Intra-venous digital subtraction angiography: an alternative method to intra-arterial digital subtraction angiography for experimental aneurysm imaging

Conventional intra-arterial digital subtraction angiography (IADSA), which necessitates surgical exposure and ligation of the femoral artery, is an invasive and expensive method of evaluation for experimental elastase-induced aneurysms in rabbits. The purpose of this study was to examine and validate intra-venous digital subtraction angiography (IVDSA) as an alternative to IADSA by comparing their diagnostic accuracies. We performed both IVDSA and IADSA for 24 elastase-induced saccular aneurysms in a rabbit model, 1 month following creation. Aneurysm sizes (neck, width and height) from both the IVDSA and IADSA procedures were evaluated and measured. Comparison of the aneurysm sizes between IVDSA and IADSA were performed with the Wilcoxon paired signed-rank test. All the aneurysms were seen clearly in both the IVDSA and IADSA techniques. Mean sizes of the IVDSA aneurysm neck, width and height were 3.41±0.80 mm, 3.61±0.93 mm and 8.07±2.11 mm, respectively. Mean sizes of the IADSA aneurysm neck, width and height were 3.43±0.80 mm, 3.66±0.92 mm and 8.16±2.25 mm, respectively. No significant difference was found in the sizes of the aneurysm neck, width and height between the two groups (P=0.311, P=0.086 and P=0.258, respectively). IVDSA appears to be an alternative method for evaluating elastase-induced aneurysms in rabbits.     

Renal digital subtraction angiography

Digital subtraction angiography (DSA), a new computer-assisted radiographic procedure, has recently been applied to the evaluation of the kidney and in the screening of patients with renal vascular hypertension. The efficacy of the method in the evaluation of the anatomy of proximal renal arteries is in the 80–90% range; however, DSA is less effective in the evaluation of renal mass lesion. In the present state of DSA development, the method has a place in screening for renal artery stenosis (RAS). Further development, particularly improvement in spatial resolution, will be necessary before this procedure can substitute for renal angiography, in the evaluation of renal masses or in some cases of RAS.     

侧位脑血管数字图像反向转动配准减影的初步研究

目的 探讨将侧位脑血管数字图像进行反向转动后配准减影的可行性及其价值.方法 (1)实验研究:在笔者用Visual Basic编写的旋转配准减影软件中对试验靶片直接进行减影处理和将靶片旋转角度后再进行减影处理.观察软件的自动旋转角度探测功能是否探测出直线旋转的角度以及减影功能是否正常.(2)患者图像回顾性研究:将15例在侧位脑血管成像过程中靶血管围绕冠状轴发生了转动的图像读入软件.对同一组蒙靶片分别进行传统的配准减影和先反转一定角度后再进行传统配准减影处理.(3)评价:由4名相关专业的高级职称医师一起对这两组图像进行对比读片.结果 (1)软件配备的自动旋转角度探测功能提示靶片应逆时针方向旋转1.3..软件减影结果正确.(2)在回顾性研究中,用传统减影方法获得较清晰图像3例,在经反转配准减影处理后,伪影明显减少,图像更加清晰;经传统配准减影后有明显伪影的图像10例,在经反转配准减影处理后,获得清晰图像,末梢的血管影像也得以显示;经传统配准减影后无法辨认的图像2例,经过反转配准减影后达到诊断要求.(3)评价结果:反转配准减影的噪声控制和血管细节显示能力都优于传统配准方法;图像没有变形失真;图像清晰度稍有下降.结论 反向转动配准减影技术能明显提高侧位脑血管数字减影图像的质量.     

Intravenous digital subtraction angiography in patients with Aorto-arteritis (Takayasu's)

Aorto-arteritis is one of the commonest vascular diseases in China as well as in Japan and other parts of Asia. The results of digital subtraction angiography (DSA) in 50 patients with aortoarteritis are reported, and the merits and demerits of intravenous (IV) DSA in the diagnosis of this entity are evaluated. Among the 51 studies performed on 50 patients, IV DSA was used in 48, intraarterial (IA) DSA in 3, and good-to-excellent visualization was obtained in 96% of patients. Aorto-arteritis of varying severity and involving the thoraco-abdominal aorta, the iliac arteries, and other major branches was clearly demonstrated by IV DSA. IV DSA, as compared to our previous experience with conventional arteriography in this entity, may be substituted for conventional arteriography in most patients. A large dose of contrast media needed for a complete study is a major deficiency of IV DSA, and it also has limitations for showing the intrarenal arterial branches.     

