CTA/MRA/Angio What's the diff?

[wonderland]

Does anyone know the differences between all of these tests???
I know they say that the angiogram is the "gold standard" but
my brain hurt when they put the dye in and the test cost 55k. Of
course, luckly, insurance covered it, but I am suppose to have another next May and I am trying to understand the differences between all of the
tests available so I can see if another test might work just as well
and not be so painful.

I had one annie coiled and have another that they just want to watch.
Anyone here with some information about these tests? Thanks to all of
you and I hope each of you have had a great holiday season.

Pamela

[alakatski]

Hi Pamela,

I am a new member and just had an aneurysm stented and coiled on Dec. 3. I am also a nurse so have a little understanding of the procedures. The CTA is basically a CAT scan that can be done with and without dye. It is a very good diagnostic test but the 4 vessel angiogram is the gold standard. It is my understanding that it actually does a mapping of the brain that is basically 3 dimensional so that the vessels/abnormalities can be looked at closely with more views. The MRA uses both MRI, Xray, and contrast dye as I understand it. The CTA and MRA are less invasive than the angiogram. I too have been overwhelmed by the costs of the procedures and have insurance but it is concerning with the amount of follow-up needed. But then again, what a necessary evil!!! I keep telling myself that this technology probably saved my life and I cannot worry about the costs!! I don't know if I explained all this very well!! Hope you continue to do well. This forum is a blessing and I so wish I had found it before my repair!!

Kathy

[JohnS]

Hi Pam,

You have the basic facts. I did not have an angiogram, thank goodness, all I needed was a CTA, and MRA. I was in an out of the CTA within 20 minutes! No adverse side effects. And I am serious, 20 minutes from the time they called me from the waiting room till I was walking out the door all done. I had and MRA scheduled but they use a different contrast material for that test than they do in a CTA, so the diagnostic center would not give the the contrast material because of my diabetes and the results of a blood test prior to the imaging appt, I had an MRI instead. Both Doctors (my NS and INR) had no problems reading either and did not feel the angiogram was needed.

The CTA process was a IV sort of needle in my right arm then once they were ready they told me here comes the dye, you will feel a warming sensation, NO KIDDING, lasted just a minute or so and I was done, the warming sensation diminshed almost immediately.

The MRI was not an MRA but was fast as well, about 40 minutes tops. Up and gone again, no side effects at all.

More info on a CTA here:

http://www.radiologyinfo.org/en/info.cfm?pg=angioct&bhcp=1

and the MRA here:

http://www.radiologyinfo.org/en/info.cfm?pg=angiomr

[wonderland]

Thank you Kathy and John!

Kathy: Welcome here. Thanks for the information. It was really helpful. You sound very well for just having been coiled and stented a few weeks ago! I hope you find all the love, support and information I did when I found this lovely place a few months ago.

John: Thanks for the links. I will go there now and learn even more.

Here is a link on Angiograms from the cite John found, in case anyone wants to see it too:

http://www.radiologyinfo.org/en/info.cfm?PG=angiocath



Pamela

[goldie411]

Hi Pamela, I'm scheduled for my MRA at the end of January. I had the coiling and stent done in May. Johns right the test doesn't take that long at all..not compared to the angio.
I go for my MRA, then within an hour my nuero doc, has scheduled my appointment with him..
The test are very expensive, thank goodness for insurance.
You said your brain hurt when they used the dye for your angio...I didn't ever feel too bad when they put the dye in my brain, but, they checked my neck a few times with that hot dye, and that burned..I would much rather have a MRI/MRA anyday of the week..plus you don't have a long stay with the other test. I know sometimes they can't see all the small vessels really good with the MRA, that's what my doc told me. Plus with the metal in my head..coils and a stent, it can make the image blurry, so it's even harder to tell what's going on in there..

Kathy, welcome to the site. You do sound great for just having your surgery done..my wishes for your continued healing..

