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PubMed2002

Hemodialysis access imaging: comparison of flow-interrupted contrast-enhanced MR angiography and digital subtraction angiography.

PURPOSE: To compare flow-interrupted contrast material-enhanced magnetic resonance (MR) angiography with conventional digital subtraction angiography (DSA) for hemodialysis access imaging. MATERIALS AND METHODS: Twenty-two accesses (14 arteriovenous grafts [AVGs], eight arteriovenous fistulas [AVFs]) in 18 consecutive patients were imaged with flow-interrupted contrast-enhanced MR angiography and subsequent conventional DSA. MR image quality was assessed as excellent, good, or nondiagnostic. Anastomotic diameters in AVGs and postanastomotic diameters in AVFs were measured in consideration of an adjacent normal segment. Reductions in the diameter of the lumen and interobserver differences were analyzed with method comparison as described by Bland and Altman and expressed as the mean difference with its 95% confidence limits (CLs) (mean +/- 2 SDs). RESULTS: Image quality obtained with flow-interrupted contrast-enhanced MR angiography was considered excellent in 73% (16 of 22) and good in 23% (5 of 22). Method comparison analysis between MR angiography and DSA indicated a mean difference of 3.2% (95% CLs: -26.7%, 33.1%) for observer 1 and 4.1% (95% CLs: -23.8%, 32.1%) for observer 2. Interobserver analysis at MR angiography indicated a mean difference of 3.2% (95% CLs: -28.8%, 35.2%), and that at DSA indicated a mean difference of 3.6% (95% CLs: -9.4%, 16.7%). CONCLUSION: Image quality and anatomic depiction with flow-interrupted contrast-enhanced MR angiography and with DSA were comparable.

Angiography, Digital Subtraction↗

PubMed2006

Fibromuscular dysplasia of the main renal arteries: comparison of contrast-enhanced MR angiography with digital subtraction angiography.

PURPOSE: To retrospectively evaluate the sensitivity and specificity of contrast material-enhanced magnetic resonance (MR) angiography by using digital subtraction angiography as the reference standard in patients with hypertension and renal artery fibromuscular dysplasia (FMD). MATERIALS AND METHODS: Institutional review board approval was obtained, with waiver of informed consent. The results of renal contrast-enhanced MR angiography were retrospectively analyzed in 25 patients with hypertension (24 women, one man; mean age, 48 years +/- 19 [standard deviation]; age range, 18-72 years) who had FMD diagnosed on the basis of clinical and angiographic features. All examinations were performed at 1.5 T. Results were analyzed by two readers, and a third reader established a consensus in case of discrepancy. Sensitivity, specificity, and 95% confidence intervals (CIs) were calculated for FMD and for each possible type of FMD lesion ("string of pearls" appearance, stenosis, and aneurysm). A linear-weighted kappa statistic was calculated to determine agreement between digital subtraction angiography and contrast-enhanced MR angiography for the diagnosis of FMD and to determine inter- and intraobserver agreement regarding FMD diagnosis. RESULTS: Fifty main renal arteries were analyzed, 35 of which demonstrated abnormal arteriographic features of FMD (stenosis, 22 arteries; string of pearls, 21 arteries; and aneurysm, four arteries). The sensitivity and specificity of contrast-enhanced MR angiography for the diagnosis of FMD were 97% (95% CI: 83%, 100%) and 93% (95% CI: 66%, 100%), respectively. Sensitivity was 68% (95% CI: 83%, 100%), 95% (95% CI: 74%, 100%), and 100% (95% CI: 40%, 100%) for the diagnosis of stenosis, string of pearls, and aneurysm, respectively. Linear-weighted kappa statistics for inter- and intraobserver agreement regarding FMD diagnosis were 0.63 and 0.92, respectively. CONCLUSION: In patients with renal FMD, contrast-enhanced MR angiography can reliably facilitate diagnosis by demonstrating characteristic lesions.

Adolescent↗

PubMed1997

Evaluation of the aortoiliac and renal arteries: comparison of breath-hold, contrast-enhanced, three-dimensional MR angiography with conventional catheter angiography.

