Digital Subtraction Angiography In Diagnosis Research Articles

Safety and efficacy of dynamic catheter-directed cerebral digital subtraction angiography for diagnosis of bowhunter syndrome spectrum disorders: A systematic review of the literature.

Dynamic catheter-directed cerebral digital subtraction angiography (dcDSA) is the gold standard for diagnosing dynamic vascular occlusion syndromes such as bowhunter syndrome (BHS). Nonetheless, concerns about its safety exist and no standardized protocols have been published to date. We describe our methodology and insights regarding the use of dcDSA in patients with BHS. We also perform a systematic literature review to identify cases of typical and atypical presentations of BHS wherein dcDSA was utilized and report on any procedural complications related to dcDSA. Our study included 104 cases wherein dcDSA was used for the diagnosis of BHS. There were 0 reported complications of dcDSA. DcDSA successfully established diagnosis in 102 of these cases. Thirty-eight cases were deemed atypical presentations of BHS. Fourteen patients endorsed symptoms during neck flexion/extension. In eight cases, there was dynamic occlusion of bilateral vertebral arteries during a single maneuver. Three patients had multiple areas of occlusion along a single vertebral artery (VA). An anomalous entry of the VA above the C6 transverse foramen was observed in four patients. One patient had VA occlusion with neutral head position and recanalization upon contralateral lateral head tilt. Our study highlights the safety and diagnostic benefits of dcDSA in characterizing the broad spectrum of BHS pathology encountered in clinical practice. This technique offers a powerful means to evaluate changes in cerebral blood flow and cervical arterial morphology in real time, overcoming the constraints of static imaging methods. Our findings pave the way for further studies on dcDSA to enhance cross-sectional imaging methods for the characterization of BHS and other dynamic vascular occlusion syndromes.

Digital Subtraction Angiography Diagnosis and Interventional Treatment Analysis of Acute Peripheral Arterial Hemorrhage

Digital Subtraction Angiography Diagnosis and Interventional Treatment Analysis of Acute Peripheral Arterial Hemorrhage

Role of Digital Subtraction Angiography in Diagnosis of Fibromusculardysplasia

Fibromuscular dysplasia (FMD) is a vascular disease characterized by abnormal arterial wall architecture, usually visualized angiographically as the classic “string of beads” sign. We present the diagnostic dilemma of a 51-year-old woman admitted for a spontaneous renal infarct, with initial examination and investigations equivocal. She was consequently assessed for thromboembolic and vasculitic disease, before proceeding to digital subtraction angiography (DSA). This invasive method elucidated an area of focal FMD, previously not seen on computed tomography angiography (CTA). This is unusual due to CTA's high sensitivity and specificity but could be attributed to the less common subtype of FMD which requires combined imaging modalities to arrive at a diagnosis. Hence, there may be a role for the dual use of CTA and DSA in young patients presenting with a spontaneous renal infarct in the absence of other diagnoses.

Comparative evaluation of color Doppler and conventional digital subtraction angiography in arterial disease

Introduction: Peripheral Arterial Occlusive Disease (PAOD) leads to narrowing and hardening of arteries which leads to increased risk of lower extremity amputation. Hence, the accuracy of non-invasive diagnostic methods such as Color Doppler (CD) needs to be assessed in comparison to the conventional digital subtraction angiography (CDSA). Objective: To compare color Doppler and conventional digital subtraction arteriography in patients of infragenicular arterial disease. To evaluate and correlate the findings of CD with arteriography as the gold standard, in PAOD of the lower extremities in supra-genicular part and to define whether color Doppler, is an alternative or an adjunct to DSA. Methods: In this study 60 patients suspected of lower limb PAD aged between 40 and 70 years were included. All these patients with symptoms suggestive of PAOD underwent color Doppler study of lower limb arterial system. Afterward, 55 patients of PAOD formed the subjects and their affected lower limbs evaluated by CD and arteriography, for localization and grading of lesion in the arteries, into normal/insignificant stenosis and occlusion. The sensitivity, specificity, and positive and negative predictive values of CD as compared to CDSA in arterial disease were calculated. Results were analyzed by two way contingency tables, using calculator, and SSP software. Results: As compared to conventional digital subtraction angiography, Doppler assessment was more sensitive specific with greater diagnostic accuracy. Conclusion: CD is better than conventional digital subtraction angiography in diagnosis of Grade 1 &2 cases, with better assessment of soft plaques, segmental flow and recanalization in PAD and CD performed well compared with conventional digital subtraction angiography. Hence color Doppler can be an alternative to conventional digital subtraction angiography in diagnosing peripheral arterial occlusive diseases in supragenicular part of lower limb arteries.

