Symptomatic peripheral vascular disease: selection of imaging parameters and clinical evaluation with MR angiography

In the first phase of this study, seven healthy subjects underwent examination with two-dimensional time-of-flight (TOF) magnetic resonance (MR) angiography to develop a protocol for evaluation of peripheral arterial vasculature from the infrarenal aorta to the foot. In the second phase, 73 patients with symptomatic peripheral vascular disease underwent examination with both conventional contrast material-enhanced arteriography and two-dimensional TOF MR angiography to evaluate the clinical usefulness of MR angiography. Postinterventional and intraoperative angiography or direct surgical exploration was the standard of reference. In 32 patients, discrepancies occurred between findings on arteriograms and those on MR angiograms; most of these discrepancies were caused by improved depiction of runoff vessels on MR angiograms. The demonstration with MR angiography of blood vessels not seen on conventional arteriograms, unidentified stenoses, or misidentified blood vessels altered surgical management in 12 patients (16%). Metal-clip artifacts obscured clinically important disease on MR angiograms in two patients. It is concluded that two-dimensional TOF MR angiography is very useful in preoperative assessment of patients with severe peripheral vascular disease.     

Extremity veins: evaluation with fast-spin-echo MR venography

The authors evaluated a flow-independent magnetic resonance (MR) imaging technique in extremity veins with slow flow that relies on the prolonged T2 of blood to create angiographic contrast. A commercially available heavily T2-weighted fast-spin-echo sequence was optimized for MR venography in volunteer and phantom studies. Good depiction of venous anatomy was routinely obtained with the optimized method. Fast-spin-echo MR venography allowed evaluation of slow-flow systems such as the calf and forearm veins.     

MR angiography in the preoperative evaluation of abdominal aortic aneurysms: a preliminary study

PURPOSE: The ability of magnetic resonance (MR) angiography to depict visceral and renal vessels was evaluated in patients with abdominal aortic aneurysms (AAAs). PATIENTS AND METHODS: MR sequences (sagittal T1-weighted, two-dimensional coronal, and three-dimensional axial time-of-flight) were compared in a prospective blinded fashion with conventional angiograms obtained preoperatively in 23 patients with AAAs. Results were correlated with surgical findings when available. RESULTS: Operative aortic clamp site was correctly predicted with conventional angiography in 95% of patients and with MR angiography in 86% (P > .1). Aneurysm neck measurements obtained with the two modalities were within 1 cm in 91% of cases. With conventional angiography as the standard of reference, 96% of all renal arteries were identified on MR angiograms but 36% of accessory arteries were missed. MR angiography enabled identification of patients who had at least one renal artery stenosis greater than 50% with a sensitivity of 100% and specificity of 89%. For identifying individual renal artery, celiac artery, and superior mesenteric artery stenoses of similar severity, the sensitivity and specificity were 67% and in excess of 96%, respectively. The celiac artery could not be evaluated in one case. CONCLUSION: The results of this small study suggest that the role of MR angiography in the preoperative evaluation of AAA warrants further investigation.     

Functional radiology of the liver: magnetic resonance imaging

Magnetic Resonance (MR) images sensitive to the flowing blood are defined as images of MR angiography. Proton movement within a magnetic field modifies both the intensity and the phase of Nuclear Magnetic Resonance (NMR) signal; two techniques of MR angiography are thus distinguished: (TOF) the "time of flight" (intensity) and the "phase-contrast" (phase) technique. In the time of flight MR angiography the blood may appear as hypointense or hyperintense compared to stationary tissues. Blood hypointensity in vessels is due to the flow void phenomenon while hyperintensity is due to the phenomenon of flow-related enhancement. In phase contrast MR angiography, protons moving within a magnetic field modify their phase directly proportional to the displacement velocity and gradient intensity. Moreover, MRI allows noninvasive measurement of blood flow. Flow velocity is measured with TOF sequences or phase-contrast sequences. In TOF sequences quantitative measurement is performed with the bolus tracking procedure. In contrast-phase sequences the velocity is measured based on the extent of signal phase modification induced by the proton displacement velocity. The recent use of liver-specific contrast media supplies information on parenchymal liver function.     

