Quantitative color-coded digital subtraction neuroangiography for pediatric arteriovenous shunting lesions

  • Grace M. Y. MaEmail author
  • Adam A. Dmytriw
  • Premal A. Patel
  • Nicholas Shkumat
  • Timo Krings
  • Manohar M. Shroff
  • Prakash Muthusami
Technical Notes



Several complex pediatric neurovascular conditions are amenable to endovascular treatment. Given the unique anatomical and physiological challenges in children, there is an ongoing need for tools and techniques that provide accurate information for treatment planning, while minimizing exposure to ionizing radiation and contrast. This is more so for neonates and infants with high-flow arteriovenous (AV) shunts that are challenging to assess using conventional techniques.


In this brief report, we describe, through representative cases, the potential role of quantitative color-coded digital subtraction angiography (qDSA) in neuroendovascular procedures in children with high-flow AV shunting lesions.


Images were obtained using an ArtisQ biplane system (Siemens Healthineers, Erlangen, Germany). Post-processing was performed at a dedicated workstation (Syngo, Siemens) using the iFlow module to generate color-coded maps of individual digital subtraction angiography runs.


Color-coded qDSA provides real-time quantitative information in high-flow AV shunting neurovascular lesions. This can potentially help direct treatment choices, optimize endovascular treatment protocols, monitor outcomes, and determine treatment end points.


Arteriovenous Quantitative Digital subtraction angiography iFlow Children 



No funding was received for this study.

Compliance with ethical standards

Conflict of interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.

Ethical approval

The study was approved by the Institutional Research Ethics Board (REB)


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Image Guided Therapy, Department of Diagnostic Imaging, Department of Medical Imaging, Hospital for Sick ChildrenUniversity of TorontoTorontoCanada
  2. 2.Division of Neuroradiology, Joint Department of Medical Imaging, Toronto Western HospitalUniversity Health Network, University of TorontoTorontoCanada
  3. 3.Wellcome / EPSRC Centre for Interventional and Surgical Sciences (WEISS)University College LondonLondonUK
  4. 4.Radiology DepartmentGreat Ormond Street Hospital for ChildrenLondonUK

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