Discover how Cerebrovascular Disease is diagnosed at Liv Hospital using advanced imaging like MRI, CT scans, and angiography to guide precise treatment.
Send us all your questions or requests, and our expert team will assist you.
Diagnosing cerebrovascular disease requires visualizing the vessels. Carotid Duplex Ultrasound is the first line screening test for plaque in the neck. It uses sound waves to measure the velocity of blood flow; higher speeds indicate narrowing (stenosis) of the vessel.
Computed Tomography Angiography (CTA) involves injecting contrast dye and taking a rapid CT scan. It provides a detailed 3D roadmap of the arteries from the aortic arch to the top of the head. It is excellent for detecting aneurysms, stenosis, and dissections. Magnetic Resonance Angiography (MRA) provides similar data without radiation, using magnetic fields to visualize flow.
Visualizing the brain tissue itself is crucial to assess damage. A Non Contrast CT Head is the standard emergency scan to rule out bleeding. It is fast and detects fresh blood instantly. However, it is insensitive to early ischemia and small vessel disease.
Magnetic Resonance Imaging (MRI) is the gold standard for brain tissue. Diffusion Weighted Imaging (DWI) can detect a stroke within minutes of onset. T2-FLAIR sequences reveal chronic “white matter hyperintensities,” which are the scars of chronic small vessel disease. Gradient Echo (GRE) or Susceptibility Weighted Imaging (SWI) can detect “microbleeds,” tiny old hemorrhages that indicate fragile vessels (amyloid angiopathy).
The “gold standard” for vascular imaging is Digital Subtraction Angiography (DSA). This is an invasive procedure where a catheter is threaded through the groin or wrist up into the neck arteries. Contrast dye is injected directly, and X-rays are taken. A computer subtracts the bones, leaving only a crystal clear image of the blood vessels.
DSA allows for dynamic assessment of blood flow speed and collateral filling. It is essential for planning surgeries for AVMs or difficult aneurysms. It is also the platform for endovascular treatment; diagnosis and treatment (like coiling an aneurysm) often happen in the same session.
Since the heart acts as the pump for the cerebral vessels, cardiac evaluation is part of the workup. An Echocardiogram checks for clots in the heart or a Patent Foramen Ovale (PFO), a hole that allows clots to cross to the brain.
Transcranial Doppler (TCD) uses ultrasound to look through the thin parts of the skull. It measures the velocity of blood flow in the brain’s major arteries. It is used to monitor for vasospasm (narrowing) after a brain bleed and can detect “micro-emboli” (tiny clots) passing through the brain circulation in real time.
In complex cases, doctors need to know if brain tissue is dead or just starving. CT Perfusion (CTP) or MR Perfusion measures the blood volume and transit time in the brain tissue. This creates a map distinguishing the “core” (unsalvageable dead tissue) from the “penumbra” (salvageable starving tissue).
This mismatch is critical for treatment decisions. If there is a large penumbra, doctors may proceed with aggressive clot removal even if the time window has passed. Similarly, in chronic carotid stenosis, perfusion imaging helps determine if the narrowing is actually starving the brain enough to warrant the risk of surgery.
Send us all your questions or requests, and our expert team will assist you.
This is the Digital Subtraction Angiography (DSA); a thin tube is guided from your leg or arm up to your neck to inject dye and take X-ray movies of your brain’s blood vessels.
CTA is faster and better for seeing the blood vessels and bone in emergencies, while MRI is much better for seeing the actual brain tissue and older strokes.
These are bright spots seen on MRI scans that represent wear and tear on the brain’s small vessels, usually caused by years of high blood pressure or aging.
The bubbles act as a contrast agent; if they cross from the right side of the heart to the left, it proves there is a hole (PFO) that could let blood clots travel to the brain.
Yes, Transcranial Doppler uses sound waves that can penetrate the thinner parts of the skull (like the temple) to measure how fast blood is moving inside the brain.
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