Isolated leptomeningeal angiomatosis in the sixth decade of life, an adulthood variant of Sturge Weber Syndrome (Type III): role of advanced Magnetic Resonance Imaging and Digital Subtraction Angiography in diagnosis

BackgroundSturge-Weber syndrome (SWS) is primarily diagnosed in pediatric population, but clinical presentation in late adulthood is rarely reported. Evolution of radiological findings in the adulthood variant of SWS with isolated leptomeningeal angiomatosis has never been reported to our knowledge.Case presentationWe report here a case of an isolated temporo-parieto-occipital leptomeningeal angiomatosis on the right cerebral hemisphere in a sixty-two-year-old male who presented with generalized seizure, GCS score 14/15 (E4 V4 M6) with equal and reacting pupils, psychomotor slowing, left hemineglect and grade 4 power in the left upper and lower limbs. Over a period of 48 h his neurological status deteriorated, but recovered spontaneously over a week on titration with anticonvulsants. He had a prior history of treatment for focal leptomeningitis, three years ago. Cerebrospinal fluid (CSF) analysis showed glucose of 75 mg/dL, proteins of 65 mg/dL and culture grew no organisms. On follow-up, he had intermittent episodes of focal seizure for two years. Initial, computed tomography of brain showed hyperdense lesion in the parieto-occipital convexity subarachnoid space on the right cerebral hemisphere mimicking subarachnoid hemorrhage and computed tomography angiography showed no significant abnormality. Magnetic resonance imaging (MRI) of brain showed intense pial enhancement in the right temporo-parieto-occipital region with a subtle T2W hyperintense signal in the underlying subcortical white matter without edema or infarct or mass effect. Digital subtraction cerebral angiography (DSA) showed hypertrophy of the cerebral arteries, arteriolo-capillary bed and venules in the right temporo-parieto-occipital territory associated with early arterio-capillary and venous opacification. Serial MRI done after six months, one and two years showed increase in the T2W hyperintense signal in the subcortical white matter and cortical atrophy with no changes in the pial enhancement. MR perfusion imaging showed reduced cerebral blood flow (CBF) and cerebral blood volume (CBV) in the right parieto-temporo-occipital cortical and subcortical regions and increased perfusion in the leptomeninges with reduction of the NAA / Cr ratios in spectroscopy.ConclusionConglomeration of various radiological findings in MRI, Perfusion, MRS and DSA with the clinical presentation can aid in establishing the diagnosis of this rare presentation of SWS-type 3 variant in late adulthood.

Ultrasonographic and hemodynamic characteristics of patients with symptomatic carotid near-occlusion: results from a multicenter registry study.

The ultrasonographic and hemodynamic features of patients with carotid near-occlusion (CNO) are still not well known. Our aim was to describe the ultrasonographic and hemodynamic characteristics of a cohort of patients with CNO. A prospective, observational, nationwide, and multicenter study was conducted from January/2010 to May/2016. Patients with digital subtraction angiography (DSA)-confirmed CNO were included. We collected information on clinical and demographic characteristics, carotid and transcranial ultrasonography and DSA findings, presence of full-collapse, collateral circulation, and cerebrovascular reactivity (CVR). One hundred thirty-five patients were analyzed. Ultrasonographic and DSA diagnosis of CNO were concordant in only 44%. This disagreement was related to the presence/absence of full-collapse: 45% of patients with CNO with full-collapse were classified as a complete carotid occlusion, and 40% with a CNO without full-collapse were interpreted as severe stenosis (p < 0.001). Mean velocities (mV) and pulsatility indexes (PIs) were significantly lower in the ipsilateral middle cerebral artery compared with the contralateral (43 cm/s vs 58 cm/s, p < 0.001; 0.80 vs 1.00, p < 0.001). Collateral circulation was identified in 92% of patients, with the anterior communicating artery (73%) being the most frequent. CVR was decreased or exhausted in 66% of cases and was more frequent in patients with a poor or absent collateral network compared with patients with ≥ 2 collateral arteries (82% vs 56%, p = 0.051). The accuracy of carotid ultrasonography in the diagnosis of CNO seems to be limited, with significant discrepancies with DSA. Decreased ipsilateral mV, PI, and CVR suggest a hemodynamic compromise in patients with CNO.

