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PubMedDate not supplied

Evaluation of aortic aneurysms and dissection of aorta by intravenous digital subtraction angiography.

Intravenous (IV) digital subtraction angiography (DSA) was performed in 12 patients with suspected aortic aneurysm/dissection. Bolus injection of 30-40 ml of contrast in mid right atrium/main pulmonary artery at a flow rate of 18-20 ml/sec. during DSA accurately localised the site and extent in all 7 patients of aortic aneurysm and in 4 patients of aortic dissection. In one patient, radiological opacity was unrelated to aorta. There were no complications. IV-DSA should be the preferred mode of evaluation for aortic aneurysm and dissection of aorta.

Adult↗
PubMed1999

Retrospective motion correction in digital subtraction angiography: a review.

Digital subtraction angiography (DSA) is a well-established modality for the visualization of blood vessels in the human body. A serious disadvantage of this technique, inherent to the subtraction operation, is its sensitivity to patient motion. The resulting artifacts frequently reduce the diagnostic value of the images. Over the past two decades, many solutions to this problem have been put forward. In this paper, we give an overview of the possible types of motion artifacts and the techniques that have been proposed to avoid them. The main purpose of this paper is to provide a detailed review and discussion of retrospective motion correction techniques that have been described in the literature, to summarize the conclusions that can be drawn from these studies, and to provide suggestions for future research.

Angiography, Digital Subtraction↗
PubMed1999

Hepatic blood supply: comparison of optimized dual phase contrast-enhanced three-dimensional MR angiography and digital subtraction angiography.

PURPOSE: To optimize and determine the value of dual-phase contrast material-enhanced three-dimensional (3D) magnetic resonance (MR) angiography for preoperative evaluation of the blood supply to the liver. MATERIALS AND METHODS: Dual phase 3D MR angiography of the hepatic arteries and portal vein was performed in 140 patients. In 80 patients, the value of fat saturation, digital image subtraction, an anticholinergic agent, and a high-caloric meal were evaluated. In the next 60 patients, MR angiographic and digital subtraction angiographic (DSA) image quality and diagnostic value were compared. RESULTS: Fat-saturated images were of significantly better quality (P < .01) than non-fat-saturated images. Digital image subtraction was useful in only 23 of 40 patients. The injection of an anticholinergic agent was superfluous, whereas administration of a high-caloric meal helped in demonstration of the superior mesenteric artery and portal vein. Classification on MR angiograms of the arterial blood supply was correct in 57 of 60 patients. All arterial and portal venous lesions were seen on MR angiograms, and MR angiograms had a significantly higher subjective image-quality ranking than did DSA images in the evaluation of the portal vein (P < .05). CONCLUSION: Fat saturation and use of a high-caloric meal improve the results of MR angiography of hepatic vessels. MR angiography was comparable to DSA for evaluation of the arterial system and was superior for demonstration of the portal vein; therefore, MR angiography could replace intraarterial DSA.

Angiography, Digital Subtraction↗
PubMed1986

The role of digital subtraction angiography in neuroradiology. An evaluation of intravenous and intra-arterial digital subtraction angiography.

A few years after the introduction of intravenous digital subtraction angiography (DSA) in clinical practice it became clear that, although the method had been developed as an alternative to arterial angiography, especially for the analysis of cerebral ischemia, its application was not as successful as the earlier reports had indicated. Based on the results of a study comparing intravenous DSA, intra-arterial DSA, and the Doppler examination, in 168 consecutive patients, a diagnostic algorithm for the management of these patients is proposed. A second and more important application of digital subtraction is its use with arterial angiography, especially with a high resolution system configuration.

Angiography, Digital Subtraction↗
PubMed1988

Fibromuscular dysplasia of renal arteries: comparison of intravenous digital subtraction angiography with conventional angiography.

