Angiograms for cerebral AVM's - Traditional x-ray vs MRA?

I’ve got a question that I keep meaning to ask my doctors. It appears that traditional angiograms are much clearer than MRA’s, but MRA’s are less invasive and don’t involve radiation.
What are the pros and cons of each? Does it boil down to doctor preference? Medical reasons? Any help you can provide is greatly appreciated. Thanks!

You may find this old discussion interesting…

Tim, it sounds like you already have a good handle on the pros and cons of each. I have read a couple of articles about the possibility of 3D CTAs replacing angiograms in the future, as they are less invasive (just IV with contrast, nothing threading its way through the plumbing) and lower risks than angiograms. So, one day, angios may be a thing of the past. It is reasonable to question repeat angios once obliteration has occurred and been confirmed. Risks and benefits should be weighed each time.

My doctor does the MRA first and has seen my DAVF retrograde and then did the angiogram
I would much rather of course not have another angiogram but we already know they were unable to get all of it and want to go back in -
I know the MRA is not always able to see the issue so its not 100%

Thanks Barbara, I appreciate it!

Thanks Angela. So the angiogram is used to see more clearly where the MRA falls short?

Dancermom, I found a good article outlining the three different options, with pros and cons of each:

In reading further, 3D CTA’s are being done today for certain applications (aneurysms, cardiac, etc). As technology marches forward, I believe it will become more and more prevalent. We live in an amazing time in the advancement of medicine!

Thanks for the article, Tim. This is what a 3D CTA looks like, by the way:

Thanks for posting this interesting question, Tim. I'm following the replies and always learning on this site.

The angiogram is a"live" view inside of the vessels as the catheter tunnels through the arteries and veins, whereas the MRI, and MRAs are more sophisticated Images with contrast dye used to light up particular areas along the route that the dye takes. My neurosurgeon found 2 small aneurysms while doing the angiogram that were not visible on MRI or MRA. From what I understand, of course, the angiogram is a bit more invasive and probably more expensive with more chance of complications due to entry in the artery of the groin, and recovery time, but it yields a very thorough and complete vision of the situation at hand. (I hope this is helpful) Unfortunately, it could also depend upon what sort of constraints your insurance puts on your doctor. Your doctor may not always have the freedom to order the test that he/ she would like to and his/her hands may be tied and are unable to order which test they want.

I’ve done a lot of homework since asking the initial question, and you’ve probably stated the differences as eloquently as I’ve heard. Thanks!

I had my 10 year checkup for an AVM, and jnitially had an MRA done. I took it to Johns Hopkins for a review to help check on continuing headaches; I did not want another angiography as they are obviously not fun and invasive. After reviewing the films, the vascular team said the MRA was not detailed enough; that an angio was only way to see if I still had small leaks and dural fistula . So I guess it's more sometimes they can tell what it is, but can't conclude what it isn't without more intense diagnostics if that makes sense. I think it's like MRA can show a flat tire but only the angio can show the slow leak.....and yes that can be crappy :(

So sweet really stated it well and much more medically accurate! (I work with elementary kids)

Thanks Virginia! Nothing replaces real world experience. Each time a person shares their personal experience, it increases my knowledge. And knowledge is power! :slight_smile: