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PubMed1984

[State of the art and developmental trends of venous and arterial digital subtraction angiography in neuroradiology].

After presentation of principle and technology of digital subtraction angiography the results of 649 investigations with the peripheral venous method are demonstrated and first experience are discussed critically. In conclusion the method of venous digital subtraction angiography can be estimated as useful for an adequate diagnosis of the extracranial brain vessels. Diagnostic statements of the intracranial vessels by venous injection are limited, and therefore a combined investigation including normal angiography remains necessary. In the next future neuroradiological investigations cannot renounce from selective arterial techniques. It can be expected that normal angiographic investigations will be replaced by digital subtraction angiography with arterial injection of contrast medium.

Angiography↗

PubMed1986

Pediatric digital subtraction angiography: intraarterial and intracardiac applications.

Intraarterial digital subtraction angiography (IA-DSA) was performed in 80 pediatric patients. Forty-four underwent arterial injections with digital filming techniques. Of the 130 injections, DSA imaging was good or excellent in 121, often allowing resolution of vessels 1 mm in size. Thirty-six of the 80 patients underwent cardiac evaluation with intra-cardiac injections. Improved contrast resolution with IA-DSA allowed the use of smaller catheters (3-4F) and smaller amounts of contrast material. Immediate availability of subtracted images (no film processing delay) resulted in shorter total procedure time. Outpatient studies are possible. IA-DSA provides several notable advantages for the pediatric patient.

Adolescent↗

PubMed2007

Detection and characterization of intracranial aneurysms with 16-channel multidetector row CT angiography: a prospective comparison of volume-rendered images and digital subtraction angiography.

BACKGROUND AND PURPOSE: The aim of our study was to compare multidetector row CT angiography (MDCTA) with digital subtraction angiography (DSA) in the detection and characterization of intracranial aneurysms. MATERIALS AND METHODS: In our blinded prospective study, 85 patients with suspected intracranial aneurysm (47 women, 38 men; age range, 19-83 years) underwent both 16-channel MDCTA and DSA. The MDCT angiograms were interpreted for the presence, location, size, ratio of the neck to the dome (N/D ratio), and lobularity of the aneurysms and relationship of the aneurysm with the adjacent arterial branches, by using volume-rendering techniques. MDCTA and DSA images (reference standard) were interpreted by 2 independent readers, and the results were compared. RESULTS: A total of 93 aneurysms were detected at DSA in 71 patients, whereas no aneurysms were detected in 14 patients. Compared with DSA, the overall sensitivity, specificity, and accuracy of MDCTA on a per-aneurysm basis were 92.5%, 93.3%, and 92.6%, respectively, for both independent readers. For aneurysms of <3 mm, however, MDCTA had a sensitivity of 74.1% for reader 1 and 77.8% for reader 2. There was excellent agreement between readers in the detection of aneurysms (kappa = 0.822). In addition, MDCTA was also accurate in determining N/D ratio of aneurysms, aneurysm lobularity, and adjacent arterial branches. CONCLUSION: MDCTA is accurate in the detection and characterization of intracranial aneurysms and can be used as a reliable alternative imaging technique to DSA in selected cases.

Adult↗

PubMed1985

Differentiation between benign and malignant disease of the breast using digital subtraction angiography of the breast.

The authors have investigated digital subtraction angiography (DSA) for the differential diagnosis of breast lesions detected initially by mammography. Eighteen patients scheduled for biopsy first underwent digital subtraction angiography of the breast (DSAB). Criteria for malignancy included the presence of abnormal vessels and a "blush" in the area of the lesion. A total of 17 lesions are currently available for histopathologic correlation. Although this is a small series, the initial results of DSAB suggest its potential utility for differentiating between benign and malignant lesions.

Angiography↗

PubMed1987

Intravenous digital subtraction angiography in the evaluation of potential renal donors.

