Elif ERGUN, Murat HABERAL, Pınar KOŞAR, Ali YILMAZ, Uğur KOŞAR

Diagnostic Value of 64-slice CTA in Detection of Intracranial Aneurysm in Patients with SAH and Comparison of the CTA Results with 2D-DSA and Intraoperative Findings

Objective: To prospectively evaluate the diagnostic value of 64-slice CTA in detecting intracranial aneurysms and to compare it with 2D-DSA and/or intra-operative findings. Material and Methods: 37 cases with SAH according to unenhanced cranial CT were included in the study. A 64-slice CTA was performed to all cases immediately after the nonenhanced cranial CT. DSA was performed in 24-48 hours following CTA. CT images were reviewed by two radiologists experienced in CT vascular imaging. The DSA reader was the angiographer who performed the DSA. The results of the CTA were compared with the DSA results and/or intraoperative findings in order to determine the diagnostic efficacy of CTA in detecting intracranial aneurysms. Results: Sensitivity, specificity, positive predictive value, negative predictive value and accuracy of CTA in detecting aneurysms were 92.8%, 83.3%, 96.2%, 71.4% and 91.2% respectively. The diagnostic value of CTA in detecting intracranial aneurysms was found to be equal to DSA by Mcnemar test. Conclusion: CTA is invaluable in detecting intracranial aneurysms. It may be used as a first line modality in SAH, and DSA may be reserved for patients with negative or equivocal CTA results.

Keywords:

Intracranial aneurysm, Multislice CTA, Subarachnoid hemorrhage, Digital subtraction angiography,

