Cerebral angiographic projections

Case contributed by Mr Brendan James Erskine
DSA (angiography)

Standard diagnostic cerebral angiographic projections

Baseline cerebral angiographic imaging

Case Discussion

Intracranial selective cerebral angiographic projections

Baseline patient positioning

  • Patient supine, head supported in radiolucent head holder or curved sponge
  • Strap across patient's head to minimize movement
  • Head positioned without rotation
  • Head tilt (radiographic baseline) determined by patient comfort
    • Patient should not be forced into an uncomfortable head tilt
    • Adjustments made for head tilt by cranio-caudal C-arm angulation

Internal carotid artery - posteroanterior (PA) projection

Internal carotid artery - lateral projection

  • Right lateral where possible
    • Minimize dose to operator (if standing in room during acquisitions)
  • Include entire skull

Internal carotid artery - transorbital oblique projection

  • Petrous ridge positioned on infra-orbital margin
  • Ipsilateral obliquity 30 degrees
  • Collimation - generally include entire skull vault; however, magnification can be employed if indication is specifically for intracranial aneurysm
  • Center on lateral edge of orbit

Internal carotid artery - reverse trans-orbital oblique projection

  • Petrous ridge positioned on infraorbital margin
  • Contralateral obliquity of 30 degrees
  • Collimation - generally include entire skull vault; however, magnification can be employed if indication is for aneurysm
  • Center to include lateral edge (side of interest) of skull

Internal carotid artery - cross compression projection

  • Petrous ridge positioned on infra-orbital margin
  • No obliquity
  • Collimate image on top and bottom
  • Image must be annotated with cross compression (or x-compression)

Vertebral artery - posteroanterior (PA) projection

  • Petrous ridge positioned on supra-orbital margin
  • Collimation to include lambdoid suture at top and approximately 5 cm below the infraorbital margin (for inclusion of possible extracranial PICA)
  • Technique variations -
    • Increase cranial angle (Townes) to demonstrate Posterior cerebral arteries
    • Decrease angle (Waters) to best demonstrate basilar artery)

Vertebral artery - lateral projection

  • Compared to lateral ICA projection
    • Increase magnification
    • Posterior border of collimation to include skull vault
    • Inferior border of collimation to include posterior arch of C1 (inclusion of possible extracranial PICA)
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Case information

rID: 46308
Published: 25th Jun 2019
Last edited: 14th Aug 2019
Inclusion in quiz mode: Excluded

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