John, I remember my last MRA and the nurse said, I was her first patient to get an IV from her..I said " do you really want to start on me"...lolol..she was gentle though...lol..
I didn't feel the dye til the very end of the test. It was like a warm blanket went down my body, they it was over..not painful at all..they did ask if I was clausterphobic (sp)..because the machine is more inclosed..I'm not afraid of tiny spaces, but, if someone is they can give you something to relax...

Have a great day all...take care Cindy

[wonderland]

Cindy: Thanks for the backround. I see my doc on January 3rd and I am
going to try to get him to order a CTA or MRA instead of the angiogram. The
test won't be until May, but I thought I'd start working on him now! Good luck on your MRA and lets us know how it turns out.

Pamela

[goldie411]

Thanks Pamela, I'll let yall know how it goes..I asked my doc at my 6 week check up after my surgery if I could have the MRA instead of the angio, on my next visit..and he called when I got home, and said yes..I was so excited..lol..
Good luck at your appointment too..it will be nice one day to have all these appointments behind us..or at least have a longer stretch in between all of them..take care Cindy

[alakatski]

Thank you all for the warm welcome to this site. I am uplifted by all your stories. I have a rather strange one. On Oct. 15 I was in a car accident and during the ER evaluation they found my 6 mm anterior communicating artery aneurysm. I had two opinions: neurosurgery wanted to cut right away and the neuroradiologist wanted to send me out to a major medical center!! I was apparently born with 3 missing arteries in my brain so instead of having good blood flow to each hemisphere of the brain, I had one major source of blood flow to the entire brain. The aneurysm was a wide-neck so Dr. Mawad in Houston did the stent and coiling. I was out of the hospital in 3 days and back in Alabama within the week. I went back to work 10 days after the procedure. I will say that I still have daily dull headaches, am still very fatigued, and seem to have problems remembering names (maybe old age?? LOL!) and words at times. I do get discouraged and teary at times but am so grateful for the minimally invasive surgery. A craniotomy would have been much more difficult, more down time and more risk. I am more grateful for that dang car accident!!! What I am having a difficult time with is that stenting/coiling leaves no visible scar... no barometer for the healing that is going on in the brain, if that makes sense. My followup is early June and will have another angio and possible addition of coils. I am so glad to have found this forum. Thank you all for your kind words and support!

Kathy

[wonderland]

Kathy: Wow! That is an amazing story. Have you posted your story on the sticky called "Learning Everyone's Journey"? You'll find a lot of our stories there. You'll also see that as a nurse you have a lot of nurse brothers and sisters here. I suffered a SAH before they found mine and I was in the hospital so much longer (about 1 1/2 months) but for sure I can tell you to take your time and don't worry too much, it will take a while to get back to normal. What you say makes a lot of sense - no scars on the outside. But we did suffer a brain injury and it will take time to have everything go back to normal. Golly gee, they put a catheder up us and into our brain and then put coils in...I am still amazed by it all.

I am glad I found this this forum and I am very glad you found it as well!

Pamela

[pamuk]

Hi Pamela, I have just read your thread, I remember when you had your annie coiled and it is good to hear from you again, you will remember I am the other Pamela, who also has had an annie coiled and who also is having annies monitored.

I understand about your apprehension over the angiogram, - I experienced eye pain during my diagnostic angiogram.

My neuro initially said I would have angiogram check ups, however,my hospital has an ultra new scanner now, so all I have is MRA, - an MRA is an MRI scan with contrast,(MRI scan has no contrast), it is the contrast that is important as it highlights the blood vessels. I have now been told that the pictures they get are so clear that I will always be able to have MRA scans. For the MRA Scan they just put the contrast dye into my arm, it is a lot easier than the angiogram.

I dont know much about CT Scans I think they look closely at the brain tissue (but I may be wrong!!) I have had a CT Scan, the day after my first surgery as I wasnt too well and they wanted to check there was no bleeding, but I cant remember much about it. I am sure other members will be able to tell you about CT Scans.

Why not ask your neuroradiologist if you can have an MRA, see what he thinks. It is worth a try.

