Comparison of case of brain aneurysm display with digital subtract angiography and computed tomography angiography

Uvod: Za detekcijo anevrizem uporabljamo dve slikovni metodi, digitalno subtrakcijsko angiografijo (DSA) in računalniško-tomografsko angiografijo (CTA). Slednji nam ponujata svoje prednosti in slabosti, zato je pomembno, da smo seznanjeni z razlikami, ki nam jih da končni rezultat - slika. Namen: Ugotoviti razlike v prikazu možganskega žilja in anevrizme v smislu poteka, razmejitve in vidljivosti, z uporabo CTA in DSA. Iz praktičnega vidika nas zanima, katera preiskava je bolj priročna in uporabna. Metode dela: Nativni CT in CTA sta bila izvedena na aparatu Siemens Somatom Sensation Open. Pri CTA smo se poslužili intravenozne aplikacije kontrastnega sredstva Iomeron 400mgI/ml, katerega volumen znaša 60ml in pretok 4ml/s. Aparat Siemens Axiom Artis dBA nam je, v kombinaciji s Seldingerjevim pristopom in kontrastnim sredstvom Visipaque 320mgI/ml, omogočil izvedbo DSA in 3D rotacijskega slikanja. Rezultati: Pri urgentno napotenih pacientih, s sumom na anevrizmo možganskega žilja, najprej opravimo nativni CT glave. Zaradi odkrite subarahnoidalne krvavitve je nadaljnja metoda izbora, zaradi hitre in neinvazivne izvedbe, CTA, ki nam v smislu diagnostike in vidljivosti anevrizem in to kljub temu, da smo odkrili anevrizmo na odcepišču kalozomarginalne arterije in arterije communicans anterior, ponudi manj informacij kot invazivna DSA, s katero smo odkrili dodatno 2-milimetersko anevrizmo na sublingualnem področju. Kvaliteta prikaza anatomije žilja, z DSA, je dosti boljša. Razprava: Ob pregledu rezultatov, izhajajoč iz teoretičnih izhodišč, omenjenih v uvodu, lahko vidimo, da sva vse trditve, nanašajoče na CTA in DSA, potrdila ter tudi dokazala. Nikakor si ne smemo dovoliti in sklepati, katera preiskava je boljša, kot sva se tega na začetku poslužila midva, ker se le-ti dopolnjujeta in predstavljata vrhunski tehniki, brez katerih moderno zdravstvo ne bi obstajalo. Zaključek: CTA zaradi svoje hitrosti, široke dostopnosti in manjše invazivnosti, ostaja primarna metoda za detekcijo anevrizem, vendar DSA ostaja zlati standard za prikaz možganskih anevrizem. Prednost slikovne tehnike DSA je, da jo lahko uporabimo za načrtovanje zdravljenja, saj nam omogoča merjenje hemodinamskega pretoka skozi obravnavano področje patologije v realnem času. Slikovni preiskavi CTA in DSA se dopolnjujetas prvo se postavi diagnozo, z drugo pa izvedemo terapijo.Introduction: Two different medical imaging modalities – digital subtract angiography and computed tomography angiography – are used for detection of brain aneurysms. They both offer us their advantages and disadvantages, therefore it is important, that we are familiar with differences, which are provided to us by the final result – the image. Purpose: To determine differences in display of blood vessels of the brain and aneurysm in terms of visibility and accuracy. From a practical point of view, we want to determine which imaging method is more useful. Methods: Native CT and CTA were both performed with Siemens Somatom Sensation Open. Intravenous cannulation was used to apply 60ml of Iomeron 400mgI/ml with flow of 4ml/s. Angiography machine Siemens Axiom Artis dBA has enabled us, with combination of Seldinger approach and contrast agent Visipaque 320mgI/ml, to perform DSA and 3D rotational angiography. Results: In case of having an emergency patient with the brain aneurysm, the native CT scan of the head is performed in the first place. Because we detected subarachnoid hemorrhage, CTA represents further scan because of its quick and non-invasive performance, with which we discovered two aneurysms, but missed a small one in sublingual area. DSA discovered that two millimeter aneurysm, offers more accurate anatomical information, especially in discovering aneurysms in the above-mentioned area. Discussion: After we checked results while referring to theoretical background, we realized that we confirmed all the statements regarding CTA and DSA which are mentioned in Introduction. It is not good to guess which imaging technique is better because they both complement each other and cannot be replace by each other. Conclusion: Because of its speed, easy accessibility and lower invasiveness, CTA remains primary imaging method for aneurysm detecting, but DSA remains a gold standard for displaying a pathology, particularly aneurysms, in blood vessels of the brain. The big advantage of DSA is that we can use it for planning a treatment because it allows us to measure hemodynamic flow in real time through the area that should be treated. CTA and DSA complement each otherwith first one we make a diagnosis, with second one we perform the medical treatment