Detection and evaluation of intracranial aneurysms in the posterior fossa by multidetector computed tomography angiography – Comparison with digital subtraction angiography

Abstract

Introduction: Posterior fossa hemorrhages are not so frequent but as posterior cranial fossa space is narrow and has many vital structures, even a small amount of bleed can lead to compression of brain stem and serious consequences. Identification and planning management of cause of bleed requires angiogram. Digital subtraction angiography (DSA) being invasive modality but is gold standard, so noninvasive computed tomography angiography (CTA) is compared to detect cause of bleed in the posterior fossa in this study. Materials and Methods: From January 2017 to October 2018, all patients with posterior fossa bleed who underwent CTA and DSA for evaluation were compared regarding identification of aneurysm as cause of bleed. Results: A total of 49 patients were evaluated in this study during study duration, of which 26 (53%) were male and 23 (47%) were female. Out of 49 patients evaluated, 47 patients had aneurysms detected on DSA. Of 25 patients who underwent both procedures, 23 patients had aneurysms, and correct diagnosis was made with CTA in 24 out of 25 aneurysms. One aneurysm missed by CTA was close to bony structure. Discussion: With advancement of CTA technology, sensitivity of detecting intracranial aneurysms has increased to >96%. The overall sensitivity in detecting aneurysms is 96% with sensitivity in detecting aneurysms >4 mm being 100%. The sensitivity of CTA for smaller sized aneurysms is low which is attributed partially to lower spatial resolution of CT compared to DSA. Conclusion: CTA is a simple, fast, and noninvasive imaging modality that can be used to detect and characterize intracranial aneurysms in the posterior fossa.

Comparison of 3D-Computed Tomographic Angiography with Digital Subtraction Angiography for Detection of aneurysms among Spontaneous Subarachnoid Haemorrhagic Patients

“…DSA may lead to ambiguous results due to its inability to project the aneurysm sufficiently. Several factors contribute even technical to this like the location of the aneurysm in vessels bifurcation, regional complex vascular anatomy, vessels arising from the sac and the small size (less than 3 mm) of the aneurysmal sac, rotational limitations of the C-arm fluoroscopy, inadequate projections due to patient incorporation or projections out of the standard protocol [10][11][12] . In addition, mural calcifications, luminal thrombi, proximity to bony structures of the skull base and to the brain parenchyma, may constitute useful information for the treatment planning of some patients and cannot be obtained by DSA.…”

“…3D-RA serves as an add-on technique to DSA providing precise measurements necessary for endovascular coiling 14 . CTA based on the three-dimensional algorithms for image post-processing, provides satisfactory sensitivity and additionally possesses the advantage of delineating more accurately the morphological features of the aneurysm than conventional DSA 11 . It is an easy to perform method, timesaving, tolerated well by patients with no contraindications to contrast material and provides an early diagnosis which assists in the decision making process.…”

The Analysis of Morphoradiological Parameters in Predicting Risk of Basilar Artery Tip Aneurysm Rupture: A Retrospective Cohort Study

“… 6 CT angiography (CTA) is the primary diagnostic tool to provide anatomic and morphological features of intracranial aneurysms. 7 Zhang et al 8 revealed DD presence, AR, and larger flow angle to be associated with BA tip aneurysm rupture. Most recently, a suggested simple machine-based nomogram based on machine learning constructed to predict aneurysmal rupture risk at different locations achieved accurate results.…”