Clinical application of hybrid subtraction digital angiography: Preliminary results

The clinical application of hybrid subtraction in digital fluoroscopy of the vasculature is reported in our first 30 patients studied. Hybrid subtraction combines the advantages of temporal and dual energy subtraction techniques to achieve simultaneous elimination of overlying bone, soft tissue, and motion induced artifacts. Hybrid subtraction improved the subjective appearance of an image in 19 of 30 (63%) studies but additional diagnostic information was only revealed in 11 of 30 (37%) patients. This study was supported in part by the General Electric Company Medical Systems Division and the National Heart, Lung, and Blood Institute (Contract #HV-02922)     

Neuroradiological applications of a new system of stereoscopic biplane digital subtraction angiography

A stereoscopic biplane digital subtraction angiography (DSA) system was developed, capable of obtaining frontal and lateral projections simultaneously during a single injection of contrast medium. This new system combines the advantages of both biplane and stereoscopic single-plane DSA, and permits high-quality neuroangiography.     

旋转血管造影技术对颅内动脉瘤的诊断价值

目的探讨旋转血管造影技术对颅内动脉瘤的诊断价值。方法对21例蛛网膜下腔出血（subarachnoid hemorrhage，SAH）患者的脑血管造影检查资料进行回顾性分析，所有患者均行常规数字减影血管造影（digital subtraction angiography，DSA）及旋转DSA检查，比较DSA和旋转DSA对动脉瘤瘤体、瘤颈和载瘤血管的显示情况。结果④21例患者共发现动脉瘤23个，常规DSA仅清晰显示16个，旋转DSA清晰显示23个。②DSA清晰显示瘤颈4个，载瘤血管11个，旋转DSA清晰显示瘤颈17个，载瘤血管21个。经统计学处理，差异均具有显著性（P〈0．01）。结论旋转DSA比常规DSA更容易发现动脉瘤．能更清晰显示动脉瘤形态、位置以及与周围血管的关系，是常规DSA不可缺少的补充。     

Intra-arterial digital subtraction angiography of the carotid arteries

Summary A cross-over test in intra-arterial digital subtraction angiography (IADSA) of the carotid arteries was performed in 50 patients to evaluate image quality and side-effects with iohexol and metrizoate injected at concentrations of 100 mg I/ml by hand. The image quality was excellent or good in all cases. Although the severity and the frequency of side-effects were higher with metrizoate, both contrast media were suitable for IADSA at this low concentration. No complications were seen. It was assumed that the risk with IADSA was less than that of conventional precerebral angiography when performed semi-selectively and with small amounts of contrast media, as in this study.     

自发性蛛网膜下腔出血的CTA与DSA对比研究

目的:探讨64层CTA与DSA对自发性蛛网膜下腔出血(spontaneous subarachnoid hemorrhage,s-SAH)的应用价值及其限度。方法:收集153例s-SAH患者的CTA及DSA检查资料,回顾性分析2种检查方法的图像质量(采取1³分评分制),并比较2种方法在脑动脉瘤检出方面的灵敏度、特异度及准确度。结果:图像质量评分CTA为(2.63±0.262)分,DSA为(2.73±0.254)分,二者差异无统计学意义(P>0.05)。CTA对脑动脉瘤的检出的灵敏度为96.2%,特异度为94.9%,准确度为95.9%;DSA灵敏度为97.7%,特异度为97.4%,准确度为97.6%,二者差异无统计学意义(P>0.05)。结论:在s-SAH患者中,CTA与DSA均能准确检出动脉瘤所致破裂出血。相较于DSA,CTA能多方位显示病变,对血管壁及血管周围情况的显示更具价值。     

中枢性眩晕飞行员全脑血管造影初步分析

目的 了解中枢性眩晕飞行员患者脑血管的形态结构.方法 利用数字减影血管造影技术对飞行员患者行主动脉弓及全脑血管造影,分析血管结构异常的类型.结果 7例患者中4例患者为一侧椎动脉纤细,其中2例发生了椎动脉闭塞,另有2例脑血管存在先天变异;1例患者有颈内动脉狭窄;2例患者造影未见异常.结论 飞行员中枢性眩晕的原因有可能是脑血管变异、脑血管闭塞和狭窄引起的. Abstract： Objective To investigate the morphological changes of cerebral blood vessels by digital subtraction angiography (DSA) in the hospitalized military pilots with central vertigo.Methods Seven pilots were examined by cerebral and aortic arch DSA through femoral artery puncture. Type and distribution of the cerebrovascular abnormalities were observed and analyzed.Results Four pilots out of 7 were thinner unilateral vertebral artery and 2 of them appeared vertebral artery occlusion and the rest 2 pilots showed congenital abnormalities of cerebral artery. One pilot was diagnosed as internal carotid artery stenosis. Only 2 pilots were not detected abnormalities by DSA.Conclusions Congenital abnormalities, stenosis and occlusion of cerebral artery would be the reasons of resulting in pilot's central vertigo.     