Clinical value of multi-slice spiral CT angiography in the diagnosis of intracranial aneurysms

Objective To investigate the clinical value of multi-slice spiral CT angiography(CTA) in the diagnosis of intracranial cerebral aneurysms. Methods From January 2014 to December 2016, the clinical data of 60 patients with suspected intracranial aneurysms in Yiwu Central Hospital were retrospectively analyzed.The patients received CTA, digital subtraction angiography(DSA) examination.Based on the postoperative pathological results, the specificity, accuracy, consistency of CTA and DSA in the diagnosis of intracranial aneurysm were calculated.CTA, DSA diagnosis results and cerebral aneurysm surgery results were analyzed.The intracranial aneurysm diameter, the maximum diameter of the aneurysm neck of CTA, DSA inspection were compared. Results Based on the postoperative pathological results, the diagnostic sensitivity, specificity and accuracy of CTA for intracranial aneurysms were 97.06%, 92.31%, 95.00%, respectively, which of DSA were 94.12%, 96.15%, 95.00%, respectively, there were no statistically significant differences between the two groups(all P>0.05). The consistency coefficient of CTA was 0.719, and DSA coefficient of agreement with the findings in operation was 0.736, the consistency was good.The intracranial artery tumor maximum diameter, maximum diameter of aneurysm neck by CTA, DSA examination had no statistically significant differences(all P>0.05). Conclusion CTA in the diagnosis of intracranial aneurysm has high sensitivity and accuracy, the diagnostic value is close to DSA and can be used as auxiliary means of DSA. Key words: Intracranial aneurysm; Cerebral angiography; Tomography, spiral computed; Angiography, digital subtraction; Diagnosis

Diagnosis of spinal dural arteriovenous fistula using 3D T2-weighted imaging.

To evaluate spinal MRIs without and with 3D T2W imaging among patients without and with spinal dural arteriovenous fistula (SDAVF) confirmed by spinal digital subtraction angiography (DSA). A retrospective case-control study was performed among patients without and with SDAVF who had both spinal MRIs and gold standard spinal DSA. Two neuroradiologists independently reviewed spinal MRIs that were performed with either sagittal T2W turbo spin echo (2D group) or sagittal 3D T2W sampling perfection with application-optimized contrasts using different flip-angle evolutions (SPACE) (3D group) and documented the presence or absence of SDAVF. Using spinal DSA diagnosis as a gold standard, the sensitivity, specificity, and interobserver agreement for the 2D-group and 3D-group MRI diagnosis were calculated. The 2D group consisted of 21 patients and the 3D group consisted of 16 patients. For both radiologists, the 2D group demonstrated a sensitivity of 100% and specificity of 100%. Interobserver agreement in the 2D group was perfect (k=1.0). For both radiologists, the 3D group demonstrated sensitivity of 100.0% and specificity of 92.3%. Interobserver agreement in the 3D group was perfect (k=1.0). While flow voids were considered more conspicuous, spinal cord signal abnormality was considered less conspicuous with 3D T2W SPACE compared with conventional 2D STIR sequence. 3D T2W SPACE should be used in conjunction with 2D T2W sequences to more accurately detect abnormal cord signal and determine when perimedullary flow voids are pathologically abnormal for the radiologic diagnosis of SDAVF.

