Computed tomography and serial scintigraphy with 99mTc-pertechnetate (radionuclide angiography and early and late static imaging) were compared in 214 patients with cerebrovascular disease. CT correctly identified 151 (95.0%) of 159 patients with completed ischemic stroke but was positive in only 11 (25%) of 44 patients with asymptomatic stenosis, transient ischemic attacks (TIA), or prolonged reversible ischemic neurological deficit (PRIND). Scintigraphy was positive in 93.1% of patients with completed stroke. CT detected 175 territories of vascular supply involved, scintigraphy 164. In patients with asymptomatic stenosis, TIA, or PRIND, scintigraphy was correct in 77.3% of cases. The combined evaluation offered a sensitivity of 97.5% in patients with completed stroke and 86.4% in those with asymptomatic stenosis, TIA, or PRIND. The rate of true-positive scintigraphic findings in patients with completed stroke did not change as the interval between ictus and study increased. In patients with intracerebral hematoma, CT was far more specific than scintigraphy. If cerebrovascular disease is suspected, radionuclide angiography should be performed first.

CEREBRAL radionuclide angiography with T cpertechnetate or DTPA (RNA) as part of cerebral serial scintigraphy has considerable sensitivity in detecting cerebrovascular disease. 1 We recently have published an algorithm which is useful in planning non-invasive diagnostic tests (RNA, Doppler sonography and transmission-computed tomography) for patients suspected of having cerebrovascular disease.2 Within this algorithm, the role of Doppler sonography (DS) was not well defined as there are no comparative data on sensitivity, specificity and diagnostic accuracy of this well established noninvasive method. 86Since DS is not expected to provide information on major intracranial cerebral artery lesions, and RNA can fail to detect extracranial lesions, the present study was designed to show whether the data obtained from DS would complement that of RNA and, thereby, increase the sensitivity of these non-invasive diagnostic methods. Efforts were made to compare the results of RNA and DS to findings obtained from radiographic angiography (RGA) by studying patients identified by RGA as having vascular alterations. Material and MethodsA total of 216 patients, all suspected clinically of having cerebrovascular disease, were studied by RNA and DS. Among these patients 86 had biplane RGA using the Seldinger technique. The results of this procedure were used to divide the patients into 3 groups: a) patients with normal angiogram, b) patients with arterial stenosis (more than 30% of the luminal

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Using a prototype of an electronic, universal examination unit equipped with a special x-ray TV installation, spotfilm exposures and digital angiographies with high spatial resolution and wide-range contrast could be made in the clinic for the first time. With transvenous contrast medium injection, the clinical results of digital angiography show excellent image quality in the region of the carotids and renal arteries as well as the arteries of the extremities. The electronic series exposures have an image quality almost comparable to the quality obtained with cutfilm changers in conventional angiography. There are certain limitations due to the input field of the 25 cm x-ray image intensifier used. In respect of the digital angiography imaging technique, the electronic universal unit is fully suitable for clinical application.