Detection of Intracranial Aneurysms: Multi–Detector Row CT Angiography Compared with DSA

Abstract

Multi-detector row CT angiography has high sensitivity and specificity for detection of intracranial aneurysms, including small aneurysms, in patients with nontraumatic acute subarachnoid hemorrhage.

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 Intraoparetaive Findings

“…Numerous studies that compare the diagnostic efficacy of multi-slice CTA with DSA have been published. The reported sensitivities of 4-slice CTA vary in the range of 81-100%, whereas the reported sensitivities of 16-and 64-slice CTA vary in the range of 92-100% (8,(15)(16)(17)(18)(19)(20)(21)(22)(23)(24). The sensitivity of 92.8% found in the present study is consistent with the reported sensitivity values.…”

“…Both of these cases occurred early in the study (the case with the 4 mm aneurysm located at RMCA was our first patient) when our experience was sub par. Lack of experience has been reported as a cause of misdiagnosis by other studies as well (2,8,18,24,32). Pedersen et al (32) reported an increase in the sensitivity of CTA from 88% to 94% after 1 year's experience.…”

“…Although methods have been developed to subtract bone in CTA images (35,36), we believe that visualization of the anatomy in three dimensions with 64-slice CTA, which has sub-millimeter section thickness and isotropic spatial resolution, mitigates this problem. Other authors have also supported this idea and reported that bone removal is not necessary (18). Venous contamination, especially when it occurs in the cavernous sinus, is reported as a limitation in detecting cerebral aneurysms by CTA (2).…”

Comparison of 64 Dedector Cranial CT Angiography with Intra-Arterial DSA For Detection of Intracranial Aneurysms

“…It should also should depict aneurysms with a high degree of accuracy (11). Use of imaging for the evaluation of patients with an intracranial aneurysm involves detection and the origin origin of the aneurysm; demonstration of the sac, neck and the surrounding vascular anatomy; orientation of the sac according to the bony structures of the skull base; morphological features of the sac; presence or absence of intraluminal thrombus or peripheral calcifications and accurate measurements of the sac, neck and aneurysm filling (1).…”

Cerebral Angiography: Not Yet Ready to Join the Dinosaurs

“…7 However, as our experience with CTA has matured, we still see that there is a negative predictive value of only 82%-96%. 2,3 As such, patients with diffuse or sulcal SAH will still need DSA to exclude a causative vascular lesion.…”