เทคนิคการอ่านภาพถ่ายรังสีหลอดเลือดสมอง(Neurosurgical tip :How to interprete the Cerebral angiographic film)

 Cerebral angiography is the gold standard investigation for diagnosis of Vascular disease and It's essential that neurosurgeon should correctly interprete the cerebral angiography for diagnosis &plan of management.  

                                                                                              
1.Identified film of the right patient
2. View at least2views:1.AP,2.Lateral,  Oblique for location and conceal by vascular distortion
3.Time:3Phases:Arterial phase,Capillary phase,Venous phase :Early (esp. early  Venous drainage in arterial phase mean arteriovenous blood shunting seen in AVM or AVF or Delay,Present or nonpresent from stenosis or occlusion or malignant increased intracranial pressure,Abnormal lesion occur in which phase
4.2Systems: Anterior(Carotid artery)&Posterior(Vertebral artery),Artery&Venous system
5.Normal anatomy and Variation :Classified normal part of artery and venous system cervical&intracranial part of specific vessels  Internal carotid a. ACA MCA PCA Vertebral artery ,Variation :Elongated or shortening,hypoplasia,occlude,congenital,Normal & abnormal Collateral
6.Shifting or distortion of artery and vein by mass lesion,hydrocephalus,brain herniation,seen on AP or Lateral view
       AP View:Anterior cerebral artery (ACA shifting:proximal,distal ,round,square shifting from midline),Middle cerebral  artery(MCA Distant of MCA bifurcation from innertable of skull shift to skull of away from skull distortion of vessel) abnormal vein shift
       Lateral view:Syvian triangle and abnormal shifting of vessel and imaginary line,Downward shifting of Posteroinferior cerebellar artery from Tonsilar herniation , abnormal  vein shift : distortion of thalamostriated vein seen in hydrocephalus etc.
7.Site &Size of lesion,site of arterial feeder,venous drainage,nidus
8.Specific  lesion :Vascular lesion:Abnormal vessel (AVM,AVF(Abnormal bag of worm),Capillary telangiectasia,Venous carvernoma ,Aneurysm,Vasospasm ,Moyamoya disease :ICAOcclusion with collateral vascular supply smoke like lesion etc.),Venous sinus lesion :tumor,Occlusion, Non vascular:Brain tumor(Meningioma :arterial draping sign,Choroid plexus papilloma),Hydrocephalus. Try to identified the target and describe lesion :site,size,arterial feeder,venous drainage

9.Give the diagnosis&Plan of treatment :Justified surgery or nonsurgery treatment.Surgical procedure planning, modality of treatment:radiosugery,endovascular technic(Embolization,Stent),medical treatment or combine surgery with multimodality treatment.
  
The best way to learn to interprete the cerebral angiographic film is begining from learn how to do Cerebral angiography and then study on the  true patient.To gain knowledge by frequent daily medical practice and step by step get more experience.

When neurosurgeon known to interprete cerebral angiogrphy ,they also known the interpretation of the MRA or MRV for diagnosis and plan of surgical operation&management