Subtraction CT angiography for evaluation of intracranial aneurysms: comparison with conventional CT angiography

Abstract

The purpose of our study was to compare the diagnostic performance of subtraction computed tomography angiography (CTA) with conventional nonsubtracted CTA and digital subtraction angiography (DSA) for the detection of intracranial aneurysms. A total of 76 patients underwent both subtraction CTA and conventional CTA for the detection and therapy planning of suspected intracranial aneurysms. Subtraction and conventional CTA images were independently assessed by two readers in a blinded manner. The possibility of endovascular treatment or surgical clipping was also assessed based on information provided by CT angiograms alone. In 64 patients, 75 aneurysms were present on DSA. On a per-aneurysm basis, the sensitivity of subtraction CTA was 98.6% for reader 1, and 100% for reader 2. However, sensitivity of conventional CTA was 94.6% for reader 1, and 93.3% for reader 2. Therapeutic decisions could be made regarding 63 patients based on information provided by subtraction CTA images. However, conventional CTA provided sufficient information to make this decision for 55 patients. Conventional CTA has limited sensitivity in detecting very small aneurysms as well as aneurysms adjacent to bone. Subtraction CTA performed on a 64-row multidetector CT is an accurate and promising diagnostic tool that seems to be equivalent to 2D DSA for the detection and pretreatment planning of intracranial aneurysms.

The value of dual-energy CTA for control of surgically clipped aneurysms

“…It is a fast and very costefficient diagnostic tool that is available in most clinical settings. Therefore CT angiography has already been proposed as an alternative method in the detection of intracranial aneurysms [15,18] as well as in the postoperative management of patients after neurosurgical clipping [19]. Yet, CTA of the head after neurosurgical clipping is also often disturbed by artefacts.…”

“…Consequently CTA is ever frequently considered as an alternative and non-invasive imaging technique to DSA [14][15][16]. The aim of this retrospective study was to evaluate the benefit of such new imaging and software techniques compared with conventional CTA and DSA-if performed-with regard to the severity of artefacts, the assessment of remnant aneurysm necks and the visibility of the surrounding vessels in the postoperative management of patients after neurosurgical clipping.…”

Diagnostic Impact of Bone-Subtraction CT Angiography for Patients with Acute Subarachnoid Hemorrhage

“…CTA has a high sensitivity and specificity in detecting intracranial aneurysms, 8,9,11,12,17,19,20 but skull base structures can hide adjacent aneurysms. 17,21 Bone-subtraction CTA 22,23 has been developed to overcome this problem.…”

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

“…Among the studies included in this meta-analysis, a total of 22 false-negative aneurysms at CTA could be identified retrospectively (20,21,23,24). These false-negative interpretations can therefore be categorized as perceptual in nature and could have been substantially bypassed by double reading.…”