Detection of Aneurysms by 64-Section Multidetector CT Angiography in Patients Acutely Suspected of Having an Intracranial Aneurysm and Comparison with Digital Subtraction and 3D Rotational Angiography

Abstract

BACKGROUND AND PURPOSE: Four-section multisection CT angiography (MSCTA) accurately detects aneurysms at or more than 4 mm but is less accurate for those less than 4 mm. Our purpose was to determine the accuracy of 64-section MSCTA (64MSCTA) in aneurysm detection versus combined digital subtraction angiography (DSA) and 3D rotational angiography (3DRA).

Diagnostic Impact of Bone-Subtraction CT Angiography for Patients with Acute Subarachnoid Hemorrhage

“…31,32 Interobserver agreement in our study was somewhat higher than that reported previously. 11,17,19,26 Intraobserver agreement was excellent as in another study by Lu et al 11 We had excellent interreader agreement for aneurysm identification and configuration. Our results are in line with those in other studies, 17,26 even with a recent study with 320 -detector row BSCTA 33 comparing CTA with intraoperative observations.…”

“…25 False-positive cases on both 16 -and 64 -detector row BSCTA can be explained a by focal venous plexus overlying the MCA. 17 Venous contrast has been described as a potential source of error. 26,27 Venous enhancement is, however, not a crucial factor in the detection of cerebral aneurysms, except for extensive en- The colored rectangular boxes highlight manual measurements with interpolation of DSA results because DSA millimeter calibrations were not transferred with the other DSA data.…”

“…CTA has a high sensitivity and specificity in detecting intracranial aneurysms, 8,9,11,12,17,19,20 but skull base structures can hide adjacent aneurysms. 17,21 Bone-subtraction CTA 22,23 has been developed to overcome this problem.…”

“…17,21 Bone-subtraction CTA 22,23 has been developed to overcome this problem. A feasibility study 22 and a study with 100 patients 24 showed that BSCTA can improve the detection of vascular pathology closely adjacent to bony structures.…”

“…7,15,16 However, it still seems unclear whether BSCTA can provide sufficient information for therapy decisions, making diagnostic DSA redundant. 17,18 We therefore tested the hypothesis that BSCTA is as accurate as DSA for the identification and characterization of cerebral aneurysms in patients with SAH, even for small aneurysms and for those at the level of the skull base. We additionally studied the reliability of BSCTA and radiation-exposure reduction by avoiding diagnostic DSA.…”