Dual-Volume Cone Beam Computed Tomography Helps Elucidate Dural Arteriovenous Fistula Anatomy in the Presence of Tantalum-Opacified Liquid Embolic

The presence of tantalum-opacified liquid embolic in incompletely treated dural arteriovenous fistulae (dAVFs) limits visibility of critically important angioarchitectural features. Modern cone beam computed tomography (CBCT) imaging can resolve the anatomy of dAVFs, allowing for a targeted embolic approach. However, distortion from beam hardening artifact is particularly limiting in CBCT imaging. We present a case of a dAVF embolized 4 times without cure at an outside hospital and ultimately referred to our practice for treatment. In this case, dual volume CBCT imaging (vs. the traditional single volume technique), combined with postprocessing tools on a modern workstation, enabled clear resolution of critical angioarchitectural features of the dAVF, leading to a targeted cure. This technique has the potential to vastly improve dAVFs resolution in the context of partial treatment, a challenging and not uncommon diagnostic and treatment challenge.