Combined radiocontrast and radionuclide cerebral angiography.

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An assessment of serial brain scans obtained at one-second intervals following a carotid injection of radiopertechne-tate was initiated to determine its value as a supplement to contrast cerebral angiography (1, 2). Twenty-five patients had the radiopertechnetate administered immediately following cerebral angiography through the same carotid puncture. The analysis of these cases forms the basis of this report. Method and Material The entire angiographic procedure was performed with the patient under general anesthesia. After the radiographic component of the examination was completed, the patient was positioned under the gamma-ray scintillation camera (Pho/ Gamma II, Nuclear-Chicago). Rapid sequence scans were first obtained in the lateral projection following a 10-millicurie radiopertechnetate (Na99mTc04) carotid injection. A frontal series was procured immediately afterward with an additional 10-millicurie injection. The Robot time-lapse camera was set to take serial 0.8-second exposures, and concomitantly the Polaroid film pack was pulled manually as quickly as possible. On the average, it takes ten to thirteen seconds to obtain the eight Polaroid scintiphotographs. The Robot camera was loaded with Kodak Panatomic-X film, and it requires approximately two-tenths second to advance the film between exposures. The radiopertechnetate was diluted to a volume of 10 ml with normal saline and injected briskly by hand through a short length of tubing into a No. 18 Cournand needle. Tubing is necessary to permit the operator to work clear of the gamma camera detector head. Of the 25 patients, 6 had tumor, 11 had cerebral vascular disease, 6 were normal, and there was one each f head trauma and arteriovenous malformation. Results Normallateral and frontal sequences are illustrated in Figure 1. The lateral view was obtained first, and there is no significant interference of the radiopertechnetate background in the quality of the frontal projections. The frontal projections are useful in establishing relative blood flows between the anterior and middle cerebral arteries. The patient illustrated in Figure 2 was shown by contrast angiography to have an occlusion of the right middle cerebral artery at its origin.