PURPOSE: To determine the diagnostic accuracy of breath-hold, contrast material-enhanced, three-dimensional (3D) magnetic resonance (MR) angiography in the assessment of the aortoiliac inflow tract and renal arteries with conventional catheter angiography as the standard of reference. MATERIALS AND METHODS: In 39 patients with symptomatic peripheral vascular disease, both catheter and contrast-enhanced, 3D MR angiography were performed. In a prospective blinded analysis, each vascular segment (23 segments per arterial tree) was evaluated for the presence of obstructive stenosis, graded as mild (<50%), severe (50%-99%), or occlusion (100%), as well as for aneurysmal disease. RESULTS: Obstructive (n = 2) and aneurysmatic aortic (n = 6) lesions and 10 of 11 accessory renal arteries were identified and graded correctly with MR angiography. For detection of hemodynamically significant stenotic lesions (>50%) or occlusions with MR angiography, sensitivity and specificity, respectively, were 93% and 98% for the renal arteries, 96% and 100% for the common iliac arteries, 93% and 93% for the external iliac arteries, and 96% and 94% for the internal iliac arteries. CONCLUSION: The diagnostic performance of contrast-enhanced 3D MR angiography is comparable with that of catheter angiography and thus may contribute to assessment of the aorta, the renal arteries, and the pelvic arterial system in patients with peripheral vascular disease before they undergo therapy.

Angiography, Digital Subtraction↗

PubMed1999

Aortoiliac and lower extremity arteries: comparison of three-dimensional dynamic contrast-enhanced subtraction MR angiography and conventional angiography.

PURPOSE: To determine the clinical feasibility of three-dimensional dynamic contrast agent-enhanced subtraction magnetic resonance (MR) angiography in patients with symptoms of lower extremity ischemia. MATERIALS AND METHODS: Twenty-three patients suspected of having lower extremity ischemia underwent three-dimensional dynamic contrast-enhanced subtraction MR angiography of the aortoiliac arteries and arteries of the lower extremity. As the reference standard, conventional angiography was also performed. For data analysis, the arterial system was divided into 10 segments. Each segment was classified as normal, mildly stenosed, moderately stenosed, severely stenosed, or occluded. RESULTS: At conventional angiography, 83 stenosed segments (14 mildly stenosed, 16 moderately stenosed, 14 severely stenosed, and 39 occluded) were identified in a total of 423 segments. For the segments with more than mild stenosis, MR angiography was 97.1% sensitive and 99.2% specific. CONCLUSION: Three-dimensional dynamic contrast-enhanced subtraction MR angiography has high sensitivity and specificity. This technique is a noninvasive alternative to conventional angiography for screening patients suspected of having lower extremity ischemia.

Aged↗

PubMed1998

Diagnostic value of spiral-CT angiography in comparison with digital subtraction angiography before and after peripheral vascular intervention.

To evaluate spiral-computed tomography (CT) angiography in primary diagnosis and/or in noninvasive follow-up after vascular intervention, we compared spiral-CT angiography and conventional angiography before and after vascular intervention. Helical-CT examinations before and after percutaneous transluminal angioplasty (PTA) or stent implantation were performed in 10 patients (mean age 63 years) with symptomatic peripheral arteriosclerotic disease. Stenoses were located in the iliac, femoral, or popliteal artery. CT examinations were done with a spiral-CT in double detector technique (CT Twin, Elscint). The parameters were as follows: slice thickness: 5.5 mm, increment: 2.7 mm, pitch: 1.5, contrast medium: 150 mL, flow rate: 2.5 mL/second, delay: 30 seconds. For evaluation, transverse planes as well as maximum intensity projections and 3-D reconstructions were used. The possible scan length reached from the aortic bifurcation down to about 10 cm below the ankle trifurcation. Preinterventional digital subtraction angiography (DSA) was superior to CT angiography (CTA: 94%, maximum intensity projection [MIP] alone: 65%), although high-grade stenoses were detected by both methods. After intervention, a resolved stenosis and improved peripheral flow could be detected by helical-CT as well as by intraarterial angiography in every patient (100%). In the primary diagnosis of vascular changes, intraarterial DSA remains the method of choice. Nevertheless, spiral-CT angiography shows comparable results after percutaneous intervention and becomes a noninvasive alternative in the postinterventional follow-up.

