Cerebral angiography
Updates to Article Attributes
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:
acute ischaemic stroke
-
vascular abnormalities1
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 distal bifurcation
ACA A1 segment
MCA M1 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 cavernous portion
ICA communicating segment (PCOM, anterior choroidal 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
-
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
-
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 to demonstrating the thalamoperforating vessels
caudal tilt (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>diagnosis and treatment of:<ul>-<li><a href="/articles/saccular-cerebral-aneurysm">aneurysms</a></li>-<li>acute <a href="/articles/ischaemic-stroke">ischaemic stroke</a>- +<li>
- +<p>diagnosis and treatment of:</p>
- +<ul>
- +<li><p><a href="/articles/saccular-cerebral-aneurysm">aneurysms</a> <sup>1</sup></p></li>
- +<li><p>acute <a href="/articles/ischaemic-stroke">ischaemic stroke</a></p></li>
- +<li>
- +<p>vascular abnormalities <sup>1</sup></p>
- +<ul>
- +<li><p><a href="/articles/arteriovenous-malformation-2">arteriovenous malformation</a></p></li>
- +<li>
- +<p><a href="/articles/cerebral-arteriovenous-fistula-1">arteriovenous fistula</a></p>
- +<ul><li><p><a href="/articles/caroticocavernous-fistula-1">caroticocavernous fistula</a></p></li></ul>
- +</li>
- +</ul>
- +</li>
- +<li><p><a href="/articles/cerebral-vasospasm-following-subarachnoid-haemorrhage">cerebral vasospasm</a> post subarachnoid haemorrhage</p></li>
- +<li><p><a href="/articles/meningioma">meningioma</a> (preoperative embolisation)</p></li>
- +</ul>
- +</li>
- +<li>
- +<p>investigation of:</p>
- +<ul>
- +<li><p><a href="/articles/reversible-cerebral-vasoconstriction-syndrome-2">reversible cerebral vasoconstriction syndrome</a></p></li>
- +<li><p><a href="/articles/moyamoya-syndrome-1">moya-moya syndrome</a></p></li>
- +</ul>
-<li>vascular abnormalities<ul>-<li><a href="/articles/arteriovenous-malformation-2">arteriovenous malformation</a></li>- +<li><p>confirming <a href="/articles/brain-death-2">brain death</a></p></li>
- +</ul><h4>Projections</h4><h5>Standard projections</h5><ul>
- +<li>
- +<p>PA internal carotid artery</p>
- +<ul>
- +<li><p>projects middle cerebral artery away from bony landmarks, minimising beam hardening artifacts</p></li>
- +<li><p>petrous ridge superimposed on supraorbital margin</p></li>
- +<li><p>include the entire skull vault</p></li>
-<a href="/articles/cerebral-arteriovenous-fistula-1">arteriovenous fistula</a><ul><li><a href="/articles/caroticocavernous-fistula-1">caroticocavernous fistula</a></li></ul>- +<p>conclusively demonstrates</p>
- +<ul>
- +<li><p>ICA lacerum portion</p></li>
- +<li><p>ICA distal bifurcation</p></li>
- +<li><p>ACA A1 segment</p></li>
- +<li><p>MCA M1 segment (including lenticulostriate vessels)</p></li>
- +<li><p>confluence of sinuses</p></li>
- +<li><p>transverse sinus</p></li>
- +<li><p>sigmoid sinus</p></li>
- +<li><p>intracavernous sinus</p></li>
- +</ul>
-<a href="/articles/cerebral-vasospasm-following-subarachnoid-haemorrhage">cerebral vasospasm</a> post subarachnoid haemorrhage</li>- +<p>lateral internal carotid artery</p>
- +<ul>
- +<li><p>include the entire skull vault</p></li>
-<a href="/articles/meningioma">meningioma</a> (preoperative embolisation)</li>- +<p>effectively demonstrates</p>
- +<ul>
- +<li><p>ICA cavernous portion</p></li>
- +<li><p>ICA communicating segment (PCOM, anterior choroidal artery)</p></li>
- +<li><p>ACA A2 segments</p></li>
- +<li><p>MCA M3 segments</p></li>
- +<li><p>ophthalmic artery</p></li>
- +<li><p>superior and Inferior sagittal sinuses</p></li>
- +<li><p>internal cerebral veins</p></li>
- +<li><p>basal vein of Rosenthal</p></li>
- +<li><p>great vein of Galen</p></li>
- +<li><p>straight sinus</p></li>
- +<li><p>cavernous sinus</p></li>