Of 65 surgically removed donor kidneys intravenous digital subtraction angiography demonstrated accurately the number of renal arteries in 58 (89 per cent). All accessory vessels missed at digital subtraction angiography were small and their presence did not interfere with successful transplantation in those donated. Of 50 surgically removed donor kidneys examined with conventional aortography only before the routine use of intravenous digital subtraction angiography the number of renal arteries was demonstrated accurately in 46 (92 per cent). Intravenous digital subtraction angiography offers advantages over conventional aortography, including most importantly the routine performance on an outpatient basis, and decreased film cost and examination time. Although the accuracy of conventional aortography (92 per cent) in detecting the number of renal arteries is slightly greater than that for intravenous digital subtraction angiography (89 per cent), the advantages of the digital examination justify its use as the initial examination for the potential renal donor. Conventional aortography can be reserved for use in patients with equivocal or technically inadequate digital examinations.

Angiography↗

PubMed2003

MR digital subtraction angiography in the diagnosis of meningiomas.

OBJECTIVE: MR digital subtraction angiography (DSA) is a technique for demonstrating the vasculature combining a rapid two-dimensional T1-weighted sequence with a bolus injection of gadolinium. We attempted to determine its contribution to the diagnosis of intracranial meningiomas. METHODS AND PATIENTS: MR DSA was performed in 18 patients with meningioma as well as in 28 patients with other tumors. The findings were analyzed regarding demonstration of tumor stain and tumor-related vessels. RESULTS: All meningiomas except one were visualized as a homogeneous and intense stain. Feeding arteries were visualized in 2 patients, and draining or abnormal veins in three. In 21 of the 28 patients with other tumors, tumor stains of varying degrees were demonstrated. CONCLUSION: MR DSA can serve as an adjunct to routine MR imaging, because it enables assessment of the hemodynamics of meningiomas and facilitates its differential diagnosis from other tumors.

Adolescent↗

PubMed2004

Pediatric head and neck lesions: assessment of vascularity by MR digital subtraction angiography.

BACKGROUND AND PURPOSE: Pediatric head and neck lesions can be difficult to characterize on clinical grounds alone. We investigated the use of dynamic MR digital subtraction angiography as a noninvasive adjunct for the assessment of the vascularity of these abnormalities. METHODS: Twelve patients (age range, 2 days to 16 years) with known or suspected vascular abnormalities were studied. Routine MR imaging, time-of-flight MR angiography, and MR digital subtraction angiography were performed in all patients. The dynamic sequence was acquired in two planes at one frame per second by using a thick section (6-10 cm) selective radio-frequency spoiled fast gradient-echo sequence and an IV administered bolus of contrast material. The images were subtracted from a preliminary mask sequence and viewed as a video-inverted cine loop. RESULTS: In all cases, MR digital subtraction angiography was successfully performed. The technique showed the following: 1) slow flow lesions (two choroidal angiomas, eyelid hemangioma, and scalp venous malformation); 2) high flow lesions that were not always suspected by clinical examination alone (parotid hemangioma, scalp, occipital, and eyelid arteriovenous malformations plus a palatal teratoma); 3) a hypovascular tumor for which a biopsy could be safely performed (Burkitt lymphoma); and 4) a hypervascular tumor of the palate (cystic teratoma). CONCLUSION: Our early experience suggests that MR digital subtraction angiography can be reliably performed in children of all ages without complication. The technique provided a noninvasive assessment of the vascularity of each lesion that could not always have been predicted on the basis of clinical examination or routine MR imaging alone.

Adolescent↗

PubMed2002

Carotid artery stenosis: contrast-enhanced MR angiography with two different scan times compared with digital subtraction angiography.

Contrast enhanced magnetic resonance angiography (CE MRA) is a non-invasive alternative to conventional digital subtraction angiography (DSA). CE MRA is increasingly used as a complement to Duplex in the preoperative assessment of carotid artery stenosis. The purpose of this study was to determine if CE MRA could replace preoperative DSA. CE MRA with a scan time of 10 or 28 s was performed in 24 consecutive patients who were scheduled for preoperative DSA because of Duplex-verified severe carotid artery stenosis. Two neuroradiologists measured the degree of stenosis with three different methods, and the image quality was evaluated. DSA was used as the gold standard. For detection of severe stenosis (N. American symptomatic carotid endarterectomy trial (NASCET) > or =70%; European symptomatic carotid endarterectomy trial (ECST) > or =80%; common carotid artery method (CCAM) > or =80%), the sensitivity of CE MRA maximum intensity projection (MIP) compared with DSA was 82%-100 %, the specificity was 74%-93% and the accuracy was 77%-90%. The inter-observer agreement was higher, the image quality was better and the intracranial main arteries were better visualized with the 28 s than with the 10 s scan time. The enhancement of the jugular veins seen in 17% of the 10 s scans and in 58% of the patients with the 28 s scans did not interfere with the evaluation of the carotid arteries. CE MRA, preferably with a scan time of 28 s, can replace DSA in the preoperative assessment of most patients with carotid artery stenosis.