Intravenous digital subtraction angiography (IV-DSA) was compared with conventional arteriography (CA) in 14 patients with fibromuscular dysplasia (FMD) of at least one renal artery. IV-DSA identified 29 of the 34 renal arteries detected by CA. A diagnostic quality IV-DSA examination was obtained in 23 of 29 renal arteries (78%). In adequately imaged renal arteries, IV-DSA correctly identified 12 of 20 FMD renal arteries, misdiagnosed 8 FMD renal arteries as normal and correctly identified 3 normal renal arteries. These poor results, due to poor spatial resolution and subtraction artifacts inherent in the IV-DSA system, warrant careful interpretation of negative examinations and further evaluation of high risk patients.

Angiography↗
PubMed1994

Comparison of magnetic resonance angiography, duplex ultrasound, and digital subtraction angiography in assessment of extracranial internal carotid artery stenosis.

The results of a prospective study comparing ultrasound, intra-arterial digital subtraction angiography, and magnetic resonance angiography in the assessment of the degree of extracranial internal carotid artery stenosis are reported in patients with symptoms of recent carotid territory ischaemia. A total of 70 patients and 137 vessels were examined by all three techniques. The results obtained by each technique were reported blind. The mean difference (SD) for the comparison of magnetic resonance angiography and digital subtraction angiography was -0.7 (14)%, for ultrasound and digital subtraction angiography 3.1 (15)%, and for magnetic resonance angiography and ultrasound -3.8 (15)%. The level of agreement was greater for the more tightly stenosed vessels. With the assumption that the results of the digital subtraction angiogram reflect the true situation, the sensitivity and specificity in the detection of > or = 30% stenoses were 93% and 82% with ultrasound and 89% and 82% with magnetic resonance angiography; for stenoses > or = 70% 93% and 92% with ultrasound and 90% and 95% with magnetic resonance angiography; and for stenoses of 70-99% 89% and 93% with ultrasound and 86% and 93% with magnetic resonance angiography. For occlusion the values were 93% and 99% with ultrasound and 80% and 99% with magnetic resonance angiography. Increased sensitivity and specificity were obtained when analysis was confined to those vessels in which ultrasound and magnetic resonance angiography were in agreement over classification. It is thus possible to accurately categorize the degree of stenosis of the extracranial internal carotid artery from a combination of ultrasound and magnetic resonance angiography. The adoption of this combination for the investigation of patients before carotid endarterectomy removes the risk associated with conventional angiography and represents an important advance in the management of carotid stenosis.

Adult↗
PubMed2000

Diabetes and peripheral arterial occlusive disease: prospective comparison of contrast-enhanced three-dimensional MR angiography with conventional digital subtraction angiography.

OBJECTIVE: The purpose of this study was to compare contrast-enhanced three-dimensional MR angiography with conventional digital subtraction angiography (DSA) for identifying and evaluating arteries of the distal calf and foot in diabetic patients with severe arterial occlusive disease who will undergo distal bypass surgery. SUBJECTS AND METHODS: Twenty-four feet of 24 consecutive patients with diabetes and limb-threatening lower extremity ischemia were prospectively imaged using an ultrafast three-dimensional fast low-angle shot sequence on a 1.5-T MR scanner. All patients also underwent DSA of the diseased extremity within 5 days. Images were interpreted in a randomized manner by two observers in conference. Each lower extremity was divided into seven potential arterial segments. Image analysis included the detection of patent, stenosed, or occluded vessel segments. A vascular surgeon formulated treatment plans on the basis of findings from DSA and then formulated treatment plans on the basis of findings from both DSA and MR angiography. RESULTS: MR angiography was significantly better than DSA in revealing peripheral runoff vessels (p < 0.001). In nine (38%) of the 24 patients, MR angiography showed patent pedal vessels suitable for distal bypass grafting that were not revealed by DSA. Because of the results of MR angiography, treatment plans changed in seven of the nine patients in whom patent vessels were subsequently used as target vessels for distal pedal bypass grafts. CONCLUSION: Contrast-enhanced three-dimensional MR angiography is superior to DSA in revealing patent vessel segments of the foot in diabetic patients with severe arterial occlusive disease. Contrast-enhanced three-dimensional MR angiography should be part of the diagnostic algorithm for patients in whom pedal bypass grafting is a therapeutic option.