Diagnostic value of 64-slice CTA to head and neck artery lesions of the elder

Objective To investigate the diagnostic value of 64-slice CT angiography (CTA) to head and neck artery pathological changes. Methods One hundred patients with clinical suspicion of head and neck vascular lesions were retrospectively analyzed. Sixty four cases of lesions were detected by 64-slice CTA, and were checked by Digital Subtraction Angiography (DSA) within a week. First, the correlation of 64-slice CTA and DSA diagnosis of head and neck artery stenosis grade was counted. Then DSA was taken as the gold standard. The sensitivity, specificity, positive predictive value, and negative predictive value of 64-slice CTA to diagnose head and neck arteries stenosis were calculated. Results Of 64 cases of patients, 2 cases of congenital vascular dysplasia, including 1 case with internal carotid artery in 2 cases, the remaining 60 patients had different degree of stenosis. The sensitivity, specificity, positive predictive value, and negative predictive value of 64-slice CTA was 95.34%, 99.48%, 97.62%, and 98.98%, respectively. Among 60 narrow patients, the plaque number was 205, including 88 soft plaques, 56 mixed plaques, and 61 calcified plaque. Conclusions The 64-silce CTA has multiple advantages including rapid, noninvasiveness, high accuracy and safety, and high application value in the diagnosis of head and neck vascular lesions. It is worth promoting. Key words: Tomography, spiral computed; Carotid artery diseases/RA

Four-dimensional computed tomography angiography is valuable in intracranial dural arteriovenous fistula diagnosis and fistula evaluation.

This study was to evaluate the value of four-dimensional computed tomography angiography (4D-CTA) in the diagnosis of intracranial dural arteriovenous fistula (DAVF). This study included 16 patients who were diagnosed to have intracranial DAVF by digital subtraction angiography (DSA). The 4D-CTA was performed by Aquilion ONE multi-detector CT scanner (Toshiba Medical Systems, Japan) equipped with 320 × 0.5 mm detector rows. Standard biplane fluoroscopy equipments (Infinix, Toshiba Medical Systems, Japan and ADVANTX LC/LP, GE Medical Systems, Milwaukee, WI, USA) were applied in the diagnosis of intra-arterial DSA. Examinations were performed to evaluate the findings of DSA and 4D-CTA in each patient. The examination results were read by two independent readers in a blind manner. All results were documented on standardized scoring sheets. In all 16 cases, the same diagnosis results of intracranial DAVF were obtained from DSA and 4D-CTA. The results of subtype (Borden and Cognard classification), venous reflux and fistula sites were also accurately exhibited in 4D-CTA. In addition, there was a little discrepancy in identifying smaller and specific arterial branches and in distinguishing fistula type (focal or diffuse) using 4D-CTA. Good-to-excellent agreements were made between 4D-CTA and DSA. Therefore, 4D-CTA could be a feasible tool for the characterization of intracranial DAVF, with respect to determining fistula site and venous drainage.

A Comparative Study of Magnetic Resonance Angiography &amp; Digital Subtraction Angiography in Diagnosis of Cerebral Arteriovenous Malformation

Background and purpose: Although phase-contrast MR angiography (MRA) provides some information regarding hemodynamics of cerebral arteriovenous malformations (AVMs), but mos t Conventional MR angiographic techniques have not been helpful in this respect. We attempted to determine the value of MR digital subtraction angiography (DSA) in assessing AVM hemodynamics. Soin this retrospective observational study was carried out to compare MRA and DSA in diagnosis of cerebral AVM. Methods and materials: It was a retrospective observational study conducted in the Department of Neurology Dhaka Medical College Hospital (DMCH), Dhaka during the period of January 2010 to December 2010. Thirty patients with haemorrhagic stroke age ranging from 13 to 65 years were selected on the basis of inclusion and exclusion criteria as the study sample. MRA and DSA were done in all the selected patients. Results: The mean age of the patients of haemorrhagic stroke was 30.3±14.3years and male female ratio was 2.7:1.The venous drainage of AVM 13 and 12 were superficial and deep respectively evaluated 100% by MRA. In the diagnosis of cerebral AVM nidussize S1&lt;3, S2:6 cm sensitivity 100% but accuracy 100% and 73.3% respectively. Sensitivity 33.3% found in diagnosis of cerebral AVM nidus size S3:&gt;6cm, 100% sensitive in the diagnosis of superficial and deep venous drainage AVM. Regarding the eloquence of brain area 15 was no eloquence by both MRA and DSA and identification of eloquence of brain area sensitivity 73.3% and accuracy 86.7%.The feeding vessels main vessels was found 22(73.3%) in both DSA and MRA findings. Distal vessels was seen 8(26.7%) in DSA but not seen in MRA findings. Intranidal aneurysm and Angiopathic AVM were seen 3(10.0%) and 4(13.3%) respectively in DSA, Conclusion: This study was carried out to diagnose the patients presented with cerebral AVM by MRA and DSA. MRA could not be evaluated flow status of AVM, distal feeding arteries, intranidal aneurysm and angiopathic AVM which could be detected by DSA. So, DSA is superior to MRA in diagnosis of cerebral AVM. DOI: http://dx.doi.org/10.3329/bjmed.v24i2.18699 Bangladesh J Medicine 2013; 24 : 51-58

