Q mra MRA + NOVA Quantitative Magnetic Resonance
Angiography
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VasSol was founded in 1999 by Dr. Fady T. Charbel, Professor
and Head of the Department of Neurosurgery at the University of
Illinois at Chicago. Dr. Charbels groundbreaking work on the
cerebrovascular flow modeling led to VasSol, the first commercial
company to emerge from the College of Medicine at UIC. Among his
many accomplishments Dr. Charbel is the inventor of the Charbel
Micro-Flowprobe and has developed many surgical techniques,
including C-FAST (Charbel flow assisted surgical technique).
President and Chief Scientific Officer Dr. Fady T. Charbel, MD,
FACS
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Imaging Diagnostic Treatment Planning MRI Image Registration
FEM AIM PCMR CT Angio OR Surgical Planning Radiology Thin Internet
Server Multimedia Notebook Rapid Prototype CANVAS (Computer Aided
Neuro Vascular Analysis and Simulation) Group
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Phase-contrast MR (PCMR) Phase shift proportional to velocity
Cross sectional area from vessel contour Flow = Velocity x Area =
x
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NOVA technique for QMRA Axial 3-D TOF MRA with 3-D surface
rendering of cerebral vasculature 3D
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NOVA technique for QMRA Cuts placed perpendicular to axis of
vessel
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NOVA technique for QMRA Gated 2D phase contrast MR scan
perpendicular to the vessel axis 2D PCMR
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PCMR is a highly accurate method, however it requires:
Perpendicular measurement plane Laminar flow Appropriate Venc
setting VENC
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NOVA 3D Quick, accurate vessel identification Optimal,
perpendicular cut Auto Venc detects Venc mismatch and determines
correct setting Venc The NOVA Solution
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NOVA is Easy to Use NOVA 3D Localizer Nova 3D Auto prescription
Auto Transfer of 3D Coordinates 3D Auto Contouring of Vessel Border
VENC Check Takes away the guesswork VENC
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Phase contrast MRA Nova Results
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Q mra Protocol for Head and Neck
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NOVA Validation In Vitro multi- tube phantom In Vivo animal
model Steady flow different flow rates Pulsatile flow different
flow rates Different vendors GE, Philips and SIEMENS
Gated/non-gated sequences Gated/non-gated sequences In Vivo
Validation of Quantitative Magnetic Resonance Angiography in Canine
Carotid Artery Model Mateo Calderon Arnulphi MD
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Phantom Validation Setup
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Phantom Actual Flow vs. NOVA
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Normative Flow Ranges Baseline Cerebral Blood Flow Study (UIC):
(Amin-Hanjani et al, International Stroke Conference, 2011) 326
healthy subjects 326 Age range 18-84 (mean 47) 18-84 ( 47 ) 48%
female/ 52% male 48% / 52% Three age groups : 18-40 41-60
>60
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NOVA Applications Cerebrovascular disease and disorders :
Extracranial and intracranial arterial stenosis and occlusion
Moyamoya Disease Arterial dissection Cerebral Aneurysm Venous
stenosis Arteriovenous Malformation Monitor pre/post treatment / :
Angioplasty and stenting EC-IC bypass flow augmentation for
ischemia and flow replacement (aneurysm, tumor) Carotid
revascularization Embolization and surgical resection of AVMs Flow
diversion for cerebral aneurysm Evaluate effectiveness of medical
therapy, and select patients for intervention
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Role of Quantitative Flow Assessment: Patient selection/
decision-making / Long-term monitoring/ post-treatment follow-up /
Accumulation of knowledge
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Basilar Artery Stent
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April 3 April 12 April 21 April 25 Serial Follow up post
basilar artery stenting
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MCA Aneurysm 10M post stent assisted coiling in- stent stenosis
within the right M1 segment measuring 50 - 70%.
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NOVA 2/2012 vessel map, 3D RMCA flow in normal range
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NOVA QMRA Evaluate individual vessels: Right AVM Primary
Draining Vein: 768 ml/min 68 cc/min MCA: 953 cc/min 184 cc/min
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NOVA Flow Rate (ml/min) of Feeding Artery and Draining Vein
During the Treatment process
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PREOP Right ICA Occlusion
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Right middle cerebral artery flow measurements, pre (left) and
post (right) diamox.
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NOVA Vessel Map Pre diamox Post diamox % change RACA and RPCA
flows decrease after diamox RMCA increases only marginally, 6%
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POST OP ANGIO AND NOVA
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VERiTAS study Vertebral flow Evaluation and Risk of Transient
Ischemic Attack and Stroke (VERiTAS) study VERiTAS Prospective
multicenter observational study of patients with symptomatic
vertebrobasilar disease using QMRA: Does flow compromise stratify
stroke risk?
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NOVA (QMRA) for Symptomatic VBD
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Normal Flow Basilar stenosis
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Low Flow Basilar occlusion
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MyRIAD Study - Mechanisms of early Recurrence of Intracranial
Atherosclerotic Disease MyRIAD Start Date: July 2014 175 patients 3
imaging modalities to elucidate the mechanisms of recurrent stroke:
NOVA QMRA MR Perfusion Transcranial Doppler
http://clinicaltrials.gov/show/NCT02121028
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Validation of a Robust PCMR Method for Quantifying CSF Flow in
Human Subjects Kezhou Wang, Xinjian Du, Wei Sun, Hagai Ganin, Yi
Sui, Lauren Ostergren, Fady T. Charbel, William G. Bradley,
Xiaohong Joe Zhou Department of Neurosurgery, University of
Illinois at Chicago Medical Center; VasSol, Inc.; GE Healthcare;
Department of Radiology, University of California at San Diego FIES
TA image showing the CSF. (b) 3D model of aqueduct with flow
measurement location shown in yellow. (c) 2D PCMR phase image
perpendicular to aqueduct.
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Quantitative Flow Assessment Intracranial atherosclerotic
occlusive disease : Current focus on anatomy of the disease
Consider the physiology of the disease FLOW MATTERS