Good luck with the check up, hope the results are good. Its good to hear from you again.

pam from england

[wonderland]

Hi, other Pam! I am seeing him next Thursday so I will definately ask him
about the MRA. I hope Stanford has the new ultra machine. They were
very excited about their new cat/angio lab when I had my angiogram in November. Hopefully they have also gotten the newer MRI machine.

[goldie411]

This new machine sounds great..I'll have to ask my hospital if they have one yet. MRI/MRA are so much easier than angios..and less stressfull...

[MikeS.]

Hi Pam,

I had a clipping procedure done at UCLA last January. I had a CT-4D scan done which maps the aneurysm is 3D, but also allows for the heartbeat, therefore getting rid of any backround distortion. Because I had the CT-4D scan done, they found that a bleb (protrusion off of the annie) was beating out of sync with the annie and the blood vessel. This has only been found in 30 or so patients world-wide, and can only be deciphered with a 4D machine. It saved my life. The neuros at UCLA (one of the best centers in the country) only use the 4D machine now on annie patients. They say it is as accurate (in my case more accurate), and it is done in 20 minutes with no pain. I had both tests done, and I reallllllllllllllly recommend the CT-4D. There are only 2 or 3 machines in the U.S., and very few Dr's know much about them. The UCLA docs say they only use the catheter angio on patients where they need to look at very microscopic anomolies. There is a neuroradiologist at UCLA named Pablo Villablanca who is an expert (and has written about both procedures) whom you can look up on the internet. If they had not found the bleb, they would not have operated since my annie was only 3mm. My doc said after the surgery that he was glad they operated, since it was ready to blow. Good luck......

Mike

[wonderland]

Mike: Thank you so much for the info. I am going to look into this. Do you know approximately what the test cost? It is a little scary to think about going to another hospital for the test because I really like and trust my dr - he definately saved my life - but I am for sure going to look into this.

Can you give us some more information about your 3mm coiling? What did it mean that the heart beat was different?

Pamela

[MikeS.]

Pam,

I'm sorry, I don't know the cost, but I believe it is less than the catheter angiogram since there is no need for an anasthesiologist. It is also safer, which is important too. My annie had a bleb which is a malformation of a berry annie. Think of it as a small annie off of an annie. With the new 4D machine they measure how the annie pulses with your heartbeat. Flow dynamics is now being used on the cutting edge of annie treatment, but there is not enough information to use the information in a diagnosis. My bleb was not beating in sync with the annie and the blood vessel. One theory is that more pressure is being created since the bleb is beating differently. This was not the factor that caused my Dr. to operate, but it was a concern. The 4D machine is turning up new information on annies, and the Dr's are trying to decipher it at this point. I believe the 4D machine will be the standard for annie diagnosis, and will supplant the catheter angiogram someday. I was having symptoms which concerned my Dr., and ultimately that was a major reason for them opting for surgery. UCLA has also been doing a follow-up study and annie patients, and have found that most annie patients do indeed have symptoms before rupture or discovery.... I don't believe they have written on that yet, since they have only interviewed around 200 patients. What I liked about my treatment was the fact that the Dr's at UCLA were concerned about the safety and pain involved in discovery and surgery, but were also humble enough to admit that so much is still unknown in this field. Even the neurointerventionists admitted how new their field was, and that so much is still yet to be learned. I felt like I was a patient and not a number, which was what I was looking for with my treatment. The catheter angio is very invasive, and they gave me a lumbar puncture at the same time which really made the experience suck. I was lucky since after that experience I had a Dr. freind recommed that I go to UCLA. Thank God I did....

Cheers,

Mike

[MikeS.]

Also, perhaps you could get the test done, but still have your doctor work with the neuroradiologist at a place where they have the machine?

[wonderland]

Mike: That is kind of what I am hoping. I am hoping that my doc will say "sure, I'll arrange for you to get the test down in LA and then I
can look at it". Where did you have the angio and lumbar puncture?

It sounds like the bleb is sort of attached to the main annie - is that right? My 2nd annie is next to but not attached to my main annie - if that makes sense.

Thanks again, Mike. And everyone have a Happy New Year!

Pamela