Clinical Application and Diagnostic Value of Noninvasive Spinal Angiography in Spinal Vascular Malformations

The purpose of this study was to explore the value of computed tomographic (CT) spinal angiography with 256-slice CT and fast dynamic contrast-enhanced 3-dimensional magnetic resonance angiography (MRA) at 3.0 T in the diagnosis of spinal vascular malformations. Seventeen patients who presented with suspected spinal vascular diseases by initial magnetic resonance and clinical findings all underwent CT spinal angiography. Among these, 10 patients underwent MRA, 15 patients underwent digital subtraction angiography (DSA) within 3 to 5 days, and 8 patients finally underwent surgical treatment. Computed tomographic angiography examination clearly showed the abnormal vascular lesions in 16 of the 17 patients, including 7 patients with the diagnosis of spinal dural arteriovenous fistula, 7 patients with perimedullary arteriovenous fistula, and 2 patients with spinal arteriovenous malformations. The results were consistent with the diagnosis of DSA or surgery. One patient was poorly diagnosed. The fistulas could be seen in 12 patients; feeding arteries were correctly displayed in 12 patients. The fistulas and feeding arteries were accurately shown in 7 of 10 patients by MRA; DSA results were also negative in the other 3 patients. Spinal angiography with 256-slice CT and contrast-enhanced MRA at 3.0 T can clearly show the extent of spinal vascular malformations, feeding arteries, and fistulas. They are safe, noninvasive, as well as rapid and can shorten the time of DSA diagnosis and treatment.

Reevaluating the Transcranial Doppler Criteria for Estimation of Anterior Circulation Artery Stenosis

The criteria for evaluating cerebral artery stenosis by transcranial Doppler sonography are inconsistent. We aimed to identify the accuracy of transcranial Doppler criteria compared with digital subtraction angiography for diagnosis of anterior circulation artery stenosis. A total of 170 patients who underwent transcranial Doppler sonography and digital subtraction angiography were recruited. The anterior circulation arteries were evaluated by transcranial Doppler sonography and digital subtraction angiography. We defined the best cutoff value for substantial anterior circulation artery stenosis by receiver operating characteristic curve analyses and calculated the sensitivity, specificity, and positive and negative predictive values. An anterior circulation artery peak systolic velocity (PSV) of 120 cm/s had the largest area under the receiver operating characteristic curve compared with PSVs of 110, 130, and 140 cm/s and mean flow velocities of 60, 70, and 80 cm/s. The sensitivity, specificity, false-positive rate, false-negative rate, accuracy, positive predictive value, negative predictive value, positive likelihood ratio, negative likelihood ratio, and Youden index for transcranial Doppler sonography were 90.6%, 85.0%, 15.0%, 9.4%, 87.9%, 87.2%, 88.9%, 6.04, 0.11, and 0.756, respectively. The reliability index included the agreement rate and κ value, which were 87.9% and 0.757. A PSV of 120 cm/s combined with additional parameters was an accurate criterion for diagnosing anterior circulation artery stenosis. Transcranial Doppler sonography could be considered a valuable method for screening diagnosis of cerebral artery stenosis.

