NAEOTOM Alpha Class - Clinical Case Video: Brain CTA Stents

Hello everyone, let me tell you about this interesting case. This is a 71 year old female patient who came to the hospital. She'd been complaining of dizziness for over 2 months. So we did some tests on her. We did a native cerebral CT and ACT angiography using ACT scanner with an energy integrating detector to assess her condition. When we looked at the CTA images, we found something. There was an irregular sacular aneurysm with a narrow neck at the A3 segment of the left anterior cerebral artery, or ACA. It was pointing forward and upward. The distance from the neck to the Dome of the aneurysm was about 12.8mm, and the maximum width of the Dome was 6.3mm. Also, there was a severe stenosis in the parent artery just before the neck of the aneurysm, but the native CT images were normal. There were no signs of subarachnoid hemorrhage. After that, the patient had endovascular treatment. We successfully implanted a flow diverter and did a balloon angioplasty. When we did a post interventional digital subtraction angiography we saw that there was some retained contrast agent near the neck of the aneurysm. 2 days later when we did a follow up CTA using a photon counting detector CT in an ultra high resolution scan mode, we still saw that residual filling of the contrast agent. The curved part of the diverter looked slender and there was no sign of braid deformation or any problems with the lumen of the parent artery. The patient didn't have any complications during her hospital stay and was discharged five days after the intervention. We also scheduled a six month follow up CTA for her. Now let's talk a bit more about this. Unruptured intracranial aneurysms, or UI AS usually don't cause any symptoms, but if they rupture, they can bleed into the brain, parynchema or the subarachnoid space, and that can lead to permanent disability or even death. Digital subtraction angiography is the gold standard for detecting cerebral aneurysms. It gives us both dynamic and morphological information about the intracranial circulation. But it's pretty expensive, not available everywhere, and there's a risk of complications. To make a good treatment plan, CTA can give us useful diagnostic information, like it can show us where the aneurysm is, what it looks like, the size of its neck and Dome, if there are any collateral arteries, or if there are problems with the parent artery. With the Neotom alpha, we can now regularly get the Quantum HD images. These images have a high spatial resolution and low image noise, all while still being efficient in terms of radiation dose. In this case, the Quantum HD images, which were acquired at 0.2mm and reconstructed with a sharp kernel of HV89, were great for making good 3 dimensional images using the cinematic rendering technique. This means we can see the detailed structures of the vascular anatomy and the flow diverter both in 2D and 3D, all from the same U char images. And we didn't see any of those artifacts that are usually caused by the struts. When we compare the dose efficiency, the Quantum HD images on the Neotom Alpha acquired at 0.2mm had a CTD IVAL of 24.1 milligray, while the standard images on the EIDCT acquired at 1mm had a CTD Ivol of 45.9 milligray. So this case shows that the Quantum HD mode with Neotom alpha has a lot of potential for evaluating the implementation of a flow diverter for an intracranial aneurysm and it makes a strong case for using Quantum HDCTA and post interventional follow up imaging in our regular clinical work. I'd like to go out.

