Cerebral angiography
Updates to Article Attributes
Body
was changed:
Cerebral angiography is an interventional procedure for the diagnosis and/or treatment of intracranial pathology.
Indications
Cerebral digital subtraction angiography (DSA) is indicated in a variety of settings including:
- diagnosis and treatment of:
- aneurysms
- acute ischaemic stroke
- vascular abnormalities
- cerebral vasospasm post subarachnoid haemorrhage
- meningioma (preoperative embolisation)
- investigation of:
- confirming brain death
Projections
Standard projections
- PA internal carotid artery
- projects middle cerebral artery away from bony landmarks, minimising beam hardening artifacts
- petrous ridge superimposed on supraorbital margin
- include the entire skull vault
- conclusively demonstrates
- ICA lacerum portion
- ICA
distaldistal bifurcation - ACA A1 segment
- MCA
M1M1 segment (including lenticulostriate vessels) - confluence of sinuses
- transverse sinus
- sigmoid sinus
- intracavernous sinus
- lateral internal carotid artery
- include the entire skull vault
- effectively demonstrates
- ICA
cavernouscavernous portion - ICA
communicatingcommunicating segment (PCOM, anteriorchoidalchoroidal artery) - ACA A2 segments
- MCA M3 segments
- ophthalmic artery
- superior and Inferior sagittal sinuses
- internal cerebral veins
- basal vein of Rosenthal
- great vein of Galen
- straight sinus
- cavernous sinus
- inferior petrosal sinus
- ICA
- transorbital oblique internal carotid
- petrous ridge positioned on infraorbital margin
- include the entire skull vault. However, magnification can be employed if the indication is specifically for an intracranial aneurysm
- ipsilateral obliquity, 30°
- effectively demonstrates
- ICA distal bifurcation
- ACA A1 segment
- ACA occasionally for ACOM
- MCA trifurcation of M1/M2 segments
- reverse transorbital oblique internal carotid
- petrous ridge positioned on infraorbital margin
- include the entire skull vault; however, magnification can be employed if the indication is specifically for an intracranial aneurysm
- contralateral obliquity 30°
- effectively demonstrates
- MCA occasionally trifurcation of M1/M2 segments
- ACA occasionally for ACOM
- cross compression projection internal carotid
- petrous ridge positioned on infraorbital margin
- no (RAO/LAO) obliquity
- effectively demonstrates
- ICA distal bifurcation
- ACA A1 segment
- ACOM provides a baseline position for cross compression and visualisation of the ACOM
- MCA M1 segment
- PA vertebral artery
- petrous ridge positioned on supraorbital margin
- effectively demonstrates
- vertebral distal portion
- basilar artery
- superior cerebellar artery (SCA)
- anterior inferior cerebellar artery (AICA)
- superior sagittal sinus
- confluence of sinuses
- transverse sinus
- sigmoid sinus
- lateral vertebral artery
- effectively demonstrates
- vertebral artery distal portion
- basilar artery (excluding basilar tip)
- PCOM
- PCA - posterior choroidal artery
- superior and inferior sagittal sinuses
- internal cerebral veins
- basal vein of Rosenthal
- great vein of Galen
- straight sinus
- effectively demonstrates
Additional positioning notes for the vertebral artery
- from the baseline vertebral PA, the c-arm is angled cranially to demonstrate the PCA best in addition
forto demonstrating the thalamoperforating vessels - caudal tilt
(water(Water's projection) will better demonstrate the basilar artery without foreshortening. - PICA origins best demonstrated in 45° ipsilateral obliquity
General patient positioning
- patient supine, head supported in a radiolucent head holder or curved sponge
- strap across the patient's head to minimise movement
- head positioned without rotation
- head tilt (radiographic baseline) determined by patient comfort
- the patient should not be forced into an uncomfortable head tilt
- adjustments made for head tilt by craniocaudally c-arm angulation
-<li><a href="/articles/arteriovenous-malformations">arteriovenous malformation</a></li>- +<li><a href="/articles/arteriovenous-malformation-2">arteriovenous malformation</a></li>
-<a href="/articles/cerebral-arteriovenous-fistulae">arteriovenous fistula</a><ul><li><a href="/articles/caroticocavernous-fistula-1">caroticocavernous fistula</a></li></ul>- +<a href="/articles/cerebral-arteriovenous-fistula-1">arteriovenous fistula</a><ul><li><a href="/articles/caroticocavernous-fistula-1">caroticocavernous fistula</a></li></ul>
-<li>include entire skull vault</li>- +<li>include the entire skull vault</li>
-<li>ICA distal bifurcation</li>- +<li>ICA distal bifurcation</li>
-<li>MCA M1 segment (including lenticulostriate vessels)</li>- +<li>MCA M1 segment (including lenticulostriate vessels)</li>
-<li>include entire skull vault</li>- +<li>include the entire skull vault</li>
-<li>ICA cavernous portion</li>-<li>ICA communicating segment (PCOM, anterior choidal artery)</li>- +<li>ICA cavernous portion</li>
- +<li>ICA communicating segment (PCOM, anterior choroidal artery)</li>
-<li>include entire skull vault. However, magnification can be employed if indication is specifically for an intracranial aneurysm</li>- +<li>include the entire skull vault. However, magnification can be employed if the indication is specifically for an intracranial aneurysm</li>
-<li>include entire skull vault; however, magnification can be employed if the indication is specifically for an intracranial aneurysm</li>- +<li>include the entire skull vault; however, magnification can be employed if the indication is specifically for an intracranial aneurysm</li>
-<li>ACOM provides baseline position for cross compression and visualisation of the ACOM</li>- +<li>ACOM provides a baseline position for cross compression and visualisation of the ACOM</li>
-<li>from the baseline vertebral PA, the c-arm is angled cranially to demonstrate the PCA best in addition for demonstrating the thalamoperforating vessels</li>-<li>caudal tilt (water's projection) will better demonstrate the basilar artery without foreshortening.</li>- +<li>from the baseline vertebral PA, the c-arm is angled cranially to demonstrate the PCA best in addition to demonstrating the thalamoperforating vessels</li>
- +<li>caudal tilt (Water's projection) will better demonstrate the basilar artery without foreshortening.</li>
-<li>strap across patient's head to minimise movement</li>- +<li>strap across the patient's head to minimise movement</li>
-<li>patient should not be forced into an uncomfortable head tilt</li>- +<li>the patient should not be forced into an uncomfortable head tilt</li>
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