- +<li><p>inferior petrosal sinus</p></li>
-<li>investigation of:<ul>-<li><a href="/articles/reversible-cerebral-vasoconstriction-syndrome-2">reversible cerebral vasoconstriction syndrome</a></li>-<li><a href="/articles/moyamoya-syndrome-1">moya-moya syndrome</a></li>-<li>confirming <a href="/articles/brain-death-2">brain death</a>- +<li>
- +<p>transorbital oblique internal carotid</p>
- +<ul>
- +<li><p>petrous ridge positioned on infraorbital margin</p></li>
- +<li><p>include the entire skull vault. However, magnification can be employed if the indication is specifically for an intracranial aneurysm</p></li>
- +<li><p>ipsilateral obliquity, 30°</p></li>
- +<li>
- +<p>effectively demonstrates</p>
- +<ul>
- +<li><p>ICA distal bifurcation</p></li>
- +<li><p>ACA A1 segment</p></li>
- +<li><p>ACA occasionally for ACOM</p></li>
- +<li><p>MCA trifurcation of M1/M2 segments</p></li>
- +</ul>
-</ul><h4>Projections</h4><h5>Standard projections</h5><ul>-<li>PA internal carotid artery<ul>-<li>projects middle cerebral artery away from bony landmarks, minimising beam hardening artifacts</li>-<li>petrous ridge superimposed on supraorbital margin</li>-<li>include the entire skull vault</li>-<li>conclusively demonstrates<ul>-<li>ICA lacerum portion</li>-<li>ICA distal bifurcation</li>-<li>ACA A1 segment</li>-<li>MCA M1 segment (including lenticulostriate vessels)</li>-<li>confluence of sinuses</li>-<li>transverse sinus</li>-<li>sigmoid sinus</li>-<li>intracavernous sinus</li>-</ul>-</li>-</ul>-</li>-<li>lateral internal carotid artery<ul>-<li>include the entire skull vault</li>-<li>effectively demonstrates<ul>-<li>ICA cavernous portion</li>-<li>ICA communicating segment (PCOM, anterior choroidal artery)</li>-<li>ACA A2 segments</li>-<li>MCA M3 segments</li>-<li>ophthalmic artery</li>-<li>superior and Inferior sagittal sinuses</li>-<li>internal cerebral veins</li>-<li>basal vein of Rosenthal</li>-<li>great vein of Galen</li>-<li>straight sinus</li>-<li>cavernous sinus</li>-<li>inferior petrosal sinus</li>-</ul>-</li>-</ul>-</li>-<li>transorbital oblique internal carotid<ul>-<li>petrous ridge positioned on infraorbital margin</li>-<li>include the entire skull vault. However, magnification can be employed if the indication is specifically for an intracranial aneurysm</li>-<li>ipsilateral obliquity, 30°</li>-<li>effectively demonstrates<ul>-<li>ICA distal bifurcation</li>-<li>ACA A1 segment</li>-<li>ACA occasionally for ACOM</li>-<li>MCA trifurcation of M1/M2 segments</li>-</ul>-</li>-</ul>-</li>-<li>reverse transorbital oblique internal carotid<ul>-<li>petrous ridge positioned on infraorbital margin</li>-<li>include the entire skull vault; however, magnification can be employed if the indication is specifically for an intracranial aneurysm</li>-<li>contralateral obliquity 30°</li>-<li>effectively demonstrates<ul>-<li>MCA occasionally trifurcation of M1/M2 segments</li>-<li>ACA occasionally for ACOM </li>-</ul>-</li>-</ul>-</li>-<li>cross compression projection internal carotid<ul>-<li>petrous ridge positioned on infraorbital margin</li>-<li>no (RAO/LAO) obliquity</li>-<li>effectively demonstrates<ul>-<li>ICA distal bifurcation</li>-<li>ACA A1 segment</li>-<li>ACOM provides a baseline position for cross compression and visualisation of the ACOM</li>-<li>MCA M1 segment</li>-</ul>-</li>-</ul>-</li>-<li>PA vertebral artery<ul>-<li>petrous ridge positioned on supraorbital margin</li>-<li>effectively demonstrates<ul>-<li>vertebral distal portion</li>-<li>basilar artery</li>-<li>superior cerebellar artery (SCA)</li>-<li>anterior inferior cerebellar artery (AICA)</li>-<li>superior sagittal sinus</li>-<li>confluence of sinuses</li>-<li>transverse sinus</li>-<li>sigmoid sinus</li>-</ul>-</li>-</ul>-</li>-<li>lateral vertebral artery<ul><li>effectively demonstrates<ul>-<li>vertebral artery distal portion</li>-<li>basilar artery (excluding basilar tip)</li>-<li>PCOM</li>-<li>PCA - posterior choroidal artery</li>-<li>superior and inferior sagittal sinuses</li>-<li>internal cerebral veins</li>-<li>basal vein of Rosenthal</li>-<li>great vein of Galen</li>-<li>straight sinus</li>- +</ul>