DSA介入下制作犬脑出血模型的研究

目的:探讨建立与人类脑出血(intra-cerebral hemorrhage,ICH)相似、稳定可靠、重复性好的犬ICH模型的可行性。方法:选择健康家犬45只,经股动脉插管DSA下,导丝经导管进入并刺破大脑中动脉。制作ICH模型,以成功后2h脑CT检查结果确定血肿部位并计算血肿体积,观察24h内血肿体积变化及犬死亡情况。结果:45只犬脑出血部位均在基底节区或临近颞叶;血肿体积2.1~4ml者明显多于4.1~5ml、1.5~2ml及≥5ml者(P均<0.01);体积为4.1~5ml者明显多于1.5~2ml及≥5ml者(P均<0.01);血肿≤4ml破入脑室者明显少于≥4.1ml者(P<0.01),前者24h无1只死亡,明显少于后者(P<0.01)。结论:DSA介入下制作犬ICH模型,血肿部位合适、大小适中、模型稳定、破入脑室及死亡率均低,更接近于人类ICH。     

Iodixanol in intra-arterial cerebral digital subtraction angiography: a comparison with iohexol

We randomised 86 patients undergoing intra-arterial cerebral digital subtraction angiography (IADSA) to receive iodixanol (Visipaque; Nycomed, Oslo, Norway) 150 mgI/ml or iohexol (Omnipaque; Nycomed) 140 mgI/ml. The efficacy and safety of these two contrast media were compared: efficacy by evaluating the diagnostic information and radiographic density yielded by the angiograms, safety by recording all discomfort connected with the injections, and all adverse events up to 24 h after the investigation. Diagnostic information was optimal in all patients and the overall radiographic density optimal in all but one (iohexol) (P=0.49). A feeling of warmth, the only discomfort reported, was experienced by 43% and 54% of patients receiving iodixanol and iohexol, respectively (P=0.26). Two patients in the iodixanol group and five in the iohexol group reported one adverse event (nausea, dizziness, visual disturbance or paraesthesiae) (P=0.30); all were of mild severity except for one moderate adverse event in each group. Iodixanol 150 mgI/ml and iohexol 140 mgI/ml were demonstrated to be suitable for IADSA, with no clinically or statistically significant differences in efficacy, discomfort or adverse events.     

Three-dimensional volume rendering digital subtraction angiography in comparison with two-dimensional digital subtraction angiography and rotational angiography for detecting aneurysms and their morphological properties in patients with subarachnoid hemorrhage

Objective

Subarachnoid hemorrhage (SAH), which can cause mortality and severe morbidity, is a serious condition whose underlying cause must be determined. We aimed to compare 2D digital subtraction angiography (2DDSA), rotational angiography (RA) and 3D volume rendering digital subtraction angiography (3DVRDSA) for detecting aneurysms and their morphological properties in patients with subarachnoid hemorrhage.

Materials and methods

After an initial diagnosis of SAH with computed tomography, 122 patients (52 males and 70 females with a mean age of 47.77 ± 12.81 ranging between 20 and 83 years) underwent 2DDSA imaging, RA and 3DVRDSA imaging for detection of aneurysms. The location of the aneurysm, the best working angles, the dome/neck ratios, the largest diameter of the aneurysm, the shape of the aneurysm, the presence of spasms or pseudostenoses, and the relationship to the neighboring arteries were recorded.

Results

2DDSA missed 15.6% of the aneurysms that had a mean size of 2.79 ± 0.74 mm. RA was superior to 2DDSA for detecting aneurysm neck, and 3DVRDSA was superior to RA for detecting aneurysm neck. 3DVRDSA conclusively depicted the shape of the aneurysms in all patients. 3DVRDSA imaging was superior to 2DDSA and RA in the detection of the aneurysm relationship to neighboring arteries. The sensitivity and specificity of 3DVRDSA imaging for the detection of vasospasms were 100 and 84%, respectively.

Conclusions

3DVRDSA imaging is superior to 2DDSA and RA for detecting intracranial aneurysms and their morphological properties, especially those of small, ruptured aneurysms. However, 2DDSA should not be neglected in cases of vasospasm.     

Localization of carotid cavernous fistula using digital subtraction angiography

Digital subtraction angiography (DSA), with its rapid imaging rate (30 video frames per second) and immediately available subtraction images, provides excellent vascular detail in localization of the exact site of internal carotid-cavernous fistula. In a patient with two fistulas, we successfully used DSA to determine the sites of fistula and accurately positioned detachable balloons to occlude them.     