Angiography↗

PubMed2005

Contrast-enhanced MR angiography and digital subtraction angiography in living renal donors: diagnostic agreement, impact on decision making, and costs.

OBJECTIVE: The objective of our study was to evaluate the diagnostic agreement, the impact on decision making, and the costs of contrast-enhanced MR angiography and digital subtraction angiography in the workup of living renal donors. CONCLUSION: Contrast-enhanced MR angiography for the preoperative evaluation of renal donors is superior to digital subtraction angiography in revealing vascular anomalies and depicting parenchymal abnormalities and is less costly; furthermore, it does not lead to preoperative decisions that differ from those based on digital subtraction angiography. If contrast-enhanced MR angiography does not provide sufficient information to make a confident decision, an additional digital subtraction angiography examination should be performed.

Adult↗

PubMedDate not supplied

Preoperative evaluation of carotid artery stenosis: comparison of contrast-enhanced MR angiography and duplex sonography with digital subtraction angiography.

BACKGROUND AND PURPOSE: Contrast-enhanced MR angiography and extracranial color-coded duplex sonography are noninvasive, preoperative imaging modalities for evaluation of carotid artery stenosis. Innovative techniques and improvements in image quality require frequent reassessment of accuracy, reliability, and diagnostic value compared with those of digital subtraction angiography (DSA). We evaluated contrast-enhanced MR angiography and duplex sonography compared with DSA for detection of high-grade carotid artery stenoses. METHODS: Four readers, blinded to clinical symptoms and the outcome of other studies, independently evaluated stenoses on contrast-enhanced MR angiograms in 71 vessels of 39 symptomatic patients. Duplex sonography was also performed in all vessels. The severity of stenosis was defined according to North American Symptomatic Carotid Endarterectomy Trial criteria (0-29%, 30-69%, 70-99%, 100%). Results of both modalities were compared with the corresponding DSA findings. RESULTS: Contrast-enhanced MR angiography had a sensitivity and specificity of 94.9% and 79.1%, respectively, for the identification of carotid artery stenoses of 70% or greater. Sensitivity and specificity of duplex sonography were 92.9% and 81.9%, respectively. Combining data from both tests revealed a sensitivity and specificity of 100% and 81.4%, respectively, for concordant results (80% of vessels). CONCLUSION: Concordant results of contrast-enhanced MR angiography and duplex sonography increase the diagnostic sensitivity to 100%. The reliability of MR angiography is comparable to that of DSA. The combination of contrast-enhanced MR angiography and duplex sonography might be preferable over DSA for preoperative evaluation in most patients, thus reducing the risk of perioperative morbidity and improving the overall outcome.

Adult↗

PubMed1996

Three-dimensional time-of-flight MR angiography and MR imaging versus conventional angiography in carotid artery dissections.

A retrospective analysis comparing the three-dimensional time-of-flight MR angiography, MR imaging and transfemoral digital substraction angiography (DSA) in cases of carotid artery dissection was made. During a 2-year period, 12 cases (11 males and 1 female), aged between 16 and 60 years, were submitted to our Hospital with the symptoms of TIA, stroke or cranial nerve palsies and the suspicion of carotid dissection. Transfemoral angiograms were done in other Institutions, while the MRI and MRA were performed in our diagnostic center. Blind interpretation of MR and angiography images was made by two independent radiologists. MR angiography in combination with MR imaging was more accurate than conventional angiography in the diagnosis of carotid artery dissection. Respective sensitivity and specificity were 100% and 100% for MRI with MRA and 91.6% and 100% for conventional angiography. From the analysis of this small series, we can conclude that MR angiography in combination with MR imaging is a reliable noninvasive method for use in diagnosis of extracranial internal carotid artery dissection.

Adolescent↗

PubMed2001

Combined right transradial coronary angiography and selective carotid angiography: safety and feasibility in unselected patients.

