A PROJECT REPORT ON THE ROLE OF " DIGITAL SUBTRACTION ANGIOGRAPHY" IN CONVENTIONAL AND MORDERN RADIOLOGY

1. PROJECT PRESENTATION
SPRING 2016

2. TABLE OF THE CONTENT
Title of the project.
Objectives of the study.
Literature survey.
 Methodology.
Data Analysis.
Result and Discussion.
Findings and conclusions.
Scope of the study.

3. DIGITAL SUBTRACTION ANGIOGRAPHY
JOSHUA MATHEW
Course: BSc MIT
Subject code :605
SPRING 2016

4. OBJECTIVE OF THE STUDY
Role of Digital subtraction angiography in vascular diseases.
Study the updations and features of the subtraction
angiography.
Find out the application of subtraction software in CTA and
MRI.
Study the latest application of DSA with fusion techniques.

5. LITERATURE SURVEY
Derdeyn CP et al, (1995)
Digital subtraction angiography is a procedure to examine blood vessel disease using
radiation (x-ray). A specialist inserts ‘catheter’, a thin tube, into the blood vassal of a
patient and inject contrast medium to take images of craniocervical, Lung, hepatic, renal,
abdominal, and limb blood vessel. To examine the effect of intraoperative angiography on
neurosurgery and angiographic technical success, safety, and accuracy. Angiographic
studies, surgical reports, and hospital records were reviewed retrospectively for 112
consecutive procedures in which intraoperative angiography was performed during
neurosurgery. DSA gives better results with very accurately. Estimate of the use of
arteriography procedures for these hospitalized patients range between 87 and 97%.
Currently, the medical world has paid attention to ‘minimal invasiveness’ to perform
operation via minimal incision.

6. LITERATURE SURVEY
Hideki Ota et al., (2004)
The purpose was to determine the accuracy of 64-section MSCTA
(64MSCTA TOSHIBA Systems) in aneurysm detection versus combined
digital subtraction angiography (DSA) and 3D rotational angiography
(Philips Allura Xper FD 20/10). The Allura Xper FD20/10 balances
superb image quality with excellent dose safety. Four-section multisection
CT angiography (MSCTA) accurately detects aneurysms at or more than 4
mm but is less accurate for those less than 4 mm.

7. METHODOLOGY
 Subtraction is simply a technique by which bone structures images are subtracted
or canceled out from a film of bones plus opacified vessels, leaving an un-
obscured image of the vessels. The Portuguese neurologist Egas Moniz, (Nobel
Prize winner 1949), in 1927developed the technique of contrast x-rays cerebral
angiography to diagnose diseases, such as tumors and arteriovenous
malformations. The idea of subtraction images was first proposed by the Dutch
radiologist Ziedses des Plantes in the 1935, when he was able to produce
subtracted images using plain films.
 Digital subtraction angiography today used to diagnose the disease of the cerebral
angiography, Coronary angiography, pulmonary angiography, renal angiography,
Fluorescein angiography, Splenoportography.
 Subtraction software's today used in Computed tomography and DSA fusion MRI
to diagnose blood vessels.

8. DATAANALYSIS
CTA
(Subtract
ion
Software)
35%
Digital
subtraction
angiography
35%
MRI DSA
(software)
20%
DSA-
MRI
FUSION
10%
MODALITY BASED
3%
6% 6%
23%
3%
13%
6%
19%
6%
9%
6%
0%
5%
10%
15%
20%
25%
DISEASE BASED GRAPH

9. RESULT AND DISCUSSION
 From the clinical study done on 30 patients sample collected from Muthoot Medical
Cardiac and Neuro center Kozhencherry, from the study period of February 2016- July
2016.
 In this study 35% of patients using Digital subtraction technique for angiographic
procedure mainly for TIA or ischemic stroke.
 35 % patients diagnose under subtraction software in Computed tomography, CTA is
superior to DSA in the evaluation of posterior circulation steno-occlusive disease when
slow flow is present.
 MRI procedure also uses subtraction software to perform the study of 20% patients and
reaming 10% of patients diagnose with DSA-MRI fusion as a modality. This technique
clearly demonstrated the anatomical relationship of the tentorial free edge and dissecting
aneurysm of the PCA's P3 segment of the patient.

10. FINDINGS AND CONCLUSION
DSA is still the Gold standard for most of these indications and modalities
like MR angiogram or CT angiogram.
The risk of DSA is much smaller now than the procedures that must be taken
before the technology is evolving, where patients have to undergo vital
surgery, such as the opening of the skull, which can also lead to infection.
Now, the risk is only the possibility of the friction between blood vessels and
the catheter, or the rupture if blood vessels. DSA now has more minimal risk.

11. SCOPE OF THE STUDY
 Three-dimensional (3D) reconstruction of intracranial vessels is of interest for
evaluation of aneurysms and it has been proved to be an effective means of
visualizing the cardiovascular system following intravenous injection of contrast
material, DSA is safer and more economical than standard arteriography.
 The new techniques in DSA, which include technological advances such as flat-
panel digital (FPD) detectors and cone beam C-arm imaging; clinical applications
such as two-dimensional (2D) and 3D DSA imaging, and C-arm flat-panel detector
computed tomography (C-arm CT); and radiation dose reduction strategies.

12. SUGGESTIONS
Technology to obtain better resolution without contrast media should be
developed to avoid contraindications and the adverse reactions and invasive
techniques.
HYBRID fusion techniques of duplex and MR with subtraction software
techniques can be introduced.