Intravenous angiography using digital video subtraction: intravenous cervicocerebrovascular angiography.

The clinical application of intravenous angiography to study the cervicocerebrovascular system using the digital video subtraction system described in a companion article is reported. About 0.75 ml/kg of a standard 76% iodine contrast solution is injected into an antecubital vein using a power injector. Then 15-20 exposures of the head and neck region at a 1/sec rate are made on the image intensifier. The images are recorded by a high performance video system and the output signal is digitized for subsequent computer manipulation. The subtraction images of these vessels produced by the computer show the vessels clearly, even though they contain very low concentrations of contrast media. Standard exposure factors of 75-80 kVp, 9-10 msec at 800-1,000 mA are used. Clinically pertinent features of the data alteration and flow through the system and the step-by-step computer procedures used to achieve and analyze the various forms of subtracted images are described. Five experimental and clinical cases demonstrate appropriate applications to cervicocerebrovascular disease: (1) evaluating the effects of surgical and medical therapy on atherosclerosis; (2) providing a screening angiographic test for patients with asymptomatic bruits and/or positive noninvasive studies; (3) evaluating patients who have significant generalized vascular disease either precluding or presenting hazardous contraindications to transarterial catheterization; (4) evaluating significantly aged patients in whom standard angiography has higher risk; and (5) evaluating currently asymptomatic patients who are medically at higher risk for developing atherosclerotic lesions. Numerous examples of the various types of image manipulations are presented: (1) linear subtraction; (2) logarithmic subtraction; (3) alterations of electronic contrast enhancement (map slope); (4) the usefulness of a series of angiographic images; and (5) the importance of multiple projections with this technique.