Digital subtraction angiography: current clinical applications.

The applications of digital subtraction angiography (DSA) in neurologic diagnosis have been evolving as clinical experience with this technology accumulates. Initial enthusiasm with the intravenous contrast material injections has been tempered by often equivocal results. Intravenous DSA (IV-DSA) is still an accurate screening technique for extracranial carotid atherosclerosis, comparable to duplex ultrasound. Intracranial imaging is less satisfying with intravenous injections but reliable information is available in the assessment of the venous sinuses and parasellar internal arteries. The future of DSA lies with intraarterial contrast injections, as this technique substantially decreases the risks and costs of definitive cerebrovascular investigation.