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Separated conjoined twins owe debt to MR imaging, Utility of stroke assessment software expands to include whole-body applications Diagnostic Imaging October, 2004

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Medical teams had worked for nearly a year to separate Carl and Clarence Aguirre, Filipino twins conjoined at the head. For the final operation in late summer, physicians at Montefiore Children’s Hospital in the Bronx pondered how to deal with a large vein the siblings shared. MR-based dedicated blood flow analysis software provided the tipping point that made it clear excision was possible.

The program, known as NOVA (non-invasive optimal vessel analysis), provides physicians with a rotating image of a volume in the neurovascular environment from which any vessel can be singled out. After selecting a vessel, the software aligns an MR plane perpendicular to its axis. Physicians can then obtain an accurate, quantitative measurement of blood flow rate at any point along this vessel through computer-created flow graphs.

NOVA can evaluate up to 14 vessels within the time frame of a standard MR angiogram. It can help physicians determine the need for treatment, access the success of therapy, and follow up patients. It does not require injection of contrast agents, offers a noninvasive alternative to catheter angiography, and can be billed as a regular MRA.

“Everyone working in neurovascular surgery has to make a decision plan. This is the perfect technology for that.” Said Dr. James T. Goodrich, director of pediatric neurosurgery at Montefiore and lead surgeon in the twin’s operation.

Neurosurgeons at Montefiore had previously been unable to calculate blood flow noninvasively outside the brain’s periphery. They feared that attempting to separate the twins without this information could leave at least one of the twins with severe brain damage or risk having one die. The software helped surgeons estimate both the direction and volume of flow, Good said.

“NOVA showed this absolutely beautiful venous circulation we had not been able to see before. Its contribution was enormous, “ he said

For more information about the Aguirre Twins, please visit http://www.montekids.org.