Psychoeducational family treatment in schizophrenia--a popular concept? A critical evaluation of different treatment models

Magnetic resonance angiography (MRA) refers to a collection of imaging techniques which accentuate the signal intensity of flowing blood and suppress the signal intensity of stationary tissues. The resulting images are processed to resemble conventional catheter angiograms but carry fundamentally different information which is derived from flow rather than anatomy. All MRA techniques are subject to a variety of artifacts can stimulate pathology. A knowledge of the techniques used to produce and display MR angiographic images is essential for their accurate interpretation.     

Breath-hold gadolinium-enhanced MR angiography of the major vessels at 1.0 T: dose-response findings and angiographic correlation

PURPOSE: To find the appropriate contrast agent dose for gadolinium-enhanced magnetic resonance (MR) angiography by using individual measurement of contrast agent transit times in a randomized study. MATERIALS AND METHODS: A total of 34 patients with disease of the aorta or its major branches or both were randomly assigned to receive a dose of 0.1, 0.2, or 0.3 mmol of gadopentetate dimeglumine per kilogram of body weight. Initially, contrast agent transit times were measured with use of a turbo fast-low-angle-shot sequence. Subsequently, a three-dimensional fast imaging with steady-state precession sequence (7.3-msec repetition time, 2.8-msec echo time) was used for breath-hold MR angiography. Gadopentetate dimeglumine was injected with an MR-compatible power injector. Efficacy was evaluated by measurement of vessel enhancement and by clinical correlation of MR angiograms with x-ray angiograms. RESULTS: Evaluation of contrast agent transit time was possible in all patients with the test doses, which provided contrast-enhanced MR angiograms of constant quality. Neither vessel enhancement nor diagnostic information was significantly different across the these study groups. CONCLUSION: The clinical gadolinium dose of 0.1 mmol/kg is sufficient for diagnostic assessment of the aorta and its major branches at contrast-enhanced MR angiography. High-dose studies appear not to be required for these large vessels.     

Gadolinium-enhanced magnetic resonance angiography of abdominal blood vessels

Contrast enhanced (CE) magnetic resonance angiography (MRA) provides high resolution angiograms within 20-40 sec. The technique is based on the acquisition of heavily T1-weighted three-dimensional (3D) gradient-echo data sets (FISP) with ultrashort echo-(< 2ms) and repetition times (< 5 ms) during arterial phase of an intravenously injected bolus of a T1-shortening agent such as Gd-DTPA. For MR-angiography of abdominal vessels CE-MRA is better suited than "time-of flight" (TOF) and phase-contrast (PC) MRA because motional artifacts can be obviated with breath-held acquisitions. We have optimised the technique and evaluated its potential for angiography of the abdominal aorta and its branches as well as the portal vein and its tributaries. Whilst CE-MRA provides reliable diagnostic accuracy in the aorta and the proximal sections of its branches, small peripheral arteries cannot be assessed accurately. The portal vein and its tributaries can often be depicted better with CE-MRA than with conventional angiography but, like conventional angiography, CE-MRA is hampered by slow and reversed flow, conditions under which TOF or "true FISP" MRA may perform bst. We have also investigated FLASH-echo-planar imaging (EPI) hybrid techniques, a further technical development which due to shorter acquisition times of 12-15 sec. allows semi-dynamic imaging of the arterial and venous phase and provide better vessel contrast due to the use of fat-suppression.     

MR angiography of the portal venous system: techniques, interpretation, and clinical applications

Magnetic resonance (MR) angiography is a noninvasive means of assessing the portal venous system that has potential advantages over currently used modalities. Time-of-flight and phase-contrast MR angiography are useful techniques that differ fundamentally in their means of data acquisition but are comparable in their ability to demonstrate normal anatomy as well as abnormalities of the portal venous system. Occasionally, artifacts caused by respiratory motion, implanted metallic devices or surgical clips, in-plane saturation, or areas of complex flow are seen at MR angiography of the portal venous system. However, most artifacts can easily be identified as such and either remedied or ignored. In addition, the suppression of signal from surrounding soft tissues may result in poor detection of parenchymal lesions. The utility of standard projection angiograms and source images can be increased through the use of intravenously administered contrast material and postprocessing techniques such as partial-volume maximum intensity projection reconstructions and shaded surface renderings. In addition to providing information on portal venous anatomy and portosystemic collateral vessels, MR angiography of the portal vein has clinical application in portal venous thrombosis and stenosis, liver transplantation, and the evaluation and planning of surgical and transjugular intrahepatic portosystemic shunts.     