We evaluated the safety and feasibility of ad hoc carotid angiography following the right transradial coronary angiography. Selective carotid angiography was performed subsequent to coronary angiography in 213 consecutive patients. A 5 Fr Simmons catheter was reformed in descending or ascending aorta, then, withdrawn and rotated to cannulate the left and right carotid artery. Both carotid angiography was performed selectively in 211 (99%) patients. In two patients with severely tortuous subclavian artery, selective cannulation of the left carotid artery failed. There was no thromboembolism or arterial dissection. After the learning phase of 50 patients, the time to reform the catheter in aorta and to cannulate the left and right carotid artery was 50 +/- 77, 66 +/- 68, and 58 +/- 57 sec, respectively. Total procedural time was 195 +/- 145 sec. In conclusion, ad hoc carotid angiography can be performed reliably and safely following the right transradial coronary angiography. It might be useful for evaluation of an isolated or associated carotid artery stenosis. Cathet Cardiovasc Intervent 2001;53:380-385.

Adolescent↗

PubMed2001

Microsurgical management of cerebral aneurysms based in CT angiography with three-dimensional reconstruction (3D-CTA) and without preoperative cerebral angiography.

OBJECTIVE: To study the possibilities of the microsurgical management of ruptured intracranial aneurysms with the sole preoperative information provided by computed tomography angiography with three-dimensional reconstruction (3D-CTA). METHODS: Patients were studied with 3D-CTA after diagnosis of subarachnoid hemorrhage. If the study had an adequate quality and revealed an aneurysm congruent with the clinical findings or neurological examination and/or with the location of the bleeding on computed tomography (CT) scan an early microsurgical clipping of the lesion was done. When the quality of the 3D-CTA study was not adequate or the quality being adequate displayed no lesions or the findings were not accurate enough to warrant direct microsurgical treatment, the patient was studied with cerebral digital subtraction (DS) angiography. A total of 44 consecutive patients harbouring a total of 47 intracranial aneurysms diagnosed by 3D-CTA and without preoperative DS angiography were submitted to microsurgical clipping and included in the study. RESULTS: The overall mortality was 15.9% and the favourable results evaluated 6 months after discharge by means of the Glasgow Outcome Scale reached 70.4%. All lesions were successfully clipped. Surgery was done a mean of 4.1 days after the admission bleeding. A total of four microlesions undiagnosed by 3D-CTA were found at surgery and clipped. Postoperative DS angiography and necropsy findings were also used as control of the 3D-CTA findings but no additional information was provided excepting the finding in DS angiography of an asymptomatic intracavernous aneurysm. Therefore the sensitivity of the 3D-CTA for diagnosis of symptomatic aneurysms was 100% and the overall sensitivity 90.4%. CONCLUSIONS: We have reached similar results in patients operated on with or without preoperative angiography. 3D-CTA provides very valuable anatomical information, which has an additional value in the microsurgical treatment of aneurysms of the anterior communicating artery complex. Finally, selected cases of ruptured intracranial aneurysms can be successfully managed with the preoperative information provided by 3D-CTA and without DS angiography.

Adolescent↗

PubMed2006

Comparison of sixty-four-slice multidetector computed tomographic coronary angiography to coronary angiography with intravascular ultrasound for the detection of transplant vasculopathy.

Coronary allograft vasculopathy (CAV) is the most important limitation to long-term survival in adult heart transplant recipients and is difficult to detect without intravascular ultrasound (IVUS). We systematically evaluated the image quality of 64-slice multidetector computed tomographic (MDCT) coronary angiography in heart transplant recipients and tested the hypothesis that this modality is comparable to invasive coronary angiography with IVUS for the detection of CAV. Heart transplant recipients (n = 20) underwent invasive coronary angiography with IVUS and MDCT coronary angiography with a 64-slice scanner. Images were systematically analyzed for image quality and the presence of CAV. In addition, multidetector computed tomography and quantitative coronary angiography were used to measure lumen diameters at prespecified locations. Image quality analysis showed that, despite high mean heart rates (77 +/- 7 beats/min) and body mass index (29.5 +/- 5.3 kg/m(2)), 83% of coronary segments were graded as of excellent or good image quality. On average, 95 +/- 9% of the overall visualized length of the coronary arteries was imaged without motion artifacts, and the mean contrast-to-noise ratio was 11.3 +/- 4.6. Compared with IVUS, multidetector computed tomography had a sensitivity of 70%, specificity of 92%, positive predictive value of 89%, and negative predictive value of 77% for the detection of CAV. MDCT vessel diameter measurements correlated well with those obtained from quantitative coronary angiography (R(2) = 0.89). In conclusion, 64-slice multidetector computed tomography provides good to excellent image quality in heart transplant recipients and has moderate to excellent test characteristics for the detection of CAV. Further, MDCT measurements of lumen diameters correlated well with quantitative coronary angiography.

