CT angiography with three-dimensional techniques for the early diagnosis of intracranial aneurysms. Comparison with intra-arterial DSA and the surgical findings

• Published in: European journal of radiology Vol. 49; no. 3; pp. 212 - 223
• Main Authors: Karamessini, Maria T, Kagadis, George C, Petsas, Theodore, Karnabatidis, Dimitrios, Konstantinou, Dimitrios, Sakellaropoulos, George C, Nikiforidis, George C, Siablis, Dimitrios
• Format: Journal Article
• Language: English
• Published: Shannon Elsevier Ireland Ltd 01.03.2004; Elsevier Science
• Subjects: Adolescent; Adult; Aged; Algorithms; Angiography, Digital Subtraction - methods; Biological and medical sciences; Cardiovascular system; Cerebral Angiography - methods; Contrast Media - administration & dosage; CTA; Female; Humans; Imaging, Three-Dimensional - methods; Intracranial Aneurysm - diagnosis; Intracranial Aneurysm - surgery; Intracranial aneurysms; Investigative techniques, diagnostic techniques (general aspects); Male; Medical sciences; Middle Aged; Neurology; Observer Variation; Radiodiagnosis. Nmr imagery. Nmr spectrometry; Reproducibility of Results; Sensitivity and Specificity; Subarachnoid hemorrhage; Three-dimensional imaging; Time Factors; Tomography, Spiral Computed - methods; Vascular diseases and vascular malformations of the nervous system; Intracranial aneurysms; CTA; Subarachnoid hemorrhage; Three-dimensional imaging; Cardiovascular disease; Psychosis; Vascular disease; Characterization; Specificity; intracranial aneurysm; Negative symptom; Surgery; Digital angiography; Diagnosis; Cerebrovascular disease; Human; Nervous system diseases; Radiodiagnosis; Acute; Instrumentation therapy; Endovascular route; Method; Cerebral disorder; Symptomatology; Sensitivity; Central nervous system disease; Medical imagery; Embolization; Early; Tridimensional image; Computerized axial tomography; Technique; Comparative study
• ISSN: 0720-048X; 1872-7727
• DOI: 10.1016/S0720-048X(03)00173-6

Introduction: Cerebral CT angiography (CTA) is an established method applied to both the detection and treatment planning of intracranial aneurysms. The aim of our study was to compare CTA and digital subtraction angiography (DSA) findings with the surgical results mainly in patients with acute SAH and to evaluate the clinical usefulness of CTA. Materials and methods: During the last 2 years, 82 consecutive patients were admitted under clinical symptoms and signs suggestive of harboring an intracranial aneurysm. CT angiography performed immediately afterwards the plain CT, while DSA was performed within the first 48 h of admission. All aneurysms detected were confirmed during surgery or endovascular embolization. Repeat DSA was performed in all patients having both the initial CTA and the DSA 15 days after the onset of symptoms negative. CT angiograms and conventional angiographies were studied by a consensus of two radiologists for each technique, who performed aneurysm detection, morphological features characterization and evaluation of the technique. Results: Surgical or/and endovascular treatment was performed in 45 patients and 53 aneurysms were confirmed. Using 3D-CT angiography, we detected 47 aneurysms in 42 patients. Conventional angiography depicted 43 aneurysms in 39 patients. The sensitivity of CTA for the detection of all aneurysms versus surgery was 88.7%, the specificity 100%, the positive predictive value (PPV) 100%, the negative predictive value (NPV) 80.7% and the accuracy 92.3%. Accordingly, the sensitivity of DSA was 87.8%, the specificity 98%, the PPV 97.7%, the NPV 89.1% and the accuracy 92.9%. Considering aneurysms ≥3 mm, CTA showed a sensitivity ranging from 93.3 to 100%, equal to that of DSA. Conclusion: Cerebral CT angiography has an equal sensitivity to DSA in the detection of intracranial aneurysms >3 mm. It has also 100% detection rate in AcoA and MCA bifurcation aneurysms, while some locations, like posterior communicating artery aneurysms, remain problematic. The delineating features of each aneurysm are better depicted with CTA due to 3D visualization. The use of digital subtraction angiography as a diagnostic tool can be limited in equivocal cases.