Perforin expression in human cell-mediated luteolysis

For a variety of reasons, small vessels have low signal intensity in magnetic resonance angiography. When the vessel signal intensity is lower than the signal intensity of background tissues, these vessels tend not to be visible on maximum-intensity-projection images. The authors developed a nonlinear second-difference spatial filtering technique that enhances the details of small vessels while suppressing both noise and uniform background tissue. Two similar nonlinear second-difference filters are presented and compared with the linear Laplacian second-difference filter. To evaluate the performance of these filters, they were applied to intracranial three-dimensional time-of-flight MR angiographic data and the results compared with the vessel enhancement obtained with a simple second-difference Laplacian filter and with magnetization transfer contrast (MTC) techniques. The comparisons demonstrated that nonlinear filtering and MTC techniques result in similar improvement in small-vessel visibility and apparent continuity. A quantitative comparison demonstrated that the improvement in the contrast-to-noise ratio is much greater with the nonlinear filters than the Laplacian filter.     

Diagnosis of pulmonary embolism with magnetic resonance angiography

BACKGROUND: Diagnosing pulmonary embolism may be difficult, because there is no reliable noninvasive imaging method. We compared a new noninvasive method, gadolinium-enhanced pulmonary magnetic resonance angiography, with standard pulmonary angiography for diagnosing pulmonary embolism. METHODS: A total of 30 consecutive patients with suspected pulmonary embolism underwent both standard pulmonary angiography and magnetic resonance angiography during the pulmonary arterial phase at the time of an intravenous bolus of gadolinium. All magnetic resonance images were reviewed for the presence or absence of pulmonary emboli by three independent reviewers who were unaware of the findings on standard angiograms. RESULTS: Pulmonary embolism was detected by standard pulmonary angiography in 8 of the 30 patients in whom pulmonary embolism was suspected. All 5 lobar emboli and 16 of 17 segmental emboli identified on standard angiograms were also identified on magnetic resonance images. Two of the three reviewers reported one false positive magnetic resonance angiogram each. As compared with standard pulmonary angiography, the three sets of readings had sensitivities of 100, 87, and 75 percent and specificities of 95, 100, and 95 percent, respectively. The interobserver correlation was good (k=0.57 to 0.83 for all vessels, 0.49 to 1.0 for main and lobar vessels, and 0.40 to 0.81 for segmental vessels). CONCLUSIONS: In this preliminary study, gadolinium-enhanced magnetic resonance angiography of the pulmonary arteries, as compared with conventional pulmonary angiography, had high sensitivity and specificity for the diagnosis of pulmonary embolism. This new technique shows promise as a noninvasive method of diagnosing pulmonary embolism without the need for ionizing radiation or iodinated contrast material.     

Angiographic and histological evaluation of porcine retinal vascular damage and protection with perfluorocarbons after massive air embolism

BACKGROUND AND PURPOSE: We have previously shown that perfluorocarbon emulsions (PFEs) reduce the severity of cerebral injury (indicated by infarct, reduced blood flow, and depressed EEG) induced by air embolism during cardiopulmonary bypass (CPB). This study used retinal fluorescein angiography to define the mechanisms of cerebral injury and to determine the efficacy of PFEs in cerebral protection. These angiographic findings were correlated to previously reported histologic findings. METHODS: Twenty domestic pigs underwent CPB with a prime of standard crystalloid or PFE (5 mg/kg) and crystalloid. After 10 minutes on CPB, a single (5 mL/kg) or double (2x2.5 mL/kg) bolus of room air or saline (control) was delivered via the right carotid artery. Retinal fluorescein angiograms were captured at 4 time points: baseline, air insult, postbypass, and postreperfusion. Following euthanasia, both eyes were removed and the retinas isolated for histological analysis with horseradish peroxidase (HRP), as previously reported. RESULTS: In control pigs, postreperfusion angiograms showed small nonperfused areas, and retinal whole mounts demonstrated vascular damage as previously reported. In 5 PFE-primed animals, postreperfusion angiograms showed hyperfluorescence, but angiograms and HRP mounts were otherwise not significantly different from baseline. Severely hyperfluorescent vessels observed angiographically also showed a correlation with HRP extravasation but were not consistently indicative of severe vascular damage. CONCLUSIONS: Retinal fluorescein angiography and retinal staining with HRP indicate that mechanisms of cerebral air embolism include nonperfusion, vascular leakage and spasm, red blood cell sludging, and hemorrhage. Priming with PFE prevented many of the sequelae associated with air embolism.     