Application of digital subtraction angiography and interventional treatment in gastrointestinal arterial hemorrhage

To investigate the clinical value of digital subtraction angiography (DSA) and interventional treatment in gastrointestinal arterial hemorrhage. DSA data and experiences of interventional treatment of 78 cases with gastrointestinal arterial hemorrhage were retrospectively analyzed. The positive rate of DSA diagnosis was 74%(58/78). Contrast media overflow direct sign was found in 33%(26/78) patients. Contrast media overflow direct sign of postoperative anastomotic stoma was found in 83%(15/18) patients. Hemorrhage causes of 15 cases were duodenal ulcer, 5 stomach ulcer, 2 gastric cancer, 1 Dieulafoy disease, 9 vascular malformation and dysplasia, 8 in anastomotic stoma bleeding after gastrointestinal operation, 10 hepatic artery blow out and bleeding after operation of liver disease, 5 Crohn disease, 6 intestinal tract diverticulum hemorrhage, 6 enteritis or ulcer and 3 polyp of small intestine, 1 midrange malignant small intestinal interstitial tumor, 2 well differentiated small intestine leiomyosarcoma, 5 colon and rectal cancer. Fifteen cases received arterial drug infusion and 36 received arterial embolization. Twenty-seven cases underwent operation after DSA and interventional treatment, whose coincidence with pathology was 78%(21/27). Technical success rate of arterial embolization was 86%(31/36) and clinical success rate was 72%(26/36). Technical success rate of arterial drug perfusion was 60%(9/15) and clinical success rate was 40%(6/15). Rebleeding rate was 16%(8/51) after intervention treatment. During follow-up for 2-36 months, 1 rebleeding patient received gastroscope treatment after embolization, but failed and died later. There were no severe complications,such as ischemic necrosis,in all the cases. DSA is very important for the location and qualitation of gastrointestinal arterial hemorrhage. Transarterial drug infusion and embolization are safe and effective, and available to selective operation and complication handling.

The value of digital subtraction angiography in diagnosis and planning endovascular treatment of children with ischemic cerebrovascular diseases

Objective To evaluate the value of digital subtraction angiography(DSA) in diagnosis and planning endovascular treatment of cerebrovascular diseases. Methods Thirty-one children suspected with ischemic cerebrovascular diseases were treated by urokinase and dextran after they underwent DSA.Results Twenty-four cases (77%) had cerebrovascular abnormalities. Two cases had arteriovenous malformations, 1 case had posterior communicating artery aneurysm,21 cases had cerebrovascular stenosis or occlusions. Shortly after intervention therapy using urokinase,muscle strength increased by one level in 13 cases,two levels in 3 cases,3 levels in 2 cases and no effect in 4 cases. The total effective rate reached 86%. Seven patients with ischemic stroke achieved 100% recanalization. Conclusion DSA is very important in diagnosis of cerebrovascular stenosis and occlusion. Key words: Digital subtraction angiography; Ischemic cerebral vascular diseases; Children

Cerebral venous sinus thrombosis revealed by digital subtraction angiography in a 69-year-old man with papilledema

A 69-year-old man complained of mild headache and abnormal visual fields in both eyes. Two months after the onset of these symptoms, the patient exhibited good central vision, abnormal visual fields, and papilledema. Enhanced computed tomography and magnetic resonance angiography of the brain showed no abnormality. Neurologic study showed no localizing signs, but increased intracranial pressure with normal composition of the cerebrospinal fluid. Digital subtraction angiography revealed thrombosis of the superior sagittal sinus. The patient was treated with heparin and acetazolamide. Thereafter, his intracranial pressure and papilledema decreased. Ophthalmologists and neurosurgeons should be aware that old cerebral sinus thrombosis may require digital subtraction angiography for diagnosis.

