Dynamic CT of micro- and macroangiopathic states of the cerebrum.

Dynamic computed tomography utilizing intravenous contrast agents affords a unique opportunity to evaluate pathologic vascular states of the cerebrum in cross-section with an imaging system which is more contrast-sensitive than either conventional film-screen or digital subtraction angiography. Dynamic scanning therefore routinely allows the non-invasive detection of pathologic vascularity in-vivo in lesions that could previously only be detected reliably primarily with in-vitro techniques. The first section of this two part report examines the microscopic vascularity observed in active demyelination, inflammatory states, trauma, infarction and other forms of acquired cerebral disease. In the second section, the ability of intravenous dynamic cranial computed tomography to detect macroscopic pathologic vascularity is reviewed. The diagnostic principles of conventional angiography apply in this technique except that the lesion is viewed in cross-section, rather than in-toto with all structures superimposed. The method therefore yields a true tomographic angiogram. Abnormal vascular states associated with malignancies, vascular malformations, aneurysms, and vascular occlusions are simply evaluated and correlate precisely with the aberrant vascular patterns revealed angiographically.