Body Mass Index↗

PubMed1999

Clinical usefulness of and problems with three-dimensional CT angiography for the evaluation of arteriosclerotic stenosis of the carotid artery: comparison with conventional angiography, MRA, and ultrasound sonography.

BACKGROUND: Prevention of stroke is aided by determination of the degree of carotid artery stenosis and progression of arterial sclerosis. Three-dimensional computed tomography (CT) angiography (3D-CTA) is a new method for evaluating the degree of arterial stenosis. The purpose of this study was to compare the accuracy of 3D-CTA with the "gold standard": conventional angiography, magnetic resonance angiography (MRA), and ultrasound sonography (US). METHODS: A total of 128 carotid bifurcations in 64 patients (42 men and 22 women; mean age, 68.5 years) were examined by 3D-CTA because of symptoms of cerebral infarction, carotid bruit, or findings suggestive of arteriosclerotic carotid artery stenosis on MRA screening. The following were used to compare 3D-CTA with conventional angiography, MRA and US: 1) estimation of the degree of stenosis; 2) depiction of irregularities in arterial walls, including calcification, intimal thickening, ulcers and plaque; and 3) surgical planning for carotid endarterectomy (CEA) and percutaneous transluminal angioplasty (PTA), and postoperative evaluation. RESULTS: A strong correlation was found between the degrees of stenosis estimated by conventional angiography and 3D-CTA MIP image (r = 0.987/p < 0.0001). On the other hand, stenosis was generally overestimated by MRA, which, however, has the advantage of being able to scan the carotid siphon to the middle cerebral artery at one time. Calcification and ulceration of the artery wall could be evaluated with 3D-CTA, whereas with US, progression of arterial sclerosis could be evaluated by differentiation of homogenous and heterogenous plaque. The anatomical relationships between the site of stenosis and the internal jugular vein and bony structures, which must be known before CEA, were confirmed by observation of rotated images using the shaded surface reconstruction (SSR) method. Because the hemodynamics of cross and collateral flows cannot be clearly imaged with 3D-CTA, standard angiography is needed to determine suitability for bypass surgery. CONCLUSIONS: The current method used in our hospital for the diagnosis of stenosis of the internal carotid artery includes MRA or US for initial screening, 3D-CTA for evaluation of the degree of stenosis and for preoperative and postoperative evaluation of CEA and PTA, and conventional angiography for evaluation of hemodynamics and determination of the indications for a bypass surgery.

Aged↗

PubMed2000

Accuracy of CT angiography versus pulmonary angiography in the diagnosis of acute pulmonary embolism: evaluation of the literature with summary ROC curve analysis.

RATIONALE AND OBJECTIVES: The authors performed this study to estimate, by using published data, the sensitivity and specificity of computed tomographic (CT) angiography in the evaluation of suspected acute pulmonary embolism (PE). MATERIALS AND METHODS: Summary receiver operating characteristic (ROC) curve analysis was used to determine the sensitivity and specificity of CT angiography in the diagnosis of acute PE. Pulmonary angiography was used as the diagnostic standard of reference. The authors reviewed the results of 11 independent studies published in the English-language literature between January 1992 and June 1999. RESULTS: The sensitivity of CT angiography in the diagnosis or exclusion of PE in the central pulmonary arteries (to the level of the segmental pulmonary arteries) ranged from 0.74 to 0.81 on the basis of specificities of 0.89-0.91. The sensitivity of CT angiography in the diagnosis or exclusion of PE in all pulmonary arteries (to the level of the subsegmental pulmonary arteries) was 0.68 on the basis of a specificity of 0.91. CONCLUSION: On the basis of the studies in the current literature, most of which used 5.0-mm collimation and single-detector CT, CT angiography may be less accurate in the diagnosis of PE than previously reported. With improvements in data acquisition, particularly the use of thinner section collimation and multidetector CT, and in the increased use of workstations for data analysis, the accuracy and utility of CT angiography will require continued investigation.