A case of pontine infarction with persistent primitive proatlantal artery

A 61-year-old woman was admitted to the hospital on September 18, 1991 because of left hemiparesis, dysphagia, and dysarthria since five days before. She was formerly pointed out diabetes mellitus and hypertension, but she did not receive any treatment. The MRI showed a high signal area in the right paramedian portion of the upper pons on T2 weighted image and proton image. The angiography showed that persistent primitive proatlantal artery originated from the left internal carotid artery and joined to the horizontal portion of the left vertebral artery. The image of carotid-vertebrobasilar system and proatlantal artery showed so severely arteriosclerotic. This is the first report of brainstem infarction with persistent primitive proatlantal artery. In this case, the pontine infarction was thought to occur on the basis of the arteriosclerosis of blood vessels and change of blood flow of carotid-vertebrobasilar system due to persistent primitive proatlantal artery.     

Improvement by FUB 181, a novel histamine H3-receptor antagonist, of learning and memory in the elevated plus-maze test in mice

PURPOSE: Initial experimental results of contrast-enhanced pulmonary MR angiography using the new superparamagnetic iron oxide blood pool agent FeO-BPA. METHOD: Pulmonary MRA was performed in 7 domestic pigs using a cardiac-triggered coronal T1-weighted FFE-Sequence before and up to 90 minutes after contrast injection obtained on a 1.5 T magnet with a standard gradient equipment. A dose of 4 mg Fe/kg bodyweight was used for MRA. The images were qualitatively assessed and compared with X-ray i.v.-DSA. RESULTS: The injection of FeO-BPA allows the acquisition of unsaturated in-plane images of the pulmonary vascular tree down to the first order subsegmental branches including vessel diameters of approximately 1.5 mm. In the normal non-occluded vasculature, no signal void is seen in the TE range of 2.8-5.5 ms secondary to exceeding susceptibility effects which are caused by the iron oxide accumulation. Even 90 minutes after injection of FeO-BPA, assessment of the pulmonary vasculature is still satisfactory. CONCLUSIONS: In the animal experiment, the use of the blood pool agent FeO-BPA provides detailed pulmonary angiograms even on a magnet with a conventional gradient system. The major advantage is the comfortable diagnostic window of > 1.5 hours which also portends its utility for future MR-guided pulmonary interventions.     

Synthesis and preliminary evaluation of MP-2269: a novel, nonaromatic small-molecule blood-pool MR contrast agent

A nonaromatic, small-molecule, gadolinium(3+)-chelate code named MP-2269 was synthesized and evaluated in animals as a potential MR contrast agent for blood pool. The ligand of MP-2269 was prepared by conjugating a lipophilic, albumin-binding moiety, 4-pentylbicyclo[2.2.2]octane-1-carboxylic acid, to an amino-functionalized DTPA derivative by means of a diaspartic acid linker. Proton relaxometry studies in vitro yielded spin-lattice relaxivities (R1) for MP-2269 of 6.2, 20.0 and 26.1 mM(-1)sec(-1) in water, rabbit blood, and human blood, respectively. The enhanced relaxivities in blood indicate significant binding of the agent to blood proteins. At a dose of 45 micromol/kg, MP-2269 showed a biphasic rabbit blood clearance profile with half-lives of 4.7 and 142 minutes, respectively, for the fast and slow components. In rats, the agent is cleared predominantly through the hepatobiliary pathway (approximately 70% in 24 h by this mode). The LD50 value of MP-2269 is approximately 3.0 mmol/kg in mice. Preliminary MR angiograms obtained in the rabbit showed excellent enhancement of blood vessels. Hence, MP-2269 has potential for future exploitation as a contrast agent for MR angiography.     

Magnetic resonance angiography of mesenteric arteries. A review

There has been continued development of MRI techniques for evaluating mesenteric vascular disease. Contrast-enhanced magnetic resonance angiography (MRA) can provide reproducible high resolution, high contrast images of the arterial and venous mesenteric vasculature and may allow detection of segmental ischemia by detection of segmental delayed mesenteric or bowel wall enhancement. Cine phase-contrast MRA can provide additional information about the rate and volume of flow within the major mesenteric arteries and veins. Real-time MRI can provide interactive visualization of the mesenteric vessels in any plane, and with suitable bowel contrast, it can be used to monitor global and segmental small bowel motility. With in vivo MR oximetry, flow independent measurements of the T2 relaxation of blood allow the oxygen saturation of the mesenteric circulation to be determined. These MR techniques can be combined for evaluating both anatomic and functional aspects of the mesenteric circulation.     

