TY - JOUR
T1 - Experience with computed tomographic angiography for the detection of intracranial aneurysms in the setting of acute subarachnoid hemorrhage
AU - Anderson, Glenn B.
AU - Findlay, J. Max
AU - Steinke, David E.
AU - Ashforth, Robert
N1 - Copyright:
Copyright 2007 Elsevier B.V., All rights reserved.
PY - 1997/9
Y1 - 1997/9
N2 - OBJECTIVE: To objectively compare computed tomographic angiography (CTA) with selective digital subtraction angiography (DSA) in the detection and anatomic definition of intracranial aneurysms, particularly in the setting of acute subarachnoid hemorrhage (SAH). METHODS: In a blinded prospective study, 40 patients with known or suspected intracranial saccular aneurysms underwent both CTA and DSA, including 32 consecutive patients with SAH in whom CTA was performed after CT images were obtained diagnostic for SAH. The CT angiograms were interpreted for the presence, location, and size of the aneurysms, and anatomic features, such as the number of aneurysm lobes, aneurysm neck size (≤ 4 mm), and the number of adjacent arterial branches were assessed. The images obtained with CTA were then compared with the images obtained with DSA, with the latter images serving as controls. RESULTS: DSA revealed 43 aneurysms in 30 patients and ruled out intracranial aneurysms in the remaining 10 patients. For aneurysm presence alone, the sensitivity and specificity for CTA was 86 and 90%, respectively. For the presence of an aneurysm, six CT angiograms showed false negative results and one CT angiogram showed a false positive result. False negative results were usually caused by technical problems with the image, tiny aneurysm domes (<3 mm), and unusual aneurysm locations (i.e., intracavernous carotid or posterior inferior cerebellar artery aneurysms). The results obtained with CTA were, compared with the results obtained with DSA, more than 95% accurate in determining dome and neck size of aneurysm, aneurysm lobularity, and the presence and number of adjacent arterial branches. In addition, CTA provided a three-dimensional representation of the aneurysmal lesion, which was considered useful for surgical planning. CONCLUSION: CTA is useful for rapid and relatively noninvasive detection of aneurysms in common locations, and the anatomic information provided in images showing positive results is at least equivalent to that provided by DSA. In cases of SAH in which the nonaugmented CT and CTA results indicate a clear source of bleeding and provide adequate anatomic detail, we think it is possible to forego DSA before urgent early aneurysm surgery. In all other cases, DSA is indicated.
AB - OBJECTIVE: To objectively compare computed tomographic angiography (CTA) with selective digital subtraction angiography (DSA) in the detection and anatomic definition of intracranial aneurysms, particularly in the setting of acute subarachnoid hemorrhage (SAH). METHODS: In a blinded prospective study, 40 patients with known or suspected intracranial saccular aneurysms underwent both CTA and DSA, including 32 consecutive patients with SAH in whom CTA was performed after CT images were obtained diagnostic for SAH. The CT angiograms were interpreted for the presence, location, and size of the aneurysms, and anatomic features, such as the number of aneurysm lobes, aneurysm neck size (≤ 4 mm), and the number of adjacent arterial branches were assessed. The images obtained with CTA were then compared with the images obtained with DSA, with the latter images serving as controls. RESULTS: DSA revealed 43 aneurysms in 30 patients and ruled out intracranial aneurysms in the remaining 10 patients. For aneurysm presence alone, the sensitivity and specificity for CTA was 86 and 90%, respectively. For the presence of an aneurysm, six CT angiograms showed false negative results and one CT angiogram showed a false positive result. False negative results were usually caused by technical problems with the image, tiny aneurysm domes (<3 mm), and unusual aneurysm locations (i.e., intracavernous carotid or posterior inferior cerebellar artery aneurysms). The results obtained with CTA were, compared with the results obtained with DSA, more than 95% accurate in determining dome and neck size of aneurysm, aneurysm lobularity, and the presence and number of adjacent arterial branches. In addition, CTA provided a three-dimensional representation of the aneurysmal lesion, which was considered useful for surgical planning. CONCLUSION: CTA is useful for rapid and relatively noninvasive detection of aneurysms in common locations, and the anatomic information provided in images showing positive results is at least equivalent to that provided by DSA. In cases of SAH in which the nonaugmented CT and CTA results indicate a clear source of bleeding and provide adequate anatomic detail, we think it is possible to forego DSA before urgent early aneurysm surgery. In all other cases, DSA is indicated.
KW - Angiography
KW - Cerebral aneurysm
KW - Computed tomography
KW - Diagnosis
KW - Subarachnoid hemorrhage
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U2 - 10.1097/00006123-199709000-00003
DO - 10.1097/00006123-199709000-00003
M3 - Article
C2 - 9310967
AN - SCOPUS:0030882021
VL - 41
SP - 522
EP - 528
JO - Neurosurgery.
JF - Neurosurgery.
SN - 0148-396X
IS - 3
ER -