The diagnostic interface between noninvasive cerebral vascular testing and digital arteriography.
Two hundred forty patients with signs and symptoms of cerebrovascular disease were evaluated by digital and/or standard arteriography. One hundred twenty symptomatic patients had intravenous digital arteriography (IVDSA) done as the initial diagnostic study. Twenty-five percent (30 patients) had inadequate intravenous examinations and required additional intra-arterial studies. Twenty-seven of the 30 supplemental arteriograms (90%) demonstrated clinically significant disease. The remaining 120 patients (30 asymptomatic, 90 symptomatic) had preangiographic screening with continuous-wave Doppler and spectral analysis. Forty-eight (40%) patients had hemodynamically severe lesions and 72 (60%) had moderate stenosis or arterial wall disease. IVDSA was performed when critical disease was present and intra-arterial arteriography (80% digital and 20% standard) was done when mild or moderate disease was found. The use of digital techniques on the basis of results of preangiographic noninvasive testing improved the diagnostic accuracy of IVDSA and reduced the incidence of inadequate studies to 6%. Intra-arterial digital angiography (IADSA) was advantageous in reducing costs and patient risks when IVDSA was inappropriate.
D000792:Angiography / Q000379:methods; D002561:Cerebrovascular Disorders / Q000000981:diagnostic imaging*; D003365:Costs and Cost Analysis; D006801:Humans; D013382:Subtraction Technique