Neuroradiology/Interventional Neuroradiology

The Pickup Family Neurosciences Institute includes five dedicated neuroradiologists, armed with the latest advances in technology for imaging. These resourcesoffer 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 actuasl brain volume in the brain areas affected earliest by Alzheimer’s disease,

Recently, Hoag added a PET/MRI 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.

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 areriovenous 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 Multispecialty clinic, and regularly attend Hoag’s quarterly Brain Aneurysm and AVM Support Group meetings.

The 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 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.

Clinical Research

MD Alexander, JM Rebhun, SW Hetts, MR Amans, F Settecase, RJ Darflinger, CF Dowd, VV Halbach, RT Higashida, DL Cooke. Technical factors affecting outcomes following endovascular treatment of posterior circulation atherosclerotic lesions. Surgical Neurology International 2017; Nov 20 (E-pub ahead of print).

FSettecase, DB McCoy, R Darflinger, MD Alexander, DL Cooke, CF Dowd, SW Hetts, RT Higashida, VV Halbach, MR Amans. Improving Mechanical Thrombectomy Time Metrics in the Angiography Suite: Use of Stroke Cart, Parallel Workflows, and Conscious Sedation. Interventional Neuroradiology 2017; Nov 16 (E-pub ahead of print)

MD Alexander, KM Meisel, VV Halbach, AH Lau, F Settecase, RJ Darflinger, AD Nicholson, CF Dowd, SW Hetts, DL Cooke, RT Higashida, MR Amans. Enlarged Condylar Veins as a Source of Pulsatile Tinnitus: Angiographic Features and Confirmation with Venous Balloon Test Occlusion. Neurographics 2017 Oct 7(5): 363-368.

JK Yang, AM Cote, CD Jordan, S Kondapavulur, AD Losey, D McCoy, A Chu, JF Yu, T Moore, C Stillson, F Settecase, MD Alexander, A Nicholson, DL Cooke, M Saeed, D Barry, AJ Martin, MW Wilson, SW Hetts. Interventional magnetic resonance imaging guided carotid embolectomy using a novel resonant marker catheter: demonstration of preclinical feasibility. Biomedical Microdevices. 2017 Sep 25; 19(4):88.

MD Alexander, VV Halbach, A Nicholson, F Settecase, R Darflinger, MR Amans. Transvenous Ethanol Sclerotherapy of Feeding Arteries for Treatment of a Dural Arteriovenous Fistula. Journal of Neurointerventional Surgery 2017 Mar;9(3):e12.

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