CARBON-DIOXIDE DIGITAL SUBTRACTION ANGIOGRAPHY - EXPANDING APPLICATIONS AND TECHNICAL EVOLUTION

Although several noninvasive techniques now exist far vascular imaging , including MR imaging, three-dimensional CT, and color-flow and duple x sonography, the gold standard to which these techniques are compared remains catheter angiography. Cut-film and digital subtraction angiog raphy (DSA) using iodinated contrast material are the standard methods by which vascular imaging is performed. However, despite the developm ent of low-osmolar contrast agents, premedication regimens, and carefu l patient selection, adverse reactions to contrast material, including idiosyncratic reactions and contrast-induced nephropathy, continue to occur in a small number of patients [1-3]. Carbon dioxide (CO2) was d eveloped as an alternative to iodinated contrast material to avoid the se problems [4], Once the behavior of intravascular gas, the methods o f safe delivery, and the principles of successful imaging are understo od, the use of CO2 as an intravascular contrast agent during DSA allow s accurate imaging with little risk. Recent advances in delivery syste ms, postprocessing capabilities, and its extension to new vascular int erventional procedures have greatly expanded the usefulness of COP ang iography in both diagnostic and interventional vascular radiology.