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PubMed2002

Comparison of intraarterial and IV gadolinium-enhanced MR angiography with digital subtraction angiography for the detection of renal artery stenosis in pigs.

OBJECTIVE: Catheter-based intraarterial injections of gadolinium are useful during MR imaging-guided endovascular procedures to generate rapid vascular road maps. Using an animal model of renal artery stenosis, we tested the hypothesis that intraarterial gadolinium-enhanced MR angiography is as accurate as IV gadolinium-enhanced MR angiography and digital subtraction angiography (DSA). We also tested the hypothesis that intraarterial MR angiography uses less gadolinium than IV MR angiography. MATERIALS AND METHODS: We induced bilateral renal artery stenosis in five pigs. All pigs underwent comparative imaging with DSA, IV MR angiography, and aortic catheter-directed intraarterial MR angiography. For IV and intraarterial MR angiography, we used the same three-dimensional acquisition. We assessed differences in quantitative stenosis measurements among DSA, IV MR angiography, and intraarterial MR angiography using the Wilcoxon's signed rank test. RESULTS: Mean stenosis measurements (+/-SD) were as follows: DSA, 58% +/- 12%; IV MR angiography, 63% +/- 9.3%; and intraarterial MR angiography, 64% +/- 11%. There were no statistically significant differences in accuracy between DSA and IV MR angiography (p = 0.06), DSA and intraarterial MR angiography (p = 0.16), or IV and intraarterial MR angiography (p = 0.70). Intraarterial MR angiography used a mean gadolinium dose of 5.6 mL, compared with 9 mL for IV MR angiography. CONCLUSION: In swine, IV and intraarterial MR angiography have a similar accuracy for detecting renal artery stenosis. Intraarterial MR angiography uses smaller doses of injected gadolinium.

Angiography, Digital Subtraction↗

PubMed1982

Intracranial intravenous digital subtraction angiography.

Intravenous digital subtraction angiography (iDSA) promises to significantly alter the use of conventional cerebral angiography in the workup of neurological patients. Understanding its diagnostic potential and its limitations are important in incorporating this new examination into the diagnostic thought process of neuroradiologic tests. Different image processing techniques such as integration of mask and contrast images promise to improve image quality for neuroradiologic application. At present, iDSA is suitable for the diagnosis and follow-up of vascular lesions (atherosclerosis, aneurysms, arteriovenous malformations, venous sinus occlusion), and tumor (meningioma). Although limited, the spatial resolution of iDSA studies is capable of demonstrating diffuse vascular disease such as arteritis and vasospasm after subarachnoid hemorrhage. In some patients in conjunction with the CT scan, iDSA may prove sufficient as the primary and only diagnostic angiographic test necessary, supplanting conventional angiography.

Arteriosclerosis↗

PubMedDate not supplied

Technical developments and instrumentation: biplane digital subtraction angiography.

Biplane digital subtraction angiography was utilized in 200 patients having intravenous or intra arterial studies. Images were of excellent quality without cross fogging by scattered radiation using an alternating exposure series. Decreased contrast load and decreased procedure time were significant benefits.

Carotid Arteries↗

PubMedDate not supplied

Biplane digital subtraction angiography.

Biplane digital subtraction angiography was performed by placing a rapid switch between the anteroposterior and lateral T.V. cameras and the A-D converter. Alternate exposures from two X-ray tubes were employed. Excellent anteroposterior and lateral DSA was obtained especially for the brain and neck. Although there was more time required for positioning, biplane imaging saved the second or the third injection in many occasions. The technique has been especially valuable for intravenous DSA of the brain and the neck.

Angiography↗

PubMed1984

Evaluation of parathyroid adenomas by intravenous digital subtraction angiography.

Intravenous digital subtraction angiography (DSA) successfully localized three previously suspected parathyroid adenomas in the lower part of the neck and one in the mediastinum. Our experience suggests that this method may have widespread application for preoperative evaluation of parathyroid adenomas, particularly after unsuccessful surgical exploration or when recurrent or ectopically located adenomas are likely. In three other cases abnormal vascular blushes in the neck on intravenous DSA were related to thyroid disease. Close correlation with the clinical and laboratory findings is necessary to avoid potential pitfalls in diagnosis.