Treatment of arteriovenous malformations with stereotactic radiosurgery employing both magnetic resonance angiography and standard angiography as a database

Twenty-one arteriovenous malformations were prospectively evaluated using magnetic resonance angiography and compared with stereotactic angiography. The goals were to establish the feasibility of magnetic resonance angiography, compare it to stereotactic angiography, employ magnetic resonance angiography in follow-up, and semiquantify flow. A correlative evaluation between flow and response to stereotactic radiosurgery was carried out. Phase contrast angiograms were obtained at flow velocities of 400, 200, 100, 60, and 20 cm/sec. The fractionated velocities provided images that selectively demonstrated the arterial and venous components of the arteriovenous malformations. Qualitative assessment of the velocity within the arteriovenous malformations and the presence of fistulae were also determined by multiple velocity images. In addition, 3-dimensional time-of-flight magnetic resonance angiograms were obtained to define the exact size and shape of the nidus. This technique also permitted evaluation of the nidus and feeding arteries for the presence of low flow aneurysms. Correlation between the two imaging modalities was carried out by subjective and semiquantitative estimation of flow velocity and estimation of nidus size. The following velocity parameters were employed: fast, intermediate, slow, and none (arteriovenous malformation obliterated). In 19 of 21 (90.5%) arteriovenous malformations, magnetic resonance angiography was equal or superior to stereotactic angiography for flow quantification and visualization of the nidus. Only 2 of 21 arteriovenous malformations were better demonstrated by stereotactic angiography than by magnetic resonance angiography (failure rate of 9.5%). The nidus size in one case was clearly underestimated by stereotactic angiography and would have resulted in a geographic miss without magnetic resonance angiography. Seven post-radiosurgery arteriovenous malformations were evaluated for follow-up with both magnetic resonance angiography and stereotactic angiography. In 6 of 7 arteriovenous malformations, magnetic resonance angiography response matched stereotactic angiography response. Correlation of flow with outcome was carried out for 14 arteriovenous malformations using magnetic resonance angiography only. Interestingly, all nine arteriovenous malformations with intermediate or slow flow demonstrated partial or complete obliteration; whereas only 3 of 5 fast flow arteriovenous malformations achieved a response with a median follow-up of 10 months. This early analysis suggests that slower flowing arteriovenous malformations may obliterate faster after stereotactic radiosurgery and flow parameters could be employed to predict response. In conclusion, magnetic resonance angiography permits semiquantitative flow velocity assessment and may therefore be superior to stereotactic angiography. An additional advantage of magnetic resonance angiography is the generation of serial transverse images which can replace the conventional CT scan employed for stereotactic radiosurgery treatment planning.(ABSTRACT TRUNCATED AT 400 WORDS)     

MRI and MR angiography of vertebral artery dissection

A review of 4,500 angiograms yielded 11 patients with dissection of the vertebral arteries who had MRI and (in 4 patients) MR angiography (MRA) in the acute phase of stroke. One patient with incidental discovery at arteriography of asymptomatic vertebral artery dissection and two patients with acute strokes with MRI and MRA findings consistent with vertebral artery dissection were included. Dissection occurred after neck trauma or chiropractic manipulation in 4 patients and was spontaneous in 10. Dissection involved the extracranial vertebral artery in 9 patients, the extra-intracranial junction in 1, and the intracranial artery in 4. MRI demonstrated infarcts in the brain stem, cerebellum, thalamus or temporo-occipital regions in 7 patients with extra- or extra-intracranial dissections and a solitary lateral medullary infarct in 4 patients (3 with intracranial and 1 with extra-intracranial dissection). In 2 patients no brain abnormality related to vertebral artery dissection was found and in one MRI did not show subarachnoid haemorrhage revealed by CT. Intramural dissecting haematoma appeared as crescentic or rounded high signal on T1-weighted images in 10 patients examined 3-20 days after the onset of symptoms. The abnormal vessel stood out in the low signal cerebrospinal fluid in intracranial dissections, whereas it was more difficult to detect in extracranial dissections because of the intermediate-to-high signal of the normal perivascular structures and slow flow proximal and distal to the dissection. In two patients examined within 36 h of the onset, mural thickening was of intermediate signal intensity on T1-weighted images and high signal on spin-density and T2-weighted images. MRA showed abrupt stenosis in 2 patients and disappearance of flow signal at and distal to the dissection in 5. Follow-up arteriography, MRI or MRA showed findings consistent with occlusion of the dissected vessel in 6 of 8 patients.     