Aged↗

PubMed2003

Evaluation of peripheral arterial bypass grafts with multi-detector row CT angiography: comparison with duplex US and digital subtraction angiography.

PURPOSE: To assess the technical feasibility of multi-detector row computed tomographic (CT) angiography in the assessment of peripheral arterial bypass grafts and to evaluate its accuracy and reliability in the detection of graft-related complications, including graft stenosis, aneurysmal changes, and arteriovenous fistulas. MATERIALS AND METHODS: Four-channel multi-detector row CT angiography was performed in 65 consecutive patients with 85 peripheral arterial bypass grafts. Each bypass graft was divided into three segments (proximal anastomosis, course of the graft body, and distal anastomosis), resulting in 255 segments. Two readers evaluated all CT angiograms with regard to image quality and the presence of bypass graft-related abnormalities, including graft stenosis, aneurysmal changes, and arteriovenous fistulas. The results were compared with McNemar test with Bonferroni correction. CT attenuation values were recorded at five different locations from the inflow artery to the outflow artery of the bypass graft. These findings were compared with the findings at duplex ultrasonography (US) in 65 patients and the findings at conventional digital subtraction angiography (DSA) in 27. RESULTS: Image quality was rated as good or excellent in 250 (98%) and in 252 (99%) of 255 bypass segments, respectively. There was excellent agreement both between readers and between CT angiography and duplex US in the detection of graft stenosis, aneurysmal changes, and arteriovenous fistulas (kappa = 0.86-0.99). CT angiography and duplex US were compared with conventional DSA, and there was no statistically significant difference (P >.25) in sensitivity or specificity between CT angiography and duplex US for both readers for detection of hemodynamically significant bypass stenosis or occlusion, aneurysmal changes, or arteriovenous fistulas. Mean CT attenuation values ranged from 232 HU in the inflow artery to 281 HU in the outflow artery of the bypass graft. CONCLUSION: Multi-detector row CT angiography may be an accurate and reliable technique after duplex US in the assessment of peripheral arterial bypass grafts and detection of graft-related complications, including stenosis, aneurysmal changes, and arteriovenous fistulas.

Adult↗

PubMedDate not supplied

Feasibility of ventricular function analysis by digital subtraction angiography.

Continuous or cine mode of digital subtraction angiography (DSA) following intravenous injection of contrast media was evaluated in regard to feasibility of obtaining physiologic data in cardiac abnormalities. Computer programs for cardiac function analysis including stroke volume, ejection fraction and display of left ventricular wall motion in end-diastole and end-systole have been developed with use of automatic contour plotting and densitometry for depth information. Experiments with contrast-filled balloons demonstrated good correlation between the true volumes and the calculated volumes. Clinical study also demonstrated good correlation between the values obtained from conventional left ventriculography and DSA.

Angiography↗

PubMedDate not supplied

Diagnostic accuracy of intravenous digital subtraction angiography for peripheral vascular diseases.

Intravenous digital subtraction angiography (IV DSA) was performed on 406 regions of 241 patients with peripheral vascular diseases. The results were compared with conventional angiograms for 167 arteries. There was excellent correlation between conventional angiograms and IV DSA. The diagnostic accuracy was 95 with 97% sensitivity and 94% specificity when more than 60% stenoses were taken into consideration. DSA is a less-invasive procedure which can be performed on out-patients for screening and follow-up evaluation of peripheral vascular diseases.

Aged↗

PubMed1984

[Diagnosis of renovascular hypertension by intravenous digital subtraction angiography and renal sequential scintigraphy].