Aged↗
PubMed1986

[Angiography and digital subtraction angiography].

In pediatrics angiography is a method that is used relatively rarely. During the last few years the introduction of nonionic contrast media has led to considerable progress in the field of conventional angiography since these contrast media are tolerated much better than the ionic ones. Also in the field of catheter techniques the introduction of new catheters has led to considerable progress. The new catheters are characterized by very thin walls and wide lumina which allow a high flow of contrast media. Their use in children has considerably reduced local complications at the puncture site. The introduction of digital subtraction techniques on the one hand made intravenous angiography in pediatric patients possible and on the other hand led to considerable reduction of contrast media as compared to conventional angiography. Motion artifacts, however, cause problems. In interventional radiology, as far as blood vessels are concerned, technical possibilities are the same for children as for adults. Dilatations of blood vessels are the main indications. For embolizations the indications are mainly tumor embolizations and bleeding embolizations.

Adolescent↗
PubMed2004

Three-dimensional angiography using rotational digital subtraction angiography: usefulness in transarterial embolization of hepatic tumors.

PURPOSE: To assess the usefulness of three-dimensional (3D) angiography using rotational digital subtraction angiography (DSA) in transarterial embolization of hepatic tumors. MATERIAL AND METHODS: Thirty-one 3D angiographies were conducted using rotational DSA during abdominal angiography for transarterial embolization of hepatic tumors. The quality of visualization of the tumor and feeder arteries as imaged by 3D angiography versus DSA anterioposterior (AP) images was compared. RESULTS: 3D rotational angiography provided excellent 3D visualization of the vascular structures of the hepatic artery, and was especially useful in patients with overlapping tumors on DSA AP images and in patients with complex vascular anatomies. Compared to DSA AP images, however, tumor stains could not be detected on 3D-A, but could be detected on DSA in four patients (13%). In 9 patients, feeding arteries could not be detected on 3D-A, but could be detected on DSA (29%). CONCLUSION: 3D rotational angiography alone may not be suitable for pre-procedural mapping in transarterial embolization of hepatic tumors, but may be of value when information supplementary to DSA AP images is needed.

Aged↗
PubMed1983

Comparison of conventional pulmonary angiography with intravenous digital subtraction angiography for pulmonary embolic disease.

Intravenous digital subtraction pulmonary angiography was performed in 33 patients with suspected pulmonary embolism. It was performed as the initial examination, followed immediately by conventional film-screen pulmonary angiography performed with selective right or left main pulmonary injections. Intravenous studies of diagnostic quality were obtained in 31 of 33 patients (93.9%). Of the satisfactory intravenous studies, pulmonary embolism was correctly diagnosed in 12 cases and excluded in 18 cases. Emboli were detected in major and second-order branches, and occasionally in third-order branches as well. There was one false-positive intravenous pulmonary study, but the overall accuracy was 90.9% considering all studies and 96.8% excluding the two inadequate intravenous examinations. It is concluded that intravenous pulmonary angiography is an acceptable substitute for routine pulmonary angiography in most patients with suspected major pulmonary embolism. The technique is less expensive, and is safer, faster, and easier to perform than conventional pulmonary angiography.

Diagnosis, Computer-Assisted↗
PubMed2004

Evaluation of carotid artery stenosis: contrast-enhanced magnetic resonance angiography compared with conventional digital subtraction angiography.

OBJECTIVE: To compare retrospectively high-resolution contrast-enhanced magnetic resonance angiography with centric k-space filling and digital subtraction angiography in the assessment of degree of carotid artery stenosis. METHODS: Two neuroradiologists independently evaluated 14 carotid arteries (in 7 patients), and the degree of carotid stenosis determined was compared to calculate interobserver reliability. Thirty-six carotid arteries (in 18 patients) were then assessed with both contrast-enhanced magnetic resonance angiography and digital subtraction angiography. The degree of stenosis was determined by consensus, and the findings of the 2 modalities were compared. RESULTS: Close interobserver agreement was found with an intraclass correlation coefficient of 0.98 (95% confidence interval 0.95-0.99). Sensitivity of 86% and specificity of 91% were found for contrast-enhanced magnetic resonance angiography detection of surgically significant carotid stenosis compared with digital subtraction angiography. The Spearman rank correlation test also found a significant correlation (R(s) = 0.90, p < 0.001) in the comparison of the classifications of degree of carotid artery stenosis. CONCLUSION: Contrast-enhanced magnetic resonance angiography shows excellent correlation with digital subtraction angiography for the evaluation of carotid artery disease and has the potential to replace it in the assessment of degree of carotid artery stenosis.