Adenoma↗

PubMed1985

100 living-related kidney donor evaluations using digital subtraction angiography.

Intravenous digital subtraction angiography (IV-DSA) combined with excretory urography was used to evaluate the renal anatomy of 100 potential living-related kidney donors. Each of the 100 patients underwent subsequent nephrectomy to verify the number and distribution of renal vessels. For the entire series, 71 patients had bilateral single, 2 bilateral multiple and 27 multiple renal arteries on one side determined by angiography. Eleven patients required standard catheter angiography due to inadequate IV-DSA studies. Four patients who had a single artery imaged by IV-DSA were found to have an additional vessel at the operation. The overall accuracy of IV-DSA to identify the number of renal vessels was 96% (85/89). The sensitivity of the exam was 100% (94/94) and the specificity was 67% (4/6). It is concluded that IV-DSA combined with excretory urography is a safe, cost effective, and suitable method to image the renal anatomy of potential kidney donors. Thus about 90% of donors can be spared the risks and inconvenience of standard angiography, and the donor evaluation can now be performed on an outpatient basis.

Adult↗

PubMed1983

Evaluation of peripheral vascular disease using digital subtraction angiography.

Intravenous digital subtraction angiography (DSA) facilitates imaging of peripheral arteries and bypass grafts on an outpatient basis. Forty-five patients underwent intravenous peripheral angiography, 16 following placement of bypass grafts. Complex oblique and sagittal angulations optimize visualization of bifurcations and overlapping vascular structures. Reprocessing techniques using integrated masks and contrast images allow for diagnostic delineation of fine vascular detail. This is a practical, noninvasive, well tolerated method for both diagnostic screening and follow-up evaluation of patients with peripheral vascular disease.

Angiography↗

PubMed1983

Evaluation of aorto-iliac occlusive disease by intravenous digital subtraction angiography.

Intravenous digital subtraction angiography (DSA) was used to evaluate 22 patients with Leriche syndrome. The technique successfully demonstrated both the level of obstruction and the reconstitution of arterial flow to the lower extremities. In view of the relative safety of DSA, compared with the axillary approach in standard angiography, the authors believe that it should be the initial procedure for presurgical evaluation of Leriche syndrome.

Angiography↗

PubMed1989

Clinically unsuspected complications of arterial surgery shown by post-operative digital subtraction angiography.

Intravenous digital subtraction angiography was performed within 20 days of 678 vascular reconstructions as a routine post-operative evaluation. After 339 carotid endarterectomies, 34 patients showed a stenosis of greater than 30% and six occlusions were seen. In 157 patients after aortic aneurysm repair, we found five anastomotic aneurysms and seven stenoses of greater than 30%. After aortic bypass surgery, 77 patients were evaluated and nine stenoses were found; no anastomotic aneurysms were seen. In 105 patients with femoro-distal bypass procedures, occlusion was reported in 11 cases and stenosis in 13 cases. One patient had two anastomotic aneurysms. To summarize, major abnormalities were present in 81 cases (12.7%) and consisted of 59 stenoses of greater than 30%, 17 occlusions and six patients with anastomotic aneurysms. Most of these were unexpected and were reason for more critical follow-up or re-operation.

Aorta, Abdominal↗

PubMed1986

Intravenous digital subtraction angiography.

Intravenous digital subtraction angiography (ivDSA) is a method whereby arterial images are produced following a peripheral or central venous injection of contrast medium. It is a safe and relatively simple procedure to undertake and is becoming more widely available. The purpose of this article is to review its clinical applications, its advantages and limitations.

Angiography↗

PubMed1985

[Value of rapid acquisition cadences synchronized with the electrocardiogram for the diagnosis of pulmonary embolism by digital subtraction angiography].

Pulmonary digital subtraction angiography was performed in 130 patients referred with possible pulmonary emboli. Findings were interpreted as a function of apparatus used (acquisition cadence, size of matrix, ECG synchronization) and of site of injection (peripheral or central). It now appears possible to diagnose pulmonary embolism with satisfactory reliability in 80 to 85% of cases. This examination is safe (absence of selective catheterization of pulmonary artery), and it could become a standard emergency diagnostic procedure for pulmonary embolic disease.

