• Ahmed Alnemari, Tarek R Mansour, Mohamad Bazerbashi, Mark Buehler, Jason Schroeder, and Daniel Gaudin.
• Division of Neurological Surgery, Department of Surgery, The University of Toledo Medical Center, Toledo, Ohio, USA.
• World Neurosurg. 2017 Sep 1; 105: 1034.e11-1034.e18.

BackgroundThis article illustrates, summarizes, and reviews the multifaceted application of four-dimensional (4D) computed tomography angiography (CTA) in the characterization and diagnosis of various cerebrovascular and tumor-associated vascular pathologies through the presentation of clinical cases, including acute and chronic stroke, arteriovenous malformations, aneurysm, moyamoya disease, and hypervascularity associated with a tumor and its relationship to preoperative embolization. The technical nuances and limitations of the 4D-CTA technique are also discussed.Case DescriptionWe present 6 cases that best elucidate the application and technical nuances of 4D-CTA and its advantages over traditional digital subtraction angiography. Along with discussion of the utility of 4D-CTA, we also examine the limitations of this technique.ConclusionsIntracranial vascular lesions can be detected with 4D-CTA and clinically evaluated using information related to vascular flow dynamics. The use of 4D-CTA provides data related to ongoing vascular changes as well as accurate spatial delineation of cerebrovascular pathologies. Overall, 4D-CTA is increasing its role in neuroimaging by providing superior information regarding structural three-dimensional imaging quality and real-time flow.Copyright © 2017 Elsevier Inc. All rights reserved.

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