Wolpert S M, Caplan L R
Department of Radiology, New England Medical Center Hospitals, Inc., Boston, MA 02111.
AJR Am J Roentgenol. 1992 Jul;159(1):191-7. doi: 10.2214/ajr.159.1.1609697.
The role of cerebral angiography in the diagnosis of cerebrovascular disease is currently being questioned because of the increasing availability of MR angiography. The purpose of this essay is to place the use of cerebral angiography in perspective in light of these new developments. In patients with atherosclerotic cerebrovascular disease, MR angiography can almost entirely supplant cerebral angiography as a screening procedure in the evaluation of the carotid bifurcation. However, detection of "pseudoocclusion" still requires cerebral angiography for accurate diagnosis. Atherosclerotic stenosis or occlusion of the major intracranial vessels at the base of the brain can be detected with MR angiography, but not as accurately as with cerebral angiography. Furthermore, for detection of more distal occlusions, cerebral angiography is still needed. A number of erroneous concepts about the risks and value of cerebral angiography have prevented its optimal use for patients with cerebrovascular disease. These myths can be countered by applying several rules to optimize the use of cerebral angiography. Subarachnoid hemorrhage is best evaluated with CT followed by detailed cerebral angiography, although MR angiography can be used as a screening test for aneurysms 3 mm or larger. Cerebral angiography is still necessary to confirm the diagnosis of cerebrovascular malformations, although MR angiography is a useful screening test. Cerebral angiography is required for the definitive diagnosis of arteritis, arterial dissection, or fibromuscular dysplasia.
由于磁共振血管造影（MR angiography）的可用性不断提高，脑血管造影在脑血管疾病诊断中的作用目前正受到质疑。本文的目的是根据这些新进展，正确看待脑血管造影的应用。在患有动脉粥样硬化性脑血管疾病的患者中，在评估颈动脉分叉时，MR血管造影几乎可以完全取代脑血管造影作为一种筛查手段。然而，检测“假性闭塞”仍需要脑血管造影来进行准确诊断。脑底部主要颅内血管的动脉粥样硬化性狭窄或闭塞可以通过MR血管造影检测到，但不如脑血管造影准确。此外，对于检测更远端的闭塞，仍需要脑血管造影。一些关于脑血管造影风险和价值的错误观念阻碍了其在脑血管疾病患者中的最佳应用。通过应用一些规则来优化脑血管造影的使用，可以反驳这些错误观念。蛛网膜下腔出血最好先用CT评估，然后进行详细的脑血管造影，尽管MR血管造影可以用作3毫米或更大动脉瘤的筛查试验。尽管MR血管造影是一种有用的筛查试验，但仍需要脑血管造影来确诊脑血管畸形。动脉炎、动脉夹层或纤维肌发育异常的明确诊断需要脑血管造影。
