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NOVA Non-invasive Optimal Vessel Analysis Qmra™ MRA + NOVA Quantitative Magnetic Resonance Angiography President and Chief Scientific Officer 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. Charbel’s 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). Dr. Fady T. Charbel, MD, FACS CANVAS (Computer Aided Neuro Vascular Analysis and Simulation) Group Imaging Treatment Planning Diagnostic Thin Internet Server MRI PCMR OR Surgical Planning Radiology Angio AIM FEM Rapid Prototype CT Image Registration Multimedia Notebook Phase-contrast MR (PCMR) Phase shift proportional to velocity 相移與速度 成正比 Cross sectional area from vessel contour 血 管的橫斷面面積 Flow = Velocity x Area 流量=速度x面積 NOVA technique for QMRA – Axial 3-D TOF MRA with 3-D surface rendering of cerebral vasculature 腦部血管系統的3D模型 NOVA technique for QMRA – Cuts placed perpendicular to axis of vessel 量測切面垂直於血管軸向 NOVA technique for QMRA – Gated 2D phase contrast MR scan perpendicular to the vessel axis 閘控2D PCMR 掃描垂直於血管軸向 PCMR is a highly accurate method, however it requires: Perpendicular measurement plane 垂直的量 測面 Laminar flow 層流 Appropriate Venc setting 適當的VENC設定 The NOVA Solution NOVA 3D Quick, accurate vessel identification 快速、準確、血管辨認 Optimal, perpendicular cut 垂直切面 Auto Venc detects Venc mismatch and determines correct setting 偵測Venc錯配並決 定正確設定 NOVA is Easy to Use NOVA 3D Localizer Nova 3D定位器 Auto prescription 自動標註血管名稱 Auto Transfer of 3D Coordinates 自動轉換3D 座標 Auto Contouring of Vessel Border 自動標示血 管邊界 VENC Check – Takes away the guesswork VENC檢查 ─ 省去猜測的工作 Nova Results Phase contrast MRA Qmra™ Protocol for Head and Neck 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 Normative Flow Ranges Baseline Cerebral Blood Flow Study (UIC): (Amin-Hanjani et al, International Stroke Conference, 2011) 326 healthy subjects 326位健康受測者 Age range 18-84 (mean 47) 年齡範圍18-84歲 (平均47歲) 48% female/ 52% male 48%女性 / 52%男性 Three age groups 三個年齡群組: 18-40 41-60 >60 NOVA Applications Cerebrovascular disease and disorders 腦血管疾病及失調: Extracranial and intracranial arterial stenosis and occlusion Moyamoya Disease Arterial dissection Cerebral Aneurysm Venous stenosis Arteriovenous Malformation Monitor pre/post treatment 監控術前/術後治療: 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 Role of Quantitative Flow Assessment: • Patient selection/ decision-making 患者選擇/決策決定 • Long-term monitoring/ post-treatment follow-up 長時間監控/ 後續治療追蹤 Accumulation of knowledge Basilar Artery Stent Serial Follow up post basilar artery stenting April 3 April 12 April 21 April 25 MCA Aneurysm 10M post stent assisted coiling instent stenosis within the right M1 segment measuring 50 - 70%. RMCA flow in normal range NOVA 2/2012 vessel map, 3D NOVA QMRA Evaluate individual vessels: Right AVM MCA: 953 cc/min 184 cc/min Primary Draining Vein: 768 ml/min 68 cc/min NOVA Flow Rate (ml/min) of Feeding Artery and Draining Vein During the Treatment process Right Frontal AVM with Treatments of Embolizations and Resection Draining Vein RICA RMCA RJV 1242 1191 953 760 1008 958 737 627 509 777 716 562 277 500 343 506 768 604 301 605 378 496 431 447 371 184 316 68 Baseline 1st Embo 2nd Embo 3rd Embo 4th Embo 5th Embo Resection PREOP Right ICA Occlusion Right middle cerebral artery flow measurements, pre (left) and post (right) diamox. NOVA Vessel Map Pre diamox Post diamox % change RACA and RPCA flows decrease after diamox RMCA increases only marginally, 6% POST OP ANGIO AND NOVA VERiTAS study Vertebral flow Evaluation and Risk of Transient Ischemic Attack and Stroke (VERiTAS) study VERiTAS研究─短暫缺血性中風在脊椎的流量風險評估 Prospective multicenter observational study of patients with symptomatic vertebrobasilar disease using QMRA: Does flow compromise stratify stroke risk? NOVA (QMRA) for Symptomatic VBD Normal Flow Basilar stenosis Low Flow Basilar occlusion MyRIAD Study - Mechanisms of early Recurrence of Intracranial Atherosclerotic Disease MyRIAD研究─臚內血管硬化的早期復發機制研究 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 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 FIESTA image showing the CSF. (b) 3D model of aqueduct with flow measurement location shown in yellow. (c) 2D PCMR phase image perpendicular to aqueduct. a b ) ) Quantitative Flow Assessment Intracranial atherosclerotic occlusive disease 顱內血管硬化阻塞疾病: Current focus on ‘anatomy’ of the disease 目前專注在疾病的解剖 Consider the ‘physiology’ of the disease 思考疾病的生理 FLOW MATTERS 血流非常重要 Thank you!