NEURORADIOLOGY/INTERVENTIONAL NEURORADIOLOGY

Pickup Family Neurosciences Institute includes five dedicated neuroradiologists, armed with the latest advances in technology for imaging. These resources offer crucial support to each of our various neurosciences programs. The latest generation multidetector CT scanners are capable not only of routine anatomic imaging but also CT angiography that provides high resolution imaging of the vascular system supplying the brain, as well as advanced perfusion analysis for stroke patients, using the automated software (RAPID, IschemaView). Perfusion analysis actually calculates how much blood flow per minute each portion of the brain receives. This determines whether, and how much salvageable brain exists, when a stroke patient arrives in our ED.

Hoag’s multiple MRI scanners include three high field 3-Tesla instruments capable of high resolution brain, neck and spine imaging, functional brain MRI, diffusion tensor imaging, which allows analysis of white matter pathways through which tumors can spread, chemical analysis of brain tissue using MRI spectroscopy, as well as brain perfusion imaging, all with 3-dimensional capabilities. In addition, Hoag neuroradiologists utilize NeuroQuant MRI Brain scans, a new tool in the evaluation of patients with memory loss and dementia. This measures actual brain volume in the brain areas affected earliest by Alzheimer’s disease.

Recently, Hoag added a PET/MR scanner, one of few such instruments available for clinical use in the United States. Also, the addition of the 3D Lab, which allows dedicated staff to reconstruct images in preparation for surgical procedures as well as allow neurologists and neurointerventionalists to immediately diagnose perfusion imaging so that physicians are able to make immediate decisions regarding the need to invasively treat patients.

After reconstruction, CT and MR images can be fed into other computers used to guide stereotactic vascular intervention, focused radiosurgery or conventional brain surgery during the procedure. Thus, our advanced imaging team supports the image-guided stereotactic and functional neurosurgery teams in their approach to brain tumors and epilepsy surgery.

Pickup Family Neurosciences Institute also collaborates with the NFL Player’s Association and Cleveland Clinic as the only West Coast location for the Brain and Body and Milestone Program administered through the trust in providing transitioning players with brain MRI as part of comprehensive services aimed at enhancing the cognitive and physical well-being of former NFL players.

Left: 3D CT Angiogram
Right: PET/MR scan shows recurrent active brain tumor surrounding a previously treated dead zone.

Hoag is also home to the latest generation of digital subtraction angiography equipment, yielding the highest resolution angiograms at the lowest radiation doses to the patient. In addition, the most up-to-date post-processing software on these machines allows for 3-dimensional reconstructions, which enable visualization of vascular anatomy and pathology such as aneurysms and arteriovenous malformations, greatly facilitating minimally invasive image-guided, catheter-based treatments such as aneurysm coiling, AVM embolization, stenting, and dural arteriovenous fistula treatment.

The Institute’s three full-time neurointerventional radiologists provide 24/7/365 staffing for stroke care, an essential part of Hoag’s Comprehensive Stroke Center certification. With a combined 30+ years of experience in Orange County in treatment of strokes, aneurysms and AVMs, Hoag neurointerventionalists use the latest endovascular techniques and devices. We continue to be recognized since 2008 as the leader in Orange County for the treatment of stroke, consistently achieving successful outcomes for patients. Hoag neurointerventionalists are also available for outpatient appointments and consultations in Hoag’s multi-specialty clinic, and regularly attend Hoag’s quarterly Brain Aneurysm and AVM Support Group meetings.

Interventional Neuroradiology volume continues to increase and patients continue to have exceptional outcomes. The additional growth in volume in 2018 may be attributed to the DEFUSE-3 and DAWN trials, which now expand the time window of opportunity for intervention in emergent large vessel occlusions (ELVO) up to 24 hours in certain situations as recommended in the updated American Stroke Association guidelines for intracranial thrombectomy. This has allowed us to help more patients with potentially devastating ischemic brain injuries.

One of the outstanding neurointerventional radiologists, Dr. Chris Baker, brought with him a great deal of experience with the Pipeline embolization device, a recent addition to the endovascular treatment possibilities for brain aneurysms. This is a simpler and more effective way to repair wide-necked and fusiform aneurysms that are very challenging to achieve a satisfactory and durable solution that eliminates the risk of rupture and potentially fatal hemorrhage. It is also a safer and faster operation because there is much less manipulation of intravascular instruments and less time under general anesthesia.

Pipeline Aneurysm Repair

comparison of pre pipeline and post pipeline repair

# AIS Thrombectomy Cases

To learn more, visit the Interventional Neuroradiology section or call 949-764-6066.