Dynamic evaluation of unruptured intracranial aneurysms by 4D-CT angiography: comparison with digital subtraction angiography (DSA) and surgical findings

• Published in: BMC medical imaging Vol. 23; no. 1; pp. 1 - 161
• Main Authors: Yang, Liping, Gao, Xing, Gao, Chao, Xu, Shichuan, Cao, Shaodong
• Format: Journal Article
• Language: English
• Published: London BioMed Central Ltd 18.10.2023; BioMed Central; BMC
• Subjects: Aneurysm; Aneurysm pulsation; Aneurysms; Angiography; Blood vessels; Care and treatment; Comparative analysis; Computed tomography; CT imaging; Diameters; Digital subtraction angiography (DSA); EKG; Electrocardiogram; Electrocardiography; Embolization; Four-dimensional CT angiography (4D-CTA); Heart beat; Image reconstruction; Mathematical analysis; Medical imaging; Medical research; Medicine, Experimental; Morphology; Neurosurgery; Patients; Physical characteristics; Pulsation; Radiation; Radiation dosage; Scanners; Unruptured intracranial aneurysms; Japan
• ISSN: 1471-2342; 1471-2342
• DOI: 10.1186/s12880-023-01107-1

Abstract Background This study was to prospectively investigate the feasibility of four-dimensional computed tomography angiography (4D-CTA) with electrocardiogram-gated (ECG) reconstruction for preoperative evaluation of morphological parameters, and compared with digital subtraction angiography (DSA). We also aimed to detect pulsation in unruptured intracranial aneurysms (UIAs) by using 4D-CTA, as a potential predicting factor of growth or rupture. Materials 64 patients with 64 UIAs underwent ECG-gated dynamic 4D-CTA imaging before treatment, of which 46 patients additionally underwent DSA. Original scanning data were reconstructed to produce 20 data sets of cardiac cycles with 5%-time intervals. The extent of agreement on UIAs morphological features assessed with 4D-CTA and DSA was estimated using the k coefficient of the Kappa test. The radiation doses were also calculated and compared between 4D-CTA and DSA. In the aneurysmal surgically treated in our institution, we were able to compare the surgical findings of the aneurysm wall with 4D-CTA images. We performed long-term follow-up on untreated patients. Results The morphological characteristics detected by 4D-CTA and DSA were consistent in aneurysm location (k = 1.0), shape (k = 0.76), maximum diameter (k = 0.94), aneurysm neck (k = 0.79) and proximity to parent and branch vessels (k = 0.85). 4D-CTA required lower radiation doses (0.32 ± 0.11 mSv) than DSA (0.84 ± 0.37 mSv, P  < 0.001). Pulsation was detected in 26 of the 64 unruptured aneurysms, and all underwent neurosurgical clipping or interventional embolization. In aneurysms surgically treated in our hospital, we observed a significant correlation between 4D-CTA findings and surgical evaluation of the aneurysmal wall, in particular the irregular pulsations detected on 4D-CTA have demonstrated to correspond to dark-reddish thinner wall at surgery. Conclusions In this proof-of-concept study, 4D-CTA provided real-time, non-invasive preoperative assessments of UIAs comparable to DSA. Moreover, optimal correlation between the irregular pulsation detected by 4D-CTA and the surgical findings support a possible role of this technique to identify aneurysms with a higher risk of rupture.