Multislice CT angiography in the selection of patients with ruptured intracranial aneurysms suitable for clipping or coiling (original) (raw)
Related papers
The Efficacy of Computed Tomographic Angiography in Identification of Intracranial Aneurysms
Life Science Journal, 2014
Objective: Computed tomographic angiography (CTA) has surfaced as a valuable non-invasive diagnostic modality in the management of intracranial aneurysms (IAs). In this study, the author reports the accuracy of CTA versus digital subtraction angiography (DSA) in the assessment of patients with IAs. Methods: A retrospective review was conducted for all patients investigated for IAs with both CTA and DSA using standard imaging protocols at king Abdulaziz university hospital between January 2008 and December 2013. Thirty-one patients with IAs underwent evaluation with CTA and DSA during the study period. Comparison between the two modalities included accuracy of detection of IAs was assessed. Results: Patient's age ranged from 17 and 70 years (average 42.8 ± 7.9 years), and 20 patients (64.5%) were females. SAH was the initial presentation in 20 patients (64.5%), five patients (16%) with headache and seizures disorder had a mass lesion on CT scans demonstrating a large IAs, and CT scans were normal in 6 patients (19.4%). Both of CTA and DSA studies detected 29 IAs in 28 patients (90.3%). Three patients had no IAs detected in both CTA and DSA examinations, in one patient operated for repeated SAH with intracerbral hematoma, a small internal carotid artery blister was detected intraoperatively and clipped. Twenty-two patients (78.6%) underwent craniotomy and microsurgical clipping of IAs, and endovascular coiling was performed in 6 patients. CTA was effective in the post-treatment follow up and evaluation of IAs; however, in two patients CTA was not accurate in assessing the recurrence of the aneurysms. Conclusion: CTA provides accurate and valuable information for patients with cerebral aneurysms. It can be used alone for the diagnosis, treatment planning, and post-treatment follow up of IAs.
Neuroradiology, 2004
Computed tomographic angiography (CTA) and magnetic resonance angiography (MSA) have been used recently for evaluation of intracranial aneurysms. If they are to replace conventional digital subtraction angiography (DSA), their sensitivity and specificity should be equal to the latter. In order to determine whether computed tomographic angiography and magnetic resonance angiography can provide the necessary information for presurgical evaluation we compared blindly the results of helical CT angiography and MR angiography with the results of digital subtraction angiography and the intraoperative findings. We evaluated 35 patients with the possible clinical diagnosis of intracranial aneurysm. Our data suggest that both CTA and MRA can provide valuable preoperative information concerning the location, the characteristics and the relationships of most intracranial aneurysms. Both original and reconstructed images should be evaluated together for higher accuracy. In addition helical CT, being a fast, inexpensive and noninvasive method, can be used as a reliable alternative to DSA in emergency situations demanding immediate operation.
Journal of neuroradiology. Journal de neuroradiologie, 2007
The aim of this study was to determine the accuracy of multi-detector row computed tomography angiography (CTA) for the triage of patients with acutely ruptured aneurysms, and to assess how therapeutic decisions based on this method compared with digital subtraction angiography (DSA). Twenty-seven consecutive patients with acute subarachnoid hemorrhage were included, and underwent both CTA and DSA. CTA was performed on a 16-detector row CT scanner with a 0.75-mm collimation and a 0.558-beam pitch. Two readers reviewed the CTA data, and two different readers reviewed the DSA data. Aneurysm characteristics were recorded and treatment by surgical clipping or endovascular coil embolization was proposed. A total of 24 aneurysms were identified on DSA in 21 patients. Sensitivity and specificity for CTA were 100% and 83%, respectively, on a per-aneurysm-basis. The correlation between DSA and CTA for the determination of sac and neck sizes was very good (r=0.92, and r=0.95, respectively, P&...
2021
Purpose: To study the agreement between digital subtraction angiography (DSA) and computed tomographic angiography (CTA) measurements on the aneurysmal neck and sac of ruptured intracranial aneurysms (IAs). Material and Methods: Through a retrospective agreement analysis of all consecutive patients who reached our Tertiary Hospital with aneurysmal subarachnoid haemorrhage, we measured the intra-class correlation, Lin’s concordance correlation and Bland-Altman analysis estimates on the maximal neck and sac diameters. We included patients who underwent both CTA and DSA in the period between 2012 and 2018. All CTA examinations were acquired using one of two CT scanners: a Toshiba Aquilion 16 CT scanner and a multi-detector Philips Ingenuity 128 CT scanner. Results: Thirty-two patients (mean age of 55 years) and an equal number of IAs fulfilled our eligibility criteria. Most IAs (87.5%) were located at the anterior circulation. Based on CTA measurements, the inter-observer agreement of ...