Intravenous digital subtraction angiography (DSA) and 131J-hippuran clearance (NSS) were evaluated in 113 patients, both methods were made as screening tests for renovascular hypertension. In 9 examinations DSA was not diagnostic, in 18 patients arterial wall lesions were found. The dynamic renal imaging with hippuran showed alterations in 86 patients, 2 patients with renal arterial stenosis had normal findings. Combination of both methods yields good results in estimation of the haemodynamic significance of a renal arterial narrowing.

Adult↗

PubMed1985

Whole body intravenous digital subtraction angiography.

A new type of intravenous digital subtraction angiography using an extra large field size is reported. Excellent image quality of large field size enables better evaluation of widespread vascular disease and eliminates the need for repeated injections of contrast material in almost all patients.

Angiography↗

PubMed1985

Stereoscopic technique in digital subtraction angiography.

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.

Angiography↗

PubMed1986

Renal artery stenosis: evaluation with intravenous digital subtraction angiography.

The ability of diagnostic intravenous digital subtraction angiography (IVDSA) to demonstrate the degree of renal artery stenosis was compared with that of intraarterial angiography in 45 patients with 92 arteries. Stenotic lesions on both IVDSA and intraarterial studies were classified as normal (0% stenosis), minor (less than 50%), low grade (50%-80%), and high grade (80%-99%). There was agreement about the degree of stenosis in 90% of the cases. IVDSA grading was correct in 94% of atheromatous lesions and in 56% of the fibromuscular dysplastic lesions. In the high-grade atheromatous lesions, the degree of stenosis was slightly overestimated on IVDSA studies in 22.5% of the cases. In fibromuscular dysplasia, stenosis was underestimated in 33% of the cases.

Angiography↗

PubMed1986

Integrated stereotaxic imaging with CT, MR imaging, and digital subtraction angiography.

A stereotaxic frame, compatible with digital subtraction angiography, computed tomography, and magnetic resonance imaging, is described along with a set of software programs that run in an independent imaging computer system, as well as in the computers associated with each modality. Plexiglas plates fastened to the sides of the frame contain fiducial markers that can be recognized in the images and from which the section position and in-plane coordinates of any point in the image relative to the frame may be determined. Coordinate measurements of isolated point targets may be made to an accuracy of better than +/- 1 mm within a 15-cm field of view in the plane of the section or projection on all modalities. The stereotaxic system is of sufficiently high accuracy to be used on a routine clinical basis with one or more of the above modalities.

Cerebral Angiography↗

PubMedDate not supplied

Impact of digital subtraction angiography on carotid evaluation.

Impact of digital subtraction angiography by intravenous injection (DSAV) was examined in a private neurology clinic. In the evaluation of threatened stroke, advent of DSAV was associated with reduced use of both traditional noninvasive tests (from 100% of patients to 36%), and conventional arteriograms (from 29% to 4%). Less compelling indications were often prescreened with noninvasive tests; more compelling symptoms usually had initial DSAV. Conventional arteriograms were done for compelling indications and negative or inadequate DSAV. The average cost of evaluation was increased slightly in patients treated medically and reduced greatly in those having surgery. While cost and convenience might support such utilization, issues of quality of evaluation require consideration.

Carotid Arteries↗

PubMed1981

Intravenous digital subtraction angiography: application to cerebrovascular surgery.

Intravenous digital subtraction angiography (DSA) was used to evaluate the extracranial and/or intracranial arteries of 87 patients with suspected cerebrovascular disorders. The examinations were performed on either an inpatient or an outpatient basis. Renografin-76 was injected into an arm vein through an angiocatheter. Extracranial examinations accurately demonstrated major artery disease such as carotid artery occlusion, stenosis, and ulceration. Intracranial examinations demonstrated an aneurysm in 9 of 10 patients and an arteriovenous malformation in 5 patients. The technique was useful in assessing the results of cerebrovascular procedures such as carotid endarterectomy, superficial temporal artery to middle cerebral artery bypass, and the obliteration of vascular anomalies. DSA also excluded the presence of an intrasellar aneurysm and showed the location of the intracranial arteries before trans-sphenoidal surgery. The findings of the DSA examinations correlated closely with the findings of conventional angiography.

Brain Ischemia↗