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

# AIS Thrombectomy Cases


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