Functional angiography

The discovery of X-rays over a century ago enabled noninvasive examination of the human body. Contrast agents that enhanced X-ray images were soon developed that advanced angiology by allowing exploration of the vascular tree. Starting as a diagnostic tool, angiography underwent technological transformations over the last century and became a basis for interventional therapy as well. Initially a static two-dimensional record of the vasculature on screen films, angiography has evolved to real-time two-dimensional display of the vasculature on television monitors, three-dimensional reconstruction from computerized tomographic (CT) scans, and, more recently, three-dimensional cone-beam reconstruction. Cinematographic angiography is referred to as dynamic angiography in current terminology, but it essentially provides no more than images of vascular structures and changes therein. Although dynamic angiography has facilitated advances in image-guided interventions, the evaluation of blood flow rate, or perfusion, and blood flow velocity using angiography remains elusive. Many lines of research have been pursued toward enabling such evaluations, but none have found their way into clinical practice. This article reviews angiographic flow assessment methods attempted over the past several decades and explores some new avenues that may facilitate the transfer of such methods into the clinical practice of diagnostic and interventional angiography and, eventually, contribute to better patient care.