Digital subtraction angiography: a review of cardiac applications.

I MAGING OF the chambers of the heart, pulmonary circulation, and great vessels by intravenous (IV) contrast injection was clinically implemented as early as 1939.’ It was not until the achievement of relatively recent advances in digital electronics, image intensification, and television technology that a major resurgence of interest in this technique occurred. These technological advances in conjunction with the pioneering work from the Universities of Kiel, Federal Republic of Germany; Arizona at Tucson; Wisconsin at Madison; as well as the Mayo Clinic in Rochester, Minn, provided the groundwork for exciting applications of digital subtraction angiography in the assessment of cardiovascular dynamics.‘-” These results initiated widespread clinical evaluation of the use of this imaging modality in cardiac diagnosis that was facilitated by commercially available digital angiography systems which provided rudimentary image manipulation capabilities. The purpose of this report is to summarize the recent applications of digital subtraction angiography in the quantitative assessment of global and regional left ventricular function, coronary anatomy, and coronary flow dynamics. Earlier work with videodensitometry or off-line digital analysis is also included when relevant to current applications of digital angiography. Practical issues regarding technical prerequisites, clinical techniques, contrast material, and image manipulation are also discussed as they relate to cardiac investigations.