Echo-Enhanced Transcranial Color Coded Duplexsonography versus Digital Subtraction Angiography for Diagnosis of Intracranial Vascular Diseases

P7 Objective: To assess the diagnostic efficacy of echo-enhanced transcranial color coded duplexsonography (eTCCD) for noninvasive evaluation of the intracranial vasculature in patients with cerebrovascular symptoms. MATERIAL AND METHODS: We prospectively evaluated 35 consecutive patients (10 women, 25 men, mean age 58,8 ± 9,7) with eTCCD (galactose palmitic acid based echo-enhancing agent) and digital subtraction angiography (DSA). All patients were admitted to our neurology department for acute onset of cerebrovascular symptoms. RESULTS: In 34/35 patients eTCCD visualized the circle of Willis. In 15/17 patients with critical symptomatic internal carotid artery obstruction (lumen diameter reduction of &gt;85% or occlusion) eTCCD correctly identified collateral flow patterns through the circle of Willis. DSA and eTCCD showed MCA-occlusion in 4 patients. In one of these patients eTCCD correctly identified a contralateral severe MCA-stenosis, which was first missed by DSA but confirmed by angiographic reevaluation. In 1 patient eTCCD missed occlusion of a M3-segment. In 2/3 patients eTCCD showed intracranial ICA-stenosis. In 3 patients with symptoms suggestive for basilar artery thrombosis DSA and eTCCD showed severe basilar stenosis in 1 patient and intracranial vertebral artery occlusion in 2 patients. DSA and eTCCD were normal in 3 patients with atypical intracranial hemorrhages and in 1 patient with subarachnoid hemorrhage. In another patient eTCCD correctly suggested a left parietooccipital AVM. DSA and eTCCD were normal in 4 other patients. CONCLUSION: eTCCD reliably detects occlusion, stenosis and collateral flow patterns of the basal cerebral arteries in patients with cerebral ischemia. For patients with cerebral hemorrhage our data are limited.

Pancreatic tumor: DSA diagnosis and treatment.

AIM:To study the clinical significance of the diagnosis and catheterized interventional treatment of digital subtraction angiography (DSA) for pancreatic tumors.METHODS: Ninety-two patients with pancreatic tumor, 69 males and 23 females, aged from 41 to 70 years (mean 57.1 years) were diagnosed with DSA. Sixty-one patients with pancreatic cancer were treated with transcatheter celiac and superior mesenteric arterial anticancer agents (MMC 20mg, EADM 40mg and 5-FU 2.0g) infusion (TCSAI).RESULTS: The DSA diagnoses were confirmed by operations and pathological examinations, with a coincidence 82.6% rate of, and a therapeutic effective rate of 42.6%.CONCLUSION: DSA is of diagnostic value for pancreatic tumors, and helpful in understanding the course of the disease, judging the prognosis and selecting the therapeutic regimen, and could improve the chemotherapeutic effect as well.

Capillary filling analysis by digital subtraction angiography for vertebro-basilar insufficiency.

Vertebro-basilar insufficiency (VBI) is a vague clinical entity including several symptoms such as faintness, dizziness, vertigo. Millikan and Siekert reported a 'syndrome of intermittent insufficiency of basilar arterial system'. But vascular abnormalities responsible for such symptoms are often hardly diagnosed by conventional angiography, because vertebro-basilar artery systems have many kinds of anomalous congenital origins. Conventional angiography gives us arterial informations such as stenosis, occlusion and malformations, but it often fails to reveal capillary perfusions because of its relatively poor density resolution. Digital subtraction angiography (DSA) is considered to have improved density resolution, and it may enable us to detect vascular perfusions more sensitively in the capillary phase. In this study, we evaluated the usefulness of the capillary filling analysis in digital subtraction angiography for diagnosis of VBI.

Usefulness of digital subtraction angiography for diagnosis of renal tumours.

DSA (digital subtraction angiography) is a new, highly effective method for visualization of kidney vascular system. By means of a digital subtraction angiography unit the image of bones and soft tissues is blotted out, and a subtractive picture of contrasted vessels alone emerges. Intra-arterial DSA is a less invasive and more comfortable method when compared to conventional angiography. Only 2-4 ml of contrast medium is administered, thinner catheters being employed at the same time. The examination can also be performed through intravenous administration of contrast medium. The DSA unit Angiotron CMP was installed at the Department of Radiology, Military Medical Academy of Lódź, in 1984. In the present material a diagnostic DSA investigation was performed in 22 patients with renal tumours. In 21 of them the tumour was correctly diagnosed on grounds of pathological vascularization and the result was dubious in only 1 patient with benign tumour.