123 6/23/2024 2024/06/23-02:22:03.28 05 450 130 0.5 23 170 225 642 101 2024/06/23-02:21:43 2024/06/23-02:21:53 2024/06/23-02:21:59 2024/06/23-02:22:01 2024/06/23-02:22:10 2024/06/23-02:22:16 80 35 2024/06/23-02:22:03 2024/06/23-02:22:06 2024/06/23-02:22:21 30 120 2024/06/23-02:22:01. 2024/06/23-02:22:08 2024/06/23-02:22:36 2024/06/23-02:22:21. 7/9/2024 16 7/11/2024 10 18 19 22 24 501 160 10:53 1.2 241 1464 2024/06/23-02:22:12 2024/06/23-02:22:26 201 200 100 444 105 2024/06/23-02:21:49 302 818 305 326 1201 2024/06/23-02:22:31 988 15 768*768 301 25 16.0 22.7 125 210 10.5 0.58 2.34 407 358 0.08 24.1 454 /11/2024 140 NAEOTOM Alpha class Clinical case video: Brain CTA stents 1: 10 2025/04/10 13:10:27 SIEMENS . Healthineers Alpha_BrainUHR_CTA_Stent_CT ... MM Reading Viewing Alpha_BrainUHR_CTA_Stent_CT_AX UCT 960+ Favorite Tools # D6701611 2:22:03.28 PM SP F583.0 Series SL Findings 10cm Printing KV 100 SP F590.0 SP F601.5 SP F593.5 MPF SPC SP F566.0 SP F556.5 SP F557.0 W 676 SP F564.0 R001 SP F549.5 +C SP P75.3 MPR 5cm SP R40.7 Clip C VRT AC 3 Slab Thickness 50.0 uCT 960+ 302 IMA n.a. #D6701611 3D Reference Point Windowing Rotate Home Position Region Growing Punch Anatomy Visualizer Fit to Segment Remove Table Bone Removal Tools HAL HRP ARH AL SP R24.8 HPL HLA AHL SP R70.8 ALH AHR SP R77.0 HPR SP R23.7 SP R45.5 SP F568.0 CT head Head W 642 Results Viewing + C 2:21:17.56 PM SP F554 4 SP A14.2 SP F536.4 PC FC Add Study Azurion Series Name Cerebral 4 fps Normal - 2_( XA, Unknown study descript # D6735698 Navigate - 2 3 IMA 2 FRM 13 Navigate - 1_01 3D-RA Prop 4s - 1 1cm Navigate - 2_01 Fluoroscopy - stored - 1 Fluoroscopy - stored - 1_01 Zoom 1.80 W 4096 Results Viewing - 2 C 2048 11 .. Results Viewing - 3 NAEOTOM Alpha syngo CT VA50A CTA Brain 0.20 Hv89 Q4_0 CT. 02_Brain CTA HD(Adult) # D6741143 15 IMA n.a. 11:00:20.30 AM SP F623.5 CTA Brain 1.00 Hv48 Q3 Patient Protocol THRESHOLD KV 140 W 1206 C 160 SP F621.0 SP F634.0 SP F629.5 SP F635.0 SP A208.2 SP L4.0 Manip Clip C VRT AC 501 W 1464 SP L3.0 sPC CTA Brain 0.20 Hv72 Q4 HAR HRA 15 IMA n.a AFR SP R55.0 ARF SP R51.2 #D6741143 SP R91.0 AFL SP R143.2 SP R75.2 SPA14.2 KV 120 Manip VRT 302 IMAn.a. SP F554.0 SP A18.5 W 200 SP SP L2.0 VRT SP L1.5 CT. Unknown study descrij 2 22:03.28 PM SP L5.0 CTA Brain 0.40 Hv56 Q4 V5 SP F637.0 THRES C 501 SP R75 2 SP L41 2 SP L41.2 W 14 Total mAs: 2028 CT_SOM PROT C 241 CTA Brain 1.00 Qr40 SPP_N SIEMENS 15 M SP F625.0 10 53 SP R21.7 Please note that the learning material is for training purposes only. For the proper use of the software or hardware, please always use the Operator Manual or Instructions for Use (hereinafter collectively "Operator Manual") issued by Siemens Healthineers. This material is to be used as training material only and shall by no means substitute the Operator Manual. Any material used in this training will not be updated on a regular basis and does not necessarily reflect the latest version of the software and hardware available at the time of the training. The Operator Manual shall be used as your main reference, in particular for relevant safety information like warnings and cautions. Please note: Some functions shown in this material are optional and might not be part of your system. Certain products, product related claims or functionalities (hereinafter collectively "Functionality") may not (yet) be commercially available in your country. Due to regulatory requirements, the future availability of said Functionalities in any specific country is not guaranteed. Please contact your local Siemens Healthineers sales representative for the most current information. The statements by Siemens Healthineers' customers described herein are based on results that were achieved in the customer's unique setting. Because there is no "typical" hospital or laboratory and many variables exist (e.g ., hospital size, samples mix, case mix, level of IT and/or automation adoption) there can be no guarantee that other customers will achieve the same results. Page 1 of 2 The reproduction, transmission, or distribution of this training or its contents is not permitted without express written authority. Offenders will be liable for damages. All names and data of patients, parameters, and configuration dependent designations are fictional and examples only. means substitute the All rights, including rights created by patent grant or registration of a utility model or design, are reserved. Siemens Healthineers HQ I Siemens Healthineers AG Siemensstr. 3 91301 Forchheim Germany Phone: +49 9191 18-0 siemens-healthineers.com Unrestricted | Published by Siemens Healthineers AG | C Siemens Healthineers AG, 2025 Health