Subtraction CT angiography for the detection of intracranial aneurysms: A meta-analysis

Abstract

Abstract. The aim of this meta-analysis was to investigate the accuracy of subtraction computed tomography angiography (CTA) for diagnosing intracranial aneurysms. A systematic literature search up to January 1, 2013 was performed in PubMed. Two independent reviewers selected 8 studies that compared subtraction CTA with digital subtraction angiography. Data from the studies were used to construct a 2x2 contingency table on a per-patient basis in ≥5 diseased and 5 non-diseased patients, with additional data on a per-aneurysm basis. Overall, subtraction CTA had a pooled sensitivity of 99% [95% confidence interval (CI), 95-100%] and specificity of 94% (95% CI, 86-97%) for detecting and ruling out cerebral aneurysms, respectively, on a per-patient basis. On a per-aneurysm basis, the pooled sensitivity was 96% (95% CI, 90-99%), and the specificity was 91% (95% CI, 85-95%).In conclusion, subtraction CTA is a highly sensitive, specific and non-inva sive method for the diagnosis and evaluation of intracranial aneurysms. IntroductionThe prevalence of cerebral aneurysm in the general population is estimated to be 1-5% (1). Ruptured intracranial aneurysms are the most important cause of non-traumatic subarachnoid hemorrhage, which is a medical emergency and can result in severe disability or mortality (2). Thus, the prompt diagnosis and treatment of intracranial aneurysm are of considerable importance for the outcome of the patient.Conventional digital subtraction angiography (DSA) has been considered the gold standard for the detection and characterization of intracranial aneurysms due to its high spatial resolution and large field of view (3,4); however, it also has several disadvantages, including the relatively high cost and the high skill level required to perform the procedure. Furthermore, DSA is an invasive procedure associated with a small but definite risk of neurological morbidity (5). There is a requirement, therefore, to find an accurate, minimally invasive imaging method that is free from these complications. Computed tomography angiography (CTA), as a relatively non-invasive imaging method, has been widely used in the screening of patients with suspected intracranial aneurysms (6). As a result of the rapid improvement in multi-detector CTA technology, the diagnostic performance of multi-detector CTA for the detection of intracranial aneurysms is now approaching that of DSA (7); however, it exhibits a disadvantage in the detection of small-sized aneurysms that are located near the skull base due to the influence of overprojecting bone structures (8).As CT technology has evolved and various subtraction and post-processing techniques have been developed, subtraction CTA, allowing bone-free visualization of aneurysms, has become possible for the diagnosis of intracranial aneurysms. There have been several reports on the potential usefulness of subtraction CTA in evaluating intracranial aneurysms; however, the results of these studies have been varied (6-8). The purpose of this meta-analysis was to calculate the ...

Meta-analysis of computed tomography angiography versus magnetic resonance angiography for intracranial aneurysm

“…Prior clinical evaluations that compared CTA or MRA with DSA revealed that the diagnostic value of CTA or MRA approaches that of DSA. A recent investigation [ 13 ] pooled 8 studies to explore the accuracy of subtraction CTA compared with DSA for diagnosing intracranial aneurysm; the pooled sensitivity and specificity were 96% and 91%, respectively. In addition, the author also suggested that CTA is a highly sensitive, specific and noninvasive imaging method to diagnose intracranial aneurysms.…”

A Review of the Applications of Dual-Energy CT in Acute Neuroimaging

“…This is partially addressed by mask subtraction CT angiography that subtracts noncontrast CT from CT angiography, although this can suffer from misregistration artifacts from movement between temporally separate scans. 51…”

“…This is partially addressed by mask subtraction CT angiography that subtracts noncontrast CT from CT angiography, although this can suffer from misregistration artifacts from movement between temporally separate scans. 51 Bone-subtraction DECT angiography has lower radiation dose than mask subtraction CT angiography without motion misregistration artifacts. When compared to threedimensional rotational digital subtraction angiography for aneurysm detection, bone-subtraction CT angiography was found to have high accuracy, with findings closely correlating with aneurysm size measurements.…”

Comprehensive review of imaging of intracranial aneurysms and angiographically negative subarachnoid hemorrhage

“…In addition, DE-CTA from various vendors now offers skull subtraction based on the material-specific properties of bone, facilitating 3D reconstruction of the intracranial vasculature and improved visualization of aneurysms at the skull base. Feng et al 21 recently showed that DE-CTA yielded a sensitivity and specificity of 95% and 100%, respectively, with a 60% reduction in average radiation exposure compared to DSA.…”