PDF

___

Westerlaan HE, Gravendeel J, Fiore D, Metzemaekers JD, Groen RJ, Mooij JJ et al. Multislice CT angiography in the selection of patients with ruptured intracranial aneurysms suitable for clip- ping or coiling. Neuroradiology 2007;49:997-1007.
Yoon DY, Lim KJ, Choi CS, Cho BM, Oh SM, Chang SK. Detection and characterization of intracranial aneurysms with 16-channel multidetector row CT angiography: a prospective comparison of volume-rendered images and digital subtraction angiography. AJNR Am J Neuroradiol 2007;28:60-7.
Kouskouras C, Charitanti A, Giavroglou C, Foroglou N, Selviaridis P, Kontopoulos V et al. Intracranial aneurysms: evaluation using CTA and MRA. Correlation with DSA and intraoperative findings. Neuroradiology 2004;46:842-50.
Maira G, Albanese A, Pentimalli L, Tirpakova B. Treatment of in- tracranial aneurysms. Clin Exp Hypertens 2006;28:371-6.
Hankey GJ, Warlow CP, Sellar RJ. Cerebral angiographic risk in mild cerebrovascular disease. Stroke 1990;21:209-22.
Waugh JR, Sacharias N. Arteriographic complications in the DSA era. Radiology 1992;182:243-6.
Cloft HJ, Joseph GJ, Dion JE. Risk of cerebral angiography in pa- tients with subarachnoid hemorrhage, cerebral aneurysm, and ar- teriovenous malformation: a meta-analysis. Stroke 1999;30:317-20
Pozzi-Mucelli F, Bruni S, Doddi M, Calgaro A, Braini M, Cova M. Detection of intracranial aneurysms with 64 channel multidetec- tor row computed tomography: comparison with digital subtrac- tion angiography. Eur J Radiol 2007; 64:15-26.
Korogi Y, Takahashi M, Katada K, Ogura Y, Hasuo K, Ochi M et al. Intracranial aneurysms:detection with three-dimensional CT an- giography with volumerendering-comparison with conventional angiographic and surgical findings. Radiology 1999;211:497-506.
McFadzean RM, Teasdale EM. Computerized tomography angiog- raphy in isolated third nerve palsies. J Neurosurg 1988;679-84.
Lenhart M, Bretschneider T, Gmeinwieser J, Ullrich OW, Schlaier J, Feuerbach S. Cerebral CT angiography in the diagnosis of acute subarachnoid hemorrhage.Acta Radiol 1997;38:791-6.
Liang EY, Chan M, Hsiang JH, Walkden SB, Poon WS, Lam WW et al. Detection and assessment of intracranial aneurysms: val- ue of CT angiography with shaded-surface display. AJR 1995; 165:1497-502.
Preda L, Gaetani P, Rodriguez y Baena R, Di Maggio EM, La Fi- anza A, Dore R et al. Spiral CT angiography and surgical cor- relations in the evaluation of intracranial aneurysms. Eur Radiol 1998;8:739-45.
Vieco PT, Shuman WP, Alsofrom GF, Gross CE. Detection of circle of Willis aneurysms in patients with acute subarachnoid hemor- rhage: a comparison of CT angiography and digital subtraction angiography. AJR 1995;165:425-30.
Wintermark M, Uske A, Charalon M, Regli L, Maeder P, Meuli R et al. Multislice computerized tomography angiography in the evalu- ation of intracranial aneurysms: a comparison with intraarterial digital substraction angiography. J Neurosurgery 2003;98:828-36.
Tipper G, U-King-Im JM, Price SJ, Trivedi RA, Cross JJ, Higgins NJ et al. Detection and evaluation of intracranial aneurysms with 16-row multislice CT angiography. Clin Radiol 2005;60:565-72.
S. Dammert, T. Krings and W. Moller-Hartmann et al., Detection of intracranial aneurysms with multislice CT: comparison with conventional angiography, Neuroradiology 2004;46:427-34.
Jayaraman MV, Mayo-Smith WW, Tung GA, Haas RA, Rogg JM, Mehta NR et al. Detection of intracranial aneurysms: multi- detector row CT angiography compared with DSA, Radiology 2004;230:510-8.
Kangasniemi M, Mäkelä T, Koskinen S, Porras M, Poussa K, Hernesniemi J. Detection of cerebral aneurysms with two-dimen- sional and three-dimensional multislice helical computed tomo- graphic angiography, Neurosurgery 2004;54:336-40.
Teksam M, McKinney A, Cakir B, Truwit CL. Multi-slice CT angiog- raphy of small cerebral aneurysms: Is the direction of aneurysm important in diagnosis? Eur J Radiol 2005;53:454-62.
Teksam M, McKinney A, Casey S, Asis M, Kieffer S, Truwit CL. Multi-section CT angiography for detection of cerebral aneu- rysms. AJNR Am J Neuroradiol 2004;25:1485-92.
McKinney AM, Palmer CS, Truwit CL, Karagulle A, Teksam M. De- tection of aneurysms by 64-section multidetector CT angiogra- phy in patients acutely suspected of having an intracranial aneu- rysm and comparison with digital subtraction and 3D rotational angiography.AJNR Am J Neuroradiol 2008;29:594-602.
Lubicz B, Levivier M, François O, Thoma P, Sadeghi N, Collignon L et al. Sixty-four-row multisection CT angiography for detection and evaluation of ruptured intracranial aneurysms: interobserv- er and intertechnique reproducibility. AJNR Am J Neuroradiol 2007;28:1949-55.
Agid R, Lee SK, Willinsky RA, Farb RI, terBrugge KG. Acute subarachnoid hemorrhage: using 64-slice multidetector CT angiography to “triage” patients’ treatment. Neuroradiology 2006;48:787-94.
Chen W, Wang J, Xing W, Xu Q, Qiu J, Huang Q et al. Accuracy of 16-row multislice computerized tomography angiography for as- sessment of intracranial aneurysms. Surg Neurol 2009;71:32-42.
Chen W, Wang J, Xin W, Peng Y, Xu Q. Accuracy of 16-row mul- tislice computed tomographic angiography for assessment of small cerebral aneurysms. Neurosurgery 2008;62:121-2.
Anderson GB, Steinke DE, Petruk KC, Ashforth R, Findlay JM. Computed tomographic angiography versus digital subtraction angiography for the diagnosis and early treatment of ruptured intracranial aneurysms. Neurosurgery 1999;45:1315-20.
Korogi Y, Takahashi M, Katada K, Ogura Y, Hasuo K, Ochi M et al. Intracranial aneurysms: detection with three-dimensional CT an- giography with volume rendering—comparison with conventional angiographic and surgical findings. Radiology 1999;211:497-506.
White PM, Teasdale EM, Wardlaw JM, Easton V. Intracranial an- eurysms: CT angiography and MR angiography for detection— prospective blinded comparison in a large patient cohort. Radiol- ogy 2001;219:739-49.
Villablanca JP, Achiriolaie A, Hooshi P, Martin N, Duckwiler G, Ja- han R et al. Aneurysms of the posterior circulation: detection and treatment planning using volume-rendered three-dimensional helical computerized tomography angiography. J Neurosurg 2005;103:1018-29.
Villablanca JP, Jahan R, Hooshi P, Lim S, Duckwiler G, Patel A et al. Detection and characterization of very small cerebral aneu- rysms by using 2D and 3D helical CT angiography. AJNR Am J Neuroradiol 2002;23:1187-98.
Pedersen HK, Bakke SJ, Hald JK, Skalpe IO, Anke IM, Sagsveen R et al. CTA in patients with acute subarachnoid haemorrhage. A comparative study with selective, digital angiography and blind- ed, independent review. Acta Radiol 2001;42:43-9.
Velthuis BK, Rinkel GJ, Ramos LM, Witkamp TD, Berkelbach van der Sprenkel JW, Vandertop WP et al. Subarachnoid hemor- rhage: Aneurysm detection and preoperative evaluation with CT angiography. Radiology 1998;208:423-30.
White PM, Wardlaw JM, Easton V. Can non-invasive imaging ac- curately depict intracranial aneurysms? A systematic review. Ra- diology 2000;217:361-70.
Sakamoto S, Kiura Y, Shibukawa M, Ohba S, Arita K, Kurisu K. Subtracted 3D CT angiography for evaluation of internal carotid artery aneurysms: comparison with conventional digital subtrac- tion angiography. AJNR Am J Neuroradiol 2006;27:1332-7.
Tomandl BF, Hammen T, Klotz E, Ditt H, Stemper B, Lell M. Bone- subtraction CT angiography for the evaluation of intracranial an- eurysms. AJNR Am J Neuroradiol 2006;27:55-9.
Osborn AG. Diagnostic Cerebral Angiography, 2nd ed. Lippin- cott Williams &Wilkins, Philadelphia, 1999.
Karamessini MT, Kagadis GC, Petsas T, Karnabatidis D, Konstan- tinou D, Sakellaropoulos GC et al. CT angiography with three- dimensional techniques for the early diagnosis of intracranial aneurysms. Comparison with intra-arterial DSA and the surgical findings. Eur J Radiol 2004;49:212-23.
Hoh BL, Cheung AC, Rabinov JD, Pryor JC, Carter BS, Ogilvy CS. Results of a prospective protocol of computed tomographic an- giography in place of catheter angiography as the only diagnos- tic and pretreatment planning study for cerebral aneurysms by a combined neurovascular team. Neurosurgery 2004;54:1329-40.