Angiography↗

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↗

PubMed2000

Regional variations in the use of diagnostic coronary angiography. A one-year population-based study of all diagnostic coronary angiographies performed in a rural and an urban Danish county.

The aim of this study was to monitor coronary angiography activity and results, and to evaluate indications and treatment consequences using regional hospital registers and case records in the rural county of Ringkjøbing and urban county of Aarhus The study included all patients who had undergone a coronary angiography during 1996. For women, there were 606 (rural) and 1296 (urban) coronary angiographies per one million inhabitants (p < 0.0001) and for men, 1884 (rural) and 3051 (urban) coronary angiographies per one million inhabitants (p < 0.0001). In both counties the age distribution of the women examined was the same as that for the men. The angiographic rates were the same in the two counties for patients examined for valvular heart disease and severe arrhythmias. For patients with ischaemic heart disease, the angiographic rate for rural patients was two to three times lower than that for urban patients (p < 0.01). Revascularization procedures were performed in 39% (rural) and 40% (urban) of the examined women (NS) and 66% (rural) and 59% (urban) of the examined men (p < 0.05). Despite wide regional differences in coronary angiography activity, angiography was deployed to the same extent for examination of patients with valvular and severe arrhythmia heart disease. For patients examined for ischaemic heart disease, angiography activity was considerably lower in the rural area. The female patients had a higher frequency of normal coronary angiograms than the male patients.

Adult↗

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↗

PubMed1994

Carotid and vertebral artery dissections: three-dimensional time-of-flight MR angiography and MR imaging versus conventional angiography.

PURPOSE: To compare three-dimensional time-of-flight magnetic resonance (MR) angiography, MR imaging, and transfemoral four-vessel angiography in diagnosis and follow-up of cervical artery dissection. MATERIALS AND METHODS: Eighteen patients with 19 extracranial internal carotid artery and five vertebral artery dissections were included in this prospective study. Blind interpretation of MR and angiographic images was made by two independent radiologists. RESULTS: MR angiography was more accurate than MR imaging in diagnosis of carotid dissection, although the difference was not statistically significant. In carotid artery dissection, respective sensitivity and specificity were 95% and 99% for MR angiography and 84% and 99% for MR imaging and in vertebral artery dissection were 20% and 100% for MR angiography and 60% and 98% for MR imaging. CONCLUSION: MR angiography is a reliable, noninvasive method for use in diagnosis and follow-up of extracranial internal carotid artery dissection. In vertebral artery dissection, however, conventional angiography remains useful.

Adult↗

PubMed2000

[The three-dimensional CT angiography findings of ruptured aneurysms hardly detectable by repeated cerebral angiography].

We reported three cases of cerebral aneurysms hardly detectable by cerebral angiography, but easily detected by three-dimensional CT angiography (3D-CTA). These cases were ruptured aneurysms with subarachnoid hemorrhage. After detection of subarachnoid hemorrhage on CT scan, cerebral angiography was performed at first, but aneurysms were not detected. Subsequently 3D-CTA was carried out, and aneurysms were detected. In all cases, cerebral angiography was repeated, after the aneurysms had been found by 3D-CTA. This time aneurysms were all detected by cerebral angiography, but each case needed photographs from special direction. The aneurysms were small by usual cerebral angiography and they were almost invisible behind the artery near which they existed. 3D-CTA was very useful for detection of small aneurysms, but small perforating arteries around the aneurysms were invisible by 3D-CTA. To find these perforating arteries, cerebral angiography was needed.

Aged↗