Use of CT Angiography and Digital Subtraction Angiography in Patients with Ruptured Cerebral Aneurysm: Evaluation of a Large Multihospital Data Base

Abstract

BACKGROUND AND PURPOSE:Both CT angiography and digital subtraction angiography are used to detect aneurysms in patients with subarachnoid hemorrhage. We examined a large multihospital data base to determine how practice is evolving with regard to the use of CT angiography and DSA in patients with ruptured cerebral aneurysm.

Detection and characterization of intracranial aneurysms: a 10-year multidetector CT angiography experience in a large center

“…However, CT angiography (CTA) is increasingly used for the detection and characterization of both ruptured and unruptured IA, given its non-invasive nature and similar sensitivity and specificity 7 9 13 14. CTA is increasingly used to evaluate stroke, trauma, intracranial hemorrhage, and headaches, which often leads to the incidental identification of IA 7 13 14. The increased screening and discovery of IA by CTA has resulted in a patient population with IA that differs from previous large trials in which patients with IA were evaluated by DSA 6 15.…”

Validation of cerebrospinal fluid findings in aneurysmal subarachnoid hemorrhage

“…Increasingly, multislice CT angiography has been promoted as a stand-alone test for excluding cerebral aneurysms, specifically in cases of CT-negative SAH [28][29][30][31][32][33]. In contrast, other reports have emphasized the suboptimal sensitivity of CT angiography when compared with cerebral DSA, particularly for aneurysms less than 5 mm in size [34,35].…”

Digital Subtraction Angiography for CT Angiogram Negative Haemorrhages

“…10,11 Given that DSA is resource-intensive and invasive, CTA is increasingly being used to detect ruptured aneurysms following SAH. 12 Imaging of head and neck vessels with CTA has improved since helical CT was introduced, and it provides high-resolution three-dimensional reconstructions and shorter acquisition time. 4 In addition to these improvements in technology, radiologists' increasing familiarity with interpreting source images has increased the utility of CTA.…”

“…Increased use of CTA, however, has not been accompanied by a matching decrease in DSA, resulting in multiple tests without gain in diagnostic yield. 12 Given the improvements in CTA and the disadvantages of DSA, it is imperative to investigate whether a DSA is truly necessary for a negative SAH finding on a CTA. 4 The purpose of this study was to review cases of suspected aneurysmal SAH at our institution to determine whether a CTA was sufficient to exclude a diagnosis of intracranial aneurysms in patients with suspected SAH.…”

“…- 9 Up to 20% of SAH patients have no aneurysm detected on initial angiography imaging 10 11 Given that DSA is resource-intensive and invasive, CTA is increasingly being used to detect ruptured aneurysms following SAH 12 …”