Angiography↗

PubMed1985

Routine evaluation of arteriopathies of the lower extremities by digital subtraction angiography.

Intravenous digital subtraction angiography (DSA) was performed in 119 patients with lower extremity ischemia using a 14" amplifier. Four injections of contrast medium were usually necessary for a complete evaluation of this vascular region. Images of good quality were obtained in most cases; movement artifacts and a faint opacification accounted for any poor results, which occurred mainly under the knee. The technique of pixel shifting turned out to be very useful to remove movement artifacts. The "measuring field" allowed us to minimize the problem of the inhomo geneous saturation of the amplifier. In 8% of the cases an intra-arterial DSA has been performed after an unsatisfactory intravenous examination. Conventional angiography appears to be no longer necessary.

Aged↗

PubMed1984

Fibromuscular dysplasia, a pitfall in intravenous digital subtraction angiography.

Intravenous Digital Subtraction Angiography (DSA) is described in a patient with severe fibromuscular renal artery dysplasia. DSA identified only a mild renovascular stenosis, while intraarterial angiography demonstrated multiple severe stenoses alternating with aneurysmatic segments. This case confirms the limitations of intravenous subtraction angiography. Higher spatial resolution is required if small stenoses are to be ruled out.

Adult↗

PubMedDate not supplied

Limitations of intravenous digital subtraction angiography.

Eighteen digital subtraction angiography (DSA) examinations were retrospectively evaluated for factors that led to their erroneous interpretation. Overlapping vessels obscured pathologic conditions in five cases. In four cases the lesions were not adequately profiled by the DSA projections. Eight lesions were rendered inconspicuous by misregistration artifacts attributable to motion, either from swallowing or from pulsation of vessel walls. One diagnostic error was caused by poor opacification from a degraded contrast bolus secondary to low cardiac output.

Arteriosclerosis↗

PubMed1999

Intracranial stenoocclusive disease: double-detector helical CT angiography versus digital subtraction angiography.

BACKGROUND AND PURPOSE: To our knowledge, no large-scale studies comparing the accuracy of CT angiography (CTA) to intraarterial digital subtraction angiography (DSA) of intracranial stenosis have been reported. We attempted to determine the diagnostic value of intracranial CT angiography (CTA) of normal vasculature and variants as well as of stenoocclusive disease. METHODS: One-hundred and twelve patients underwent CTA and intraarterial angiography, and 2205 vascular segments were examined to ascertain presence, visibility, and degree of arterial stenoses (n = 105) as well as anatomic variants. Source, maximum intensity projection (MIP), and MIP-generated multiplanar reformatted (MPR) images were evaluated. RESULTS: All 55 anatomic variants were identified correctly. Visibility of small-vessel segments was increased from 75% to 83% by using source images. MPR was helpful in differentiating distal vertebral hypoplasia from stenosis and in overcoming artifacts. All 43 occlusive segments were graded correctly (sensitivity = 100%, predictive value = 93.4%) as follows: severely stenotic ([n = 23], sensitivity = 78%, predictive value = 81.8%); moderately stenotic ([n = 36], sensitivity = 61%, predictive value = 84.6%); and mildly stenotic ([n = 3], sensitivity = 66%, predictive value = 28%). Normal segments (n = 2100) had a sensitivity of 99.5%, and CTA evinced a specificity of 99% for detecting stenoocclusive disease. Approximately one-third of wrong assessments were related to the petrous segment of the carotid artery. CONCLUSION: CTA with double-detector technology and advanced postprocessing algorithms, including MPR, is about as reliable as MRA in depicting the vasculature of the anterior and posterior circulation and in grading intracranial stenoocclusive lesions, with the exception of the petrous segment of the carotid artery. CTA might be superior to MRA in the evaluation of poststenotic low-flow segments.

Angiography, Digital Subtraction↗

PubMed1988

Left ventricular imaging by digital subtraction angiography.

Digital radiography is a rapidly developing new approach to cardiovascular imaging that converts radiographic and fluoroscopic video images into digital format for subsequent image enhancement analysis, and storage. Left ventriculography can be performed by this method using either intravenous or low-dose intraventricular contrast administration. Advantages over standard radiography include reduced radiation and contrast medium burden, visualization of very low contrast medium concentrations, and an image format that can be directly analyzed by quantitative techniques. As these cardiac applications are developed and improved archiving is implemented, it is likely that the digital left ventriculography will replace standard cardiac angiography.

