[Clinical usefulness of stereoscopic digital subtraction angiography].
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Biomedical subjects
Publications and source records attributed to H Bussaka.
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Magnetic resonance images of 128 patients with compressive lesions of the cervical spinal canal were reviewed to determine whether a high signal intensity lesion within the spinal cord was present on T2 and proton density weighted spin echo images. Such high signal intensity was observed in 24 cases or 18.8%. The incidence was higher in herniated disk (32.4%), atlanto-axial dislocation (28.6%), and ossification of the posterior longitudinal ligament (22.7%), whereas the abnormality was found sporadically in cervical spondylosis and vertebral body tumors. The high intensity lesion on T2 weighted images was generally observed in patients with constriction or narrowing of the spinal cord. The lesion was not demonstrated on T1 weighted spin echo images. Spinal cord constriction or localized narrowing seemed to be the most important predisposing factor in producing such a high signal intensity. The pathophysiologic basis of such an abnormality was presumed to be myelomalacia or cord gliosis secondary to a long-standing compressive effect of the spinal cord.
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Stereoscopic DSA is performed with alternate exposures from a twin focal X-ray tube (6,5 cm focal separation). Excellent intravenous and intra-arterial DSA images of the cerebral vessels are obtained with separation of overlapping parts of the normal and abnormal vasculature. The clinical value of DSA has been enhanced by use of stereoscopic DSA.
A new neuroangiographic unit has been developed with use of a "C" type gantry, which is capable of rotation and angulation for various angiographic projections. Two sets of a twin focal X-ray tube and an imaging system are mounted on the gantry. Each imaging system consists of a 9 inch image intensifier and a 14 X 14 rapid film changer, which can be exchanged in position rapidly. Stereoscopic magnification and stereoscopic contact angiography, fluoroscopy and DSA are performed in monoplane and biplane and switched over to each other expeditiously and easily. The detailed angiographic information is obtained with lower complication rate and lower exposure to patients. Interventional neuroradiologic procedures are performed efficiently on this unit.
The central nervous system is rarely involved by Wegener's granulomatosis. A case of Wegener's granulomatosis with involvement of the cerebral arteries was reported. Computed tomography showed extensive brain edema with angiographic demonstration of cerebral vasculitis.
A digital subtraction angiography (DSA) system has been modified for capabilities of a 1024 x 1024 matrix with 10 bit depth. Spatial resolution was increased with expansion of the matrix, but contrast resolution was not increased as determined by phantom experiments. Smaller focal spots and magnification factors were also important for improvement of spatial resolution. Clinical evaluation using carotid, vertebral, and cervical DSA with intra-arterial contrast injections demonstrated that there was slight improvement in the image quality, but the final diagnosis and management of patients were not changed with the use of high resolution DSA. Further improvements in image quality of DSA will be accomplished by improvements of image intensifiers and use of smaller focal spots.
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Stereoscopic technique was applied to digital subtraction angiography (DSA) with alternate exposures from twin focus spots (6.5-cm separation) of an x-ray tube. Correct identification of two crossed aluminum wires was obtained more than 90% of the time when there was separation of more than 5 mm. Excellent clinical images of intravenous as well as intraarterial DSA have been obtained, and the clinical value of DSA was enhanced by application of the stereoscopic technique.