Angiography, Digital Subtraction↗
PubMed2001

Surveillance of peripheral arterial bypass grafts with three-dimensional MR angiography: comparison with digital subtraction angiography.

OBJECTIVE: The purpose of this study was to use contrast-enhanced three-dimensional MR angiography to assess the patency of peripheral arterial bypass grafts of the lower extremity. SUBJECTS AND METHODS: The study included 39 patients with 45 lower limb grafts. Twenty-eight were saphenous vein grafts, 13 were expanded polytetrafluoroethylene, and two were Dacron grafts. Digital subtraction angiography correlation was available for 30 patients (31 grafts). MR angiography was performed on a 1.5-T system with a multichannel quadrature phased array peripheral vascular coil. The scanning delay was determined with a test bolus technique, using half-time to maximum signal intensity in the graft. Arterial imaging was accomplished with two three-dimensional MR angiography acquisitions with gadopentetate dimeglumine administered using an automated injector. The pelvic and femoral arteries were imaged, the MR table was repositioned, and the lower limb arteries were imaged. The three-dimensional MR angiography sequence used the following parameters: TR/TE, 5.2/1.5 msec; inversion time, 28 msec; flip angle, 30 degrees. The proximal anastomosis, graft, and distal anastomosis were characterized as normal, stenosed, occluded, or ectatic or aneurysmatic. RESULTS: Sensitivity and specificity values for MR angiography regarding the assessment of grafts were 100% for 87 evaluable segments for which digital subtraction angiography correlation was available: stenosis (n = 10), occlusions (n = 9), ectasia or aneurysms (n = 8). Six segments could not be assessed because of the presence of intravascular stents or metallic clips. CONCLUSION: Contrast-enhanced three-dimensional MR angiography is well suited for the characterization of arterial grafts, for planning subsequent vascular interventions, and for excluding further lesions.

Aged↗
PubMed2002

Evaluation of arterial bypass grafts of the pelvic and lower extremities with gadolinium-enhanced magnetic resonance angiography: comparison with digital subtraction angiography.

RATIONALE AND OBJECTIVES: The aim of this study was to compare contrast-enhanced magnetic resonance angiography (CE MRA) with digital subtraction angiography (DSA) in the assessment of patency and stenoses in bypass grafts. METHODS: Fifteen patients were examined with both CE MRA and DSA. Fifteen bypass grafts were evaluated by four readers for potential stenosis in five locations. The stenoses were classified in five types: 1 (0% to 24% stenosis), 2 (25% to 49%), 3 (50% to 74%), 4 (75% to 99%), and 5 (occlusion). RESULTS: Using both techniques, 70 of 75 evaluated locations (93.3%) were classified identically. This included six stenoses < 50% and six stenoses > 50%, respectively. Four of five overestimations of stenoses were scaled in DSA as stenoses type 1. One stenosis was categorized as type 3 in DSA. Sensitivity for CE MRA for detecting stenoses >or= 25% was 100% and the specificity 90%. Interobserver agreement for all evaluations was 0.77 (Spearman rank correlation test). CONCLUSION: In the assessment of low-grade stenosis in bypass grafts, CE MRA overestimates stenoses slightly but yields good results in comparison with DSA.

Angiography, Digital Subtraction↗
PubMed2003

CT angiography, MR angiography and rotational digital subtraction angiography for volumetric assessment of intracranial aneurysms. An experimental study.

