cerebral angiography
Cerebral
angiography • Cerebral angiographic projections - Ganzer Fall bei Radiopaedia
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 ischemic stroke
- vascular abnormalities
- cerebral vasospasm post subarachnoid hemorrhage
- meningioma (preoperative embolization)
- investigation of:
- confirming brain death
Projections
Standard projections
- PA internal carotid artery
- projects middle cerebral artery away from bony landmarks, minimizing beam hardening artifacts
- petrous ridge superimposed on supraorbital margin
- include 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 entire skull vault
- effectively demonstrates
- ICA cavernous portion
- ICA communicating segment (PCOM, anterior choidal 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 entire skull vault. However, magnification can be employed if 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 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 baseline position for cross compression and visualization 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 for 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 patient's head to minimize movement
- head positioned without rotation
- head tilt (radiographic baseline) determined by patient comfort
- patient should not be forced into an uncomfortable head tilt
- adjustments made for head tilt by craniocaudally c-arm angulation
Siehe auch:
und weiter:
Assoziationen und Differentialdiagnosen zu zerebrale Angiographie: