64-Slice CT Angiography in the Detection of Intracranial Aneurysms: Comparison with DSA and Surgical Findings

Abstract

The overall results of CT angiography on 64-slice MSCT published in the last five years are very close to results of DSA which is still a gold standard in the diagnosis of intracranial aneurysms. The aim of this study is to contribute to the confidence in reliability of this method and to try to answer the question of whether CTA should be used as the first diagnostic modality in patients with suspect intracranial aneurysms. In the period from October 2008 to August 2009 we diagnosed 118 aneurysms in 73 patients. We included in this study only those patients who underwent either DSA, surgical treatment or both after MSCTA, and the remainder of the above patients were not treated and are followed up, or died before treatment. So our group comprised 47 patients who were divided into two groups. The first group of 22 patients underwent DSA after MSCTA. We found 36 aneurysms in this group. One aneurysm was falsely positive compared to DSA, while 35 were in concordance with DSA. DSA revealed five aneurysms smaller than 4 mm not disclosed by MSCTA. The second group comprised 25 patients who were operated according to MSCTA findings only. There were 33 aneurysms in this group: 25 aneurysms were operated and surgical findings agreed with MSCTA. Eight aneurysms smaller than 4 mm were not operated and we do not have confirmation for them. In all false positive and false negative cases the misdiagnosed aneurysms were in fact 1-1.5 mm outpouchings that were not responsible for SAH. According to the available literature and our results, MSCTA has proved a very reliable method, simple and safe, competent to be used as a diagnostic modality of choice in the patients with SAH or suspect unruptured aneurysm. DSA should be used in cases of negative or uncertain findings on MSCTA, excluding cases of perimesencephalic SAH with negative MSCTA. The relative disadvantage of this method is its lower sensitivity in the detection of tiny outpouchings, especially in the infraclionid region where this method has still limited possibilities.

Diagnostic value of multislice computerized tomography angiography for aortic dissection: A comparison with DSA

“…DSA should be used in cases of negative or uncertain findings on MSCTA. However, it has decreased sensitivity in the detection of small outpouchings (7). MSCTA has the potential to replace DSA as the gold standard in the examination of vascular diseases, such as aortic dissection.…”

Meta-analysis of diagnostic significance of sixty-four-row multi-section computed tomography angiography and three-dimensional digital subtraction angiography in patients with cerebral artery aneurysm

“…An additional 2 studies were removed after a further assessment. Finally, 8 cohort studies published from 2008 to 2013 were analyzed in the current meta-analysis [20][21][22]24,25,28,36,37]. Table 1.…”

“…The operating process is to form a pre-contrast image from radiological equipment; then, images are acquired after injecting contrast medium into the blood vessels and removing distracting structures from the first image [24]. Therefore, it was widely accepted that DSA primarily aims to image blood vessels with high image quality (b 3 mm), results that are not possible using CTA imaging [25].…”

Intracranial Aneurysms and Vascular Malformations: Diagnosis for Therapy

“…So the "preinterventional era" is confronted with a following, detailed "new time" of our patients with endovascular-interventional and radiation therapy but with a big change of the diagnostic modalities like CTA, MRA, DSA rot-3D etc. with more accuracy and better information for planning and the choice of therapy or just to control 8,17 . In this period the interventional procedures were done in the majority of the patients by the neurosurgeons (Neurosurgical university clinic CDK Salzburg, head: Prof. Dr. B. Richling), the radiotherapy in other outside clinics.…”