Malformations resolution

Selective spinal DSA has a better spatial resolution and plays a main role in the exclusion of spinal vascular malformations. In selected cases affection of the radicular artery and occlusion of the anterior spinal artery system can be demonstrated as well as collateral supply even in the later course of the ischemia (Mull et al. 2002). Thus, spinal DSA helps to identify pathologic vascular conditions in spinal cord ischemia. The main indication remains to exclude a spinal vascular malformation. Angiographic information about the acute phase of spinal cord ischemia is not yet available. 

Ideally, there should be no venous enhancement. Nevertheless, except for specific indications such as cavernous sinus aneurysm and arteriovenous malformation (AVM) assessment, this is seldom clinically limiting. Z-direction coverage, in-plane and longimdinal resolution, and signal-to-noise ratio should be maximized, while radiation dose, total amount of contrast administered, and acquisition slice thickness should be minimized. Our routine stroke CTA protocol for 16- or 64-slice MDCT scanners covers from the great vessel origins at the aortic arch to the cranial vertex. 

Concluding, MDCT undoubtedly represents a major advance in the imaging of congenital heart disease. Its application to small children, in particular, is promising, due to the ease and speed of acquisition and 3D imaging with high spatial resolution. However, it is equally true that for a large number of simple and common malformations, such as atrial septal defects... 

Computed tomography (CT) demonstrates the extension of venous malformations but the contrast resolution is less than with MRl. The lesion is hypodense or heterogeneous with a slow contrast enhancement after injection of contrast material (Fig. 2.4a,b). Phle-boliths, when present, are easily seen. 

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