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The value of angiography in cerebrovascular disease
E Zeitler1, W Seyfarth, E J Richter
1Department of Radiology, Nürnberg Hospital.
Insights
Digital subtraction angiography (DSA) reduces risks for cerebral artery imaging. DSA, especially with thoracic aorta catheterization, offers optimal diagnosis for cerebrovascular occlusive disease.
Area of Science:
- Neuroradiology
- Vascular Imaging
- Diagnostic Radiology
Background:
- Cerebral angiography risks are reduced with digital subtraction angiography (DSA).
- Conventional subtraction angiography provides optimal imaging for specific intracerebral pathologies and preoperative planning.
- Cerebrovascular occlusive disease diagnosis benefits from complementary imaging techniques.
Purpose of the Study:
- To evaluate the diagnostic efficacy and safety of digital subtraction angiography (DSA) for cerebrovascular disease.
- To compare different DSA application methods for diagnosing cerebrovascular occlusive disease.
- To determine the optimal imaging strategy for cerebrovascular disease diagnosis and follow-up.
Main Methods:
- Digital subtraction angiography (DSA) using 4-5 French catheters inserted into the thoracic ascending aorta.
- Comparison of contrast media application via intravenous pre-atrial route versus selective carotid artery angiography.
- Integration of DSA with Doppler and B-scan ultrasonography (duplex-scan method).
Main Results:
- DSA with thoracic aorta catheterization provides adequate sensitivity and specificity for diagnosing cerebrovascular occlusive disease with limited examination risk.
- Intravenous contrast media application is associated with fewer complications causing lasting neurological defects compared to selective carotid angiography.
- The quality of diagnostic interpretation depends on the degree of arteriosclerotic obliteration and morphological details.
Conclusions:
- DSA, particularly when combined with thoracic aorta catheterization and duplex-scan, represents the optimal diagnostic approach for cerebrovascular disease.
- Intravenous contrast media application is preferred for post-operative and screening purposes despite lower specificity.
- DSA significantly enhances the diagnosis of cerebrovascular occlusive disease, offering a balance between diagnostic accuracy and patient safety.
Abstract:
The expanding availability of digital subtraction angiography has essentially contributed in lowering the risks in the use of angiography of the cerebral arteries. The best results in imaging the cerebral artery are achieved by conventional subtraction angiography after selective catheterisation. This is, however, only important for diagnosis in intracerebral pathological changes distal of the Circulus Willisi or in connection with preoperative interventional radiological treatment. Pre-clinical diagnosis of patients with cerebrovascular occlusive disease as well as clinical diagnosis with Doppler and B-scan US sonography can be optimally complemented by DSA using 4-5 French catheters entered in the thoracic ascending aorta. Using this technique, the sensitivity and specificity with an image-matrix of 512 is diagnostically adequate and includes an only limited examination risk. Complication with lasting neurological defects will be least observed after intravenous pre-atrial application of contrast media and most after selective angiography of the carotid artery. Here the extent of the multiple arteriosclerotic obliteration is of essential importance. The quality of interpretation of the diagnostic findings essentially depends on indications not only about the grade of obliteration but also on the morphological details. At present DSA with application of contrast media into the thoracic ascending aorta in combination with the duplex-scan method represent the optimum for the diagnosis of cerebrovascular disease. In spite of lower specificity intravenous application of contrast media has to be preferred for post-operative controls and controls of progressing disease with "screening".