A Simple Technic for Cerebral Arteriography

Abstract

Egas Moniz (2), in 1927, introduced a specialized roentgen technic whereby it is possible, with the aid of certain radioopaque substances injected into the vascular supply of the brain, to visualize normal and abnormal cerebral vessels. The illustrations of his monograph, covering a wide variety of pathological conditions, can be duplicated with a relatively simple procedure now used in our department. The purpose of this communication is to present briefly this simple technic. Robb and Steinberg (14), in 1939, and Stewart, Breimer, and Maier, in 1941 (16), reported the successful use of diodrast to demonstrate the chambers of the heart and the pulmonary circulation. Gross (5, 6), after experience with cerebral arteriography in dogs, expressed a preference for a 50 per cent solution of diodrast rather than colloidal thorium dioxide, or thorotrast, which Egas Moniz believed most suitable of the available radio-opaque substances. Eisenstein and Taylor (3), who reported a case of porencephalic cyst with arteriographic studies, used thorotrast as their contrast medium. The difference of opinion in regard to the technic of cerebral arteriography is understandable in view of the relative newness of the procedure. Our technic has been worked out in assisting the surgeons of the neurosurgical division of Duke University Hospital. Co-operation between the neurosurgeon and roentgenologist is essential to gratifying results. In each individual case, the two should plan the type of demonstration most desired before any procedure is instituted, and discuss any modifications which may be necessary. If this is done, good visualization of the cerebral arteries is not beyond the potentiality of the average 200-milliampere fast Bucky diagnostic unit. Co-ordination and team-work of all persons concerned assures good results. Abnormalities of arteries of the anterior and middle fossae are relatively easy to show (Figs. 1 and 3), but the arterial channels of the posterior fossa are usually poorly filled and less detail is obtainable. Changes in and about the circle of Willis are the most easily demonstrated (Figs. 2 and 4). For a contrast medium, our experience is limited to the use of thorotrast. To date, we have encountered none of the untoward effects or potential dangers described by Gross (5) and others. The radioactivity of thorium dioxide, recognized for some time, does not necessarily contraindicate its use for arteriography, when only a small amount is injected as in the procedure presented here. In our department thorotrast has been used for the roentgen demonstration of the liver and spleen in a number of patients, seen over a period of years, without dangerous effects.