- +</li>
- +<li>
- +<p>reverse transorbital oblique internal carotid</p>
- +<ul>
- +<li><p>petrous ridge positioned on infraorbital margin</p></li>
- +<li><p>include the entire skull vault; however, magnification can be employed if the indication is specifically for an intracranial aneurysm</p></li>
- +<li><p>contralateral obliquity 30°</p></li>
- +<li>
- +<p>effectively demonstrates</p>
- +<ul>
- +<li><p>MCA occasionally trifurcation of M1/M2 segments</p></li>
- +<li><p>ACA occasionally for ACOM </p></li>
- +</ul>
- +</li>
- +</ul>
- +</li>
- +<li>
- +<p>cross compression projection internal carotid</p>
- +<ul>
- +<li><p>petrous ridge positioned on infraorbital margin</p></li>
- +<li><p>no (RAO/LAO) obliquity</p></li>
- +<li>
- +<p>effectively demonstrates</p>
- +<ul>
- +<li><p>ICA distal bifurcation</p></li>
- +<li><p>ACA A1 segment</p></li>
- +<li><p>ACOM provides a baseline position for cross compression and visualisation of the ACOM</p></li>
- +<li><p>MCA M1 segment</p></li>
- +</ul>
- +</li>
- +</ul>
- +</li>
- +<li>
- +<p>PA vertebral artery</p>
- +<ul>
- +<li><p>petrous ridge positioned on supraorbital margin</p></li>
- +<li>
- +<p>effectively demonstrates</p>
- +<ul>
- +<li><p>vertebral distal portion</p></li>
- +<li><p>basilar artery</p></li>
- +<li><p>superior cerebellar artery (SCA)</p></li>
- +<li><p>anterior inferior cerebellar artery (AICA)</p></li>
- +<li><p>superior sagittal sinus</p></li>
- +<li><p>confluence of sinuses</p></li>
- +<li><p>transverse sinus</p></li>
- +<li><p>sigmoid sinus</p></li>
- +</ul>
- +</li>
- +</ul>
- +</li>
- +<li>
- +<p>lateral vertebral artery</p>
- +<ul><li>
- +<p>effectively demonstrates</p>
- +<ul>
- +<li><p>vertebral artery distal portion</p></li>
- +<li><p>basilar artery (excluding basilar tip)</p></li>
- +<li><p>PCOM</p></li>
- +<li><p>PCA - posterior choroidal artery</p></li>
- +<li><p>superior and inferior sagittal sinuses</p></li>
- +<li><p>internal cerebral veins</p></li>
- +<li><p>basal vein of Rosenthal</p></li>
- +<li><p>great vein of Galen</p></li>
- +<li><p>straight sinus</p></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>PICA origins best demonstrated in 45° ipsilateral obliquity</li>- +<li><p>from the baseline vertebral PA, the c-arm is angled cranially to demonstrate the PCA best in addition to demonstrating the thalamoperforating vessels</p></li>
- +<li><p>caudal tilt (Water's projection) will better demonstrate the basilar artery without foreshortening.</p></li>
- +<li><p>PICA origins best demonstrated in 45° ipsilateral obliquity</p></li>
-<li>patient supine, head supported in a radiolucent head holder or curved sponge</li>-<li>strap across the patient's head to minimise movement</li>-<li>head positioned without rotation</li>-<li>head tilt (radiographic baseline) determined by patient comfort<ul>-<li>the patient should not be forced into an uncomfortable head tilt</li>-<li>adjustments made for head tilt by craniocaudally c-arm angulation</li>- +<li><p>patient supine, head supported in a radiolucent head holder or curved sponge</p></li>
- +<li><p>strap across the patient's head to minimise movement</p></li>
- +<li><p>head positioned without rotation</p></li>
- +<li>
- +<p>head tilt (radiographic baseline) determined by patient comfort</p>
- +<ul>
- +<li><p>the patient should not be forced into an uncomfortable head tilt</p></li>
- +<li><p>adjustments made for head tilt by craniocaudally c-arm angulation</p></li>
References changed:
- 1. Harrigan M & Deveikis J. Diagnostic Cerebral Angiography. Handbook of Cerebrovascular Disease and Neurointerventional Technique. 2012;:99-131. <a href="https://doi.org/10.1007/978-1-61779-946-4_2">doi:10.1007/978-1-61779-946-4_2</a>
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