BACKGROUND AND PURPOSE: The purpose of this work was to assess intertechnique and interobserver reproducibility of 64-row multisection CT angiography (CTA) used to detect and evaluate intracranial aneurysms. , 54 consecutive patients with nontraumatic subarachnoid hemorrhage (SAH) underwent both CTA and digital substraction angiography (DSA). Four radiologists independently reviewed CT images, and 2 other radiologists reviewed DSA images. Aneurysm diameter (D), neck width (N), and the presence of a branch arising from the sac were assessed. RESULTS: DSA revealed 67 aneurysms in 48 patients and no aneurysm in 6 patients. Mean sensitivity and specificity of CTA for the detection of intracranial aneurysms were, respectively, 94% and 90.2%. For aneurysms less than 3 mm, CTA had a mean sensitivity of 70.4%. Intertechnique and interobserver agreements were good for the detection of aneurysms (mean ϭ 0.673 and 0.732, respectively) and for the measurement of their necks (mean ϭ 0.753 and 0.779, respectively). Intertechnique and interobserver agreements were excellent for the measurement of aneurysm diameters (mean ϭ 0.847 and 0.876, respectively). In addition, CTA was accurate in determining the N/D ratio of aneurysms and adjacent arterial branches. However, the N/D ratio was overestimated by all of the readers at CTA. CONCLUSION: Sixty-four-row multisection CTA is an imaging method with a good interobserver reproducibility and a high sensitivity and specificity for the detection and the morphologic evaluation of ruptured intracranial aneurysms. It may be used as an alternative to DSA as a first-intention imaging technique in patients with SAH.
American Journal of Neuroradiology, 2007
BACKGROUND AND PURPOSE: The purpose of this work was to assess intertechnique and interobserver reproducibility of 64-row multisection CT angiography (CTA) used to detect and evaluate intracranial aneurysms. , 54 consecutive patients with nontraumatic subarachnoid hemorrhage (SAH) underwent both CTA and digital substraction angiography (DSA). Four radiologists independently reviewed CT images, and 2 other radiologists reviewed DSA images. Aneurysm diameter (D), neck width (N), and the presence of a branch arising from the sac were assessed. RESULTS: DSA revealed 67 aneurysms in 48 patients and no aneurysm in 6 patients. Mean sensitivity and specificity of CTA for the detection of intracranial aneurysms were, respectively, 94% and 90.2%. For aneurysms less than 3 mm, CTA had a mean sensitivity of 70.4%. Intertechnique and interobserver agreements were good for the detection of aneurysms (mean ϭ 0.673 and 0.732, respectively) and for the measurement of their necks (mean ϭ 0.753 and 0.779, respectively). Intertechnique and interobserver agreements were excellent for the measurement of aneurysm diameters (mean ϭ 0.847 and 0.876, respectively). In addition, CTA was accurate in determining the N/D ratio of aneurysms and adjacent arterial branches. However, the N/D ratio was overestimated by all of the readers at CTA. CONCLUSION: Sixty-four-row multisection CTA is an imaging method with a good interobserver reproducibility and a high sensitivity and specificity for the detection and the morphologic evaluation of ruptured intracranial aneurysms. It may be used as an alternative to DSA as a first-intention imaging technique in patients with SAH.
Stroke, 2005
Patients with a history of aneurysmal subarachnoid hemorrhage may have aneurysms on screening several years after the hemorrhage. For determining the benefits of follow-up screening, it is important to know whether these aneurysms have developed after the hemorrhage or are visible in retrospect, and if so, whether the size has increased. Aneurysms were categorized into de novo aneurysms and aneurysms visible in retrospect (already present) with increased or stable size. We studied aneurysm characteristics for these 3 categories: the relation between aneurysm development or enlargement and duration of follow up and the relation between enlargement and initial size of the aneurysm. In 87 of 495 patients (17.6%), aneurysms were detected; for 51 of these patients with 62 aneurysms, the original catheter or computed tomographic angiogram was available for comparison. Of the 62 aneurysms, 19 were de novo and 43