arteriovenous fistula treatment between July 2022 and November 2024 was reviewed. Three imaging modalities were evaluated: preoperative CTA, preoperative HR-CBCT, and intraoperative HR-CBCT. Five perforator arteries-the recurrent artery of Heubner, anterior choroidal artery, lateral lenticulostriate arteries, basilar artery perforators, and posterior cerebral artery perforators-were independently scored by four neuroradiologists using a three-point visibility scale (3 = visible, 2 = not visible due to limited field of view, 1 = not visible due to resolution). Reader confidence was recorded, and statistical analysis was performed using R.

resultsPerforator visualization was significantly higher with both preoperative and intraoperative HR-CBCT compared with CTA. On preoperative imaging, confidence was significantly higher for anterior choroidal and lateral lenticulostriate arteries (p < 0.001), but not for the recurrent artery of Heubner (p = 0.102). Intraoperative scans showed no significant reduction in visibility. Effective dose did not differ between CTA and HR-CBCT (p = 0.700).

conclusionsPreoperative and intraoperative HR-CBCT provide superior perforator visualization compared with CTA, with intraoperative imaging closely matching preoperative performance.

Indexed as

Cerebrovascular interventionCT angiographyHigh-resolution cone-beam CTIntracranial perforator arteriesIntraoperative imaging

Identifiers

PMID42234016

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.