Stepped digital angiography with dynamic subtraction: a new diagnostic approach to peripheral angiography

On the basis of our first experiences, a purchasable angiography system for peripheral angiography with dynamic subtraction and stepping (DPSA) has been developed. This study reports on the optimization of this technique and the first clinical results in comparison with conventional screen-film angiography and digital subtraction angiography (DSA) in single steps. For each method, 25 angiograms were interpreted to compare the image quality, the radiation exposure, the contrast medium and the film consumption as well as the examination time. Image quality proved to be comparable in DPSA and DSA in single steps. Both techniques showed better results than conventional angiography, especially in the region of the knee and lower leg. Using DPSA radiation exposure dropped by a factor of 2 compared with conventional angiography and by a factor of 6 compared with DSA in single steps. Consumption of contrast medium can also be reduced in comparison with the other two methods. Film consumption is incomparably higher in conventional screen-film angiography. With DPSA the examination time can be reduced by half on average compared with the other two methods. DPSA may come to be the standard in peripheral angiography. Correspondence to: U. Fink     

Timing algorithm for bolus chase MR digital subtraction angiography

Acquire multiple longitudinal locations in the lower extremity after a single contrast injection, appropriate table translation and contrast injection are required. An approximate model based on constant bolus velocity was developed to describe the space-time course of a contrast bolus in the lower extremity. This model was verified in dynamic MR angiograms acquired in a group of patients using time-resolved 2D MR digital subtraction angiography (MRDSA). From this contrast bolus passage model, a timing algorithm for table translation and contrast injection was developed for bolus chase MRDSA, subsequently validated in bolus chase 2D MRDSA experiments. All targeted major peripheral arteries were well depicted in bolus chase 2D MRDSA using this timing algorithm and a single 15-ml contrast dose.     

大脑中动脉狭窄的磁共振血管成像与数字减影血管造影的对照研究

目的 探讨磁共振血管成像(MRA)在大脑中动脉狭窄或闭塞病变中的诊断价值.方法 35例缺血性脑血管病患者先后行MRA及DSA检查,以DSA为金标准,分析MRA对不同程度大脑中动脉狭窄的诊断价值.结果 35例患者70支大脑中动脉中,MRA显示正常血管28支,病变血管42支,病变部位47处,MRA与DSA诊断符合53处,符...     

旋转式三维数字减影血管造影在脑动脉瘤临床诊断和治疗中的应用价值

目的：探讨旋转式三维数字减影血管造影在脑动脉瘤诊断和治疗中的应用价值，提高诊断水平，增强治疗效果。方法：回顾性分析了213例脑动脉瘤患者的二维、三维数字减影脑血管造影的影像学资料，并对其结果进行了对比分析。结果：213例患者中共检出222枚脑动脉瘤，其中囊性动脉瘤197枚，梭形动脉瘤16枚，夹层动脉瘤9枚；在222枚脑动脉瘤中，小型动脉瘤105枚，中型动脉瘤89枚，大型动脉瘤22枚，巨大型动脉瘤6枚。常规DSA清楚显示的有205枚，17枚显示可疑由三维数字减影脑血管造影进一步证实；对138例脑动脉瘤患者进行手术开颅银夹夹闭治疗，19例进行介入性金属微弹簧圈栓塞治疗。结论：旋转式三维脑血管造影可有效提高脑动脉瘤的诊断准确性和多种治疗方法的安全十牛及疗效。     

三维数字减影血管造影技术诊断脑血管疾病的应用价值

目的评价三维数字减影血管造影(3D—DSA)技术诊断脑血管疾病的应用价值。方法对临床怀疑和确诊为脑血管疾病的71例患者行常规脑血管数字减影造影(DSA)和3D—DSA。结果本组共检查71例,经3D—DSA技术共检出动脉瘤44例64枚、颅内动静脉畸形(AVM)19例、血管狭窄致脑缺血8例(6例颈内动脉狭窄、大脑前动脉闭塞)。结论3D—DSA诊断脑血管疾病具有极大的临床应用价值。尤其对颅内动脉瘤、AVM、血管狭窄的诊断最为准确、快速、安全。     

Klippel—Trenaunay综合征动脉DSA检查的影像探讨

目的：探讨Klippel-Trenaunay综合征在患肢动脉DSA检查中的影像表现及意义。方法：分析10例Klippel-Trenaunay综合征的患肢动脉DSA的影像表现。结果：10例Klippel-Trenaunay综合征患肢中静脉回流明显提早显影、有微、小动静脉瘘4例,患肢动脉二、三级小分支明显增多9例,软组织内造影剂聚集6例,软组织内血管瘤1例。结：动脉DSA检查开拓了我们对Klippel-Trenaunay综合征的进一步认识。