Vessel enhancement filtering in three-dimensional MR angiograms using long-range signal correlation

Small vessels in three-dimensional MR angiograms have low visibility in maximum-intensity projection images because of their low contrast. In a previous study, we had two nonlinear filters that appeared to give significant improvement in small vessel detail. In this paper, we report on a generalization of this filter that allows a more general modeling of the vessels and a more complete suppression of background. One implementation of the general filter gave a vessel mean contrast-to-noise ratio that is 2.52 and 3.51 times higher than the vessel mean contrast-to-noise ratio obtained using our previously reported maximum-minimum (max-min) filter and cross-section filter, respectively.     

Value of image subtraction in 3D gadolinium-enhanced MR angiography of the renal arteries

The objective of this study was to evaluate quantitatively and qualitatively the effect of image subtraction on the image quality of three-dimensional (3D) gadolinium-enhanced MR angiograms of the renal arteries. Breath-hold 3D gadolinium MR angiography (MRA) as well as conventional contrast angiography of the renal arteries was performed on 20 patients with suspected renovascular hypertension. MR angiograms were acquired before and during dynamic infusion of gadolinium-diethylenetriamine pentaacetic acid (Gd-DTPA). Contrast-enhanced images were compared with images that had undergone voxel-by-voxel signal intensity subtraction of contrast-enhanced data from precontrast data. One false positive finding for significant renal artery stenosis was recorded with MRA using conventional angiography as the gold standard. Image subtraction did not alter the diagnosis at MRA in any case. The mean contrast-to-noise ratio (CNR) was significantly higher (P < .05) on the subtraction MR angiograms compared to the nonsubtracted MR angiograms. There was no significant difference in the signal-to-noise ratio (SNR). Qualitative analysis revealed a significant improvement in image quality after image subtraction with respect to visualization of the distal renal arteries. In conclusion, image subtraction improves the quality of renal MRA in terms of both CNR and visualization of the distal renal arteries.     

Digital subtraction rotational angiography for aneurysms of the intracranial anterior circulation: injection method and optimization

PURPOSE: To optimize parameters of rotational angiography for examination of the internal carotid circulation; to compare rotational angiography with standard digital subtraction angiography (DSA) in the evaluation of aneurysms of the intracranial internal carotid circulation; and to determine tolerance and safety limits of prolonged internal carotid injection angiography. METHODS: Rotational angiograms were obtained during injection of the internal carotid circulation as part of the clinical angiographic evaluation of aneurysms in 41 patients. Injection rates, X-ray delays, and fields of view were studied retrospectively. Findings at rotational angiography and standard DSA were compared. Nonionic contrast material was injected over 6 seconds, and patients were studied before and after prolonged injection angiography by physical and laboratory examination, including measurement of blood pressure, pulse, and intracranial pressure. RESULTS: Vascular conspicuity was equivalent at carotid injection rates of 4 and 5 mL/s delivered over 6 seconds. At 3 mL/s, more image manipulation was required to see small vascular structures. One-second X-ray delay combined with 6-second injection duration provided the best arterial depiction of intracranial vessels from start to end of rotational angiography. Maximal rotational resolution was with a 17-cm field of view. Identification of aneurysms and small vessels was equivalent at all injection rates. Aneurysm detection was equivalent with rotational angiography and DSA. In 9 of 31 aneurysms, the neck was defined more clearly with rotational angiography than with DSA, compared with 2 of 31 that were seen better with DSA. Aneurysms of the intracranial internal carotid circulation were seen with rotational angiography and not DSA in 12 of 41 cases. No change was noted in clinical or laboratory findings. CONCLUSION: Rotational angiography provided better definition of the aneurysmal neck and greater clarity of aneurysms than did DSA; it also improved the level of confidence in predicting the presence or absence of aneurysms, especially in the anterior communicating artery; however, in our small series it did not significantly increase the detection of aneurysms. Prolonged injection angiography was well tolerated in all patients.