Alt complicationswere recorded from the initial 2488 cases studied with digital intravenous angiography (DIVA) at New York University Medical Center. Mechanisms of producing these reactions were categorized into procedure-related, contrast-mediumrelated, or disease-related.The complications included extravasation of contrast matonal into the arm (1 1 patients) and mediastinum (two), acute pulmonary edema (four), hypotension (23), thrombophlebitis (two), and grand mal seizure (one). Recommendations are made that would allow DIVA to be performed more safely.In a relatively short period of time digital intravenous angiography (DIVA) has become a prime radiologic method for the study of the intracranial, extracranial [1][2][3][4][5][6][7], and peripheral vasculature [8-1 5]. It is our purpose to report on the complications of DIVA in the first 2488 cases studied at our institution.We have attempted to categorize these complications as procedure-related, contrast-medium-related, or disease-related.
Materials and MethodsThis article appears in the September/Octotier 1984 issue of AJNR and the December 1984 issue of AJR.
Eighty-six patients who presented with a variety of intracranial lesions were examined with intravenous digital subtraction angiography (IV-DSA). A grading system was used to evaluate the ability of IV-DSA to answer specific diagnostic questions regarding intracranial tumors, vasospasm following subarachnoid hemorrhage, lesions of the sella, dural sinus occlusion, and post-therapeutic embolization. Eighty-four per cent of the examinations provided clinically useful information. In 15% of the cases limited but useful information was obtained; only 1% of the examinations provided no useful information. We conclude that IV-DSA can routinely provide useful information in the evaluation of the variety of intracranial lesions described above.
Giant intracranial aneurysms often present as mass lesions rather than with subarachnoid hemorrhage. Routine computed tomographic (CT) scans with contrast material will generally detect them , but erroneous diagnosis of basal meningioma is possible. Rapid sequential scanning (dynamic CT) after bolus injection of 40 ml of Renografin-76 can conclusively demonstrate an intracranial aneurysm , differentiating it from other lesions by transit-time analysis of the passage of contrast medium. In five patients, the dynamics of contrast bolus transit in aneurysms were consistently different from the dynamics in pituitary tumors , craniopharyngiomas, and meningiomas, thereby allowing a specific diagnosis. Dynamic CT was also useful after treatment of the aneurysms by carotid artery ligation and may be used as an alternative to angiographic evaluation in determining luminal patency or thrombosis.
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