The purpose of our experimental study was to assess the accuracy and precision of CT angiography (CTA), MR angiography (MRA) and rotational digital subtraction angiography (DSA) for measuring the volume of an in vitro aneurysm model. A rigid model of the anterior cerebral circulation harbouring an anterior communicating aneurysm was connected to a pulsatile circuit. It was studied using unenhanced 3D time-of-flight MRA, contrast-enhanced CTA and rotational DSA angiography. The source images were then postprocessed on dedicated workstations to calculate the volume of the aneurysm. CTA was more accurate than MRA (P=0.0019). Rotational DSA was more accurate than CTA, although the difference did not reach statistical significance (P=0.1605), and significantly more accurate than MRA (P<0.00001). CTA was more precise than MRA (P=0.12), although this did not reach statistical significance. Rotational DSA can be part of the diagnosis, treatment planning and support endovascular treatment of intracranial aneurysms. The emerging endovascular treatment techniques which consist of using liquid polymers as implants to exclude aneurysms from arterial circulation would certainly benefit from this precise measurement of the volume of aneurysms.

Angiography, Digital Subtraction↗
PubMed1985

[Conventional angiography and digital subtraction angiography in arterial occlusive disease of the extracranial branches of cerebral arteries].

In this paper the advantages and disadvantages of different arteriographic methods, i.e. conventional angiography, intraarterial DSA and intravenous DSA, are discussed for the purpose of examining the extracranial supraaortic branches. The analysis of individual vascular regions in arteriography of the aortic arch is assessed. In addiction, the value of i.v. DSA is demonstrated, comparing own results with data in the literature. Indications of the three different angiographic techniques are outlined.

Angiography↗
PubMed2003

Duplex ultrasound and magnetic resonance angiography compared with digital subtraction angiography in carotid artery stenosis: a systematic review.

BACKGROUND AND PURPOSE: The purpose of this work was to review and compare published data on the diagnostic value of duplex ultrasonography (DUS), MR angiography (MRA), and conventional digital subtraction angiography (DSA) for the diagnosis of carotid artery stenosis. METHODS: We performed a systematic review of published studies retrieved through PUBMED, from bibliographies of review papers, and from experts. The English-language medical literature was searched for studies that met the selection criteria: (1) The study was published between 1994 and 2001; (2) MRA and/or DUS was performed to estimate the severity of carotid artery stenosis; (3) DSA was used as the standard of reference; and (4) the absolute numbers of true positives, false negatives, true negatives, and false positives were available or derivable for at least one definition of disease (degree of stenosis). RESULTS: Sixty-three publications on duplex, MRA, or both were included in the analysis, yielding the test results of 64 different patient series on DUS and 21 on MRA. For the diagnosis of 70% to 99% versus <70% stenosis, MRA had a pooled sensitivity of 95% (95% CI, 92 to 97) and a pooled specificity of 90% (95% CI, 86 to 93). These numbers were 86% (95% CI, 84 to 89) and 87% (95% CI, 84 to 90) for DUS, respectively. For recognizing occlusion, MRA yielded a sensitivity of 98% (95% CI, 94 to 100) and a specificity of 100% (95% CI, 99 to 100), and DUS had a sensitivity of 96% (95% CI, 94 to 98) and a specificity of 100% (95% CI, 99 to 100). A multivariable summary receiver-operating characteristic curve (ROC) analysis for diagnosing 70% to 99% stenosis demonstrated that the type of MR scanner predicted the performance of MRA, whereas the presence of verification bias predicted the performance of DUS. For diagnosing occlusion, no significant heterogeneity was found for MRA; for DUS, the presence of verification bias and type of DUS scanner were explanatory variables. MRA had a significantly better discriminatory power than DUS in diagnosing 70% to 99% stenosis (regression coefficient, 1.6; 95% CI, 0.37 to 2.77). No significant difference was found in detecting occlusion (regression coefficient, 0.73; 95% CI, -2.06 to 3.51). CONCLUSIONS: These results suggest that MRA has a better discriminatory power compared with DUS in diagnosing 70% to 99% stenosis and is a sensitive and specific test compared with DSA in the evaluation of carotid artery stenosis. For detecting occlusion, both DUS and MRA are very accurate.

Angiography, Digital Subtraction↗