Prospective Comparison of Multi-Detector Computed Tomographic Angiography with Digital Subtraction Angiography for the Diagnosis of Intracranial Aneurysms in Patients with Acute Non-Traumatic Subarachnoid Hemorrhage
DOI:
https://doi.org/10.2015/hc.v9i3.620Keywords:
intracranial aneurysms, subarachnoid hemorrhage, multi-detector computed tomographic angiography, intra-arterial digital subtraction angiography, morphologic information, imaging techniquesAbstract
Background Rupture of intracranial aneurysms and malformations are the main causes of spontaneous subarachnoid hemorrhage (SAH). Multi-detector computed tomography angiography (CTA) and intra-arterial digital subtraction angiography (DSA) are used to evaluate cerebrovascular structures and to detect such abnormalities with an intention to treat them.
Objective The aim of the present study was to compare CTA and DSA findings in the detection of a cerebral aneurysm in patients with acute non-traumatic SAH and to depict the diagnostic value of CTA.
Methods During the last 3 years 52 patients with non-traumatic SAH were prospectively studied. Four patients underwent only 16-slice multi-detector CTA and 48 patients underwent both CTA and DSA in an acute setting. Aneurysm morphologic information on CTA was compared to DSA, which is considered the gold standard imaging technique.
Results The sensitivity of CTA per aneurysm was 97.9% (95% confidence intervals-CI 0.83-1), the specificity 100% (CI 0.50-0.99), the positive diagnostic likelihood ratio 0 and the negative diagnostic likelihood ratio 0.02. DSA successfully depicted 47 aneurysms in 40 patients from our study group. One aneurysm was missed on CTA (2 mm) which retrospectively was identified. In 8 patients with SAH no aneurysm was detected by either CTA or DSA.
Conclusion 16-slice multi-detector CTA can be successfully used as a first choice imaging tool in the diagnostic algorithm of non-traumatic SAH and efficiently guide the therapeutic strategy.
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- Aneurysm of the ACoA and its neck in a 27-year old male with WFNS grade I. (a) Selective IADSA of left ICA, detection of the aneurysm and its neck
- Aneurysm of the ACoA and its neck in a 27-year old male with WFNS grade I. (b) CTA coronal MPR image of the aneurysm
- Aneurysm of the ACoA and its neck in a 27-year old male with WFNS grade I. (c) 3D-CTA, detects the 5mm saccular aneurysm of the ACoA
- Aneurysm of the ACoA and its neck in a 27-year old male with WFNS grade I. (d)
- Right ICA aneurysm and its neck in a 48 year old female with WFNS grade I.(a) Selective IADSA of the right ICA, detection of the aneurysm and its neck
- Right ICA aneurysm and its neck in a 48 year old female with WFNS grade I.(b) 3D-CTA depict the 1.2cm supraclinoid saccular aneurysm of the right ICA and its neck
- Right ICA aneurysm and its neck in a 48 year old female with WFNS grade I. (c) Axial image of the aneurysm becomes as in the previous one
- Right ICA aneurysm and its neck in a 48 year old female with WFNS grade I. (d) CTA, coronal MIP of the aneurysm
- 3D-CTA in the circle of Willis in a 44 year old male. Three aneurysms were depicted, one in the right ACA, one in the ACoA and one in the right ICA
- 3D-CTA at 50 days follow-up in a 46-year-old woman with aneurysm’s surgical clipping in ACoA. The small aneurysm before the left MCA bifurcation is the aneurysm which was missed in CTA
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