Angiography↗

PubMed2004

Comparison of MR angiography versus digital subtraction angiography as a basis for planning treatment of lower limb occlusive disease.

PURPOSE: To compare contrast-enhanced moving-bed magnetic resonance angiography (MRA) with digital subtraction angiography (DSA) for the ability to provide adequate information on which to construct a therapeutic strategy in patients suffering from peripheral arterial occlusive disease (PAOD). METHODS: A prospective study was conducted involving 48 consecutive patients (25 men; mean age 65.7+/-10.2 years) with PAOD who underwent MRA and DSA of the peripheral arteries on 2 consecutive days. Every leg was divided into 3 anatomical regions (suprainguinal, femoropopliteal, calf), and the sensitivity and specificity for the detection of significant (>70%) lesions, as well as the interobserver variability, were calculated. The potential differences in the therapeutic strategy based on the results of both modalities were evaluated. RESULTS: The MRA and DSA studies in the 48 study patients produced 864 arterial segments for interpretation. The sensitivity of MRA for the detection of significant lesions was 94.7% for the suprainguinal, 89.5% for the femoropopliteal, and 91.3% for the calf arteries. Corresponding specificity was 98.1%, 96.2% and 93.4%, respectively. The interobserver correlation for the detection of significant lesions by MRA and DSA was excellent (kappa>0.8) for all 3 segments, with slightly superior values for MRA. MRA and DSA agreed in the grading of 821 (95.0%) segments. In 8 (16.7%) patients, MRA suggested an additional intervention, and in 3 (6.3%) patients, additional DSA was necessary for the final diagnosis. CONCLUSIONS: The accuracy of MRA for the detection of significant lesions is comparable to DSA. Basing the therapeutic strategy solely on the results of MRA can reduce the number of DSAs by three quarters, but at the risk of incurring lesion overestimation in approximately 17%.

Aged↗

PubMed2005

Assessment of critical limb ischemia in patients with diabetes: comparison of MR angiography and digital subtraction angiography.

OBJECTIVE: The purpose of our study was to evaluate the diagnostic accuracy of hybrid MR angiography by comparison with digital subtraction angiography (DSA) in diabetic patients with critical limb ischemia. SUBJECTS AND METHODS: Thirty-one patients prospectively underwent both hybrid MR angiography and DSA. The hybrid MR angiography study consisted of high-resolution MR angiography of a single calf and foot using a contrast-enhanced 3D gradient-echo volumetric interpolated breath-hold examination with surface coils, followed by three-station bolus chase MR angiography with a dedicated peripheral vascular coil. Two blinded reviewers separately analyzed maximum-intensity-projection hybrid MR angiograms and DSA images. The peripheral vessels were divided into 10 anatomic segments for review. The status of each segment was graded as normal, stenosis less than 50% in diameter, stenosis greater than 50%, or occluded. The sensitivity and specificity of hybrid MR angiography were determined using DSA as the gold standard. Treatment options were considered separately from the results of each examination. RESULTS: Among 310 analyzed segments, the sensitivities of hybrid MR angiography for stenosis and occlusion were, respectively, 95% and 95% for reviewer 1 and 96% and 90% for reviewer 2. The specificities of hybrid MR angiography for stenosis and occlusion were, respectively, 98% and 98% for reviewer 1 and 98% and 99% for reviewer 2. In 25 patients (81%), the quality of bolus chase MR angiography images was insufficient to assess runoff arteries. All treatments proposed on the basis of DSA findings were endorsed by hybrid MR angiography findings. Eleven more treatments were formulated on the basis of hybrid MR angiography findings. Of these, four were due to overestimation of stenosis on MR angiography and seven were due to the detection of patent infrageniculate arteries on hybrid MR angiography that were not detected on DSA. CONCLUSION: Hybrid MR angiography depicts runoff arteries not seen on DSA. Hybrid MR angiography may be useful for treatment planning in selected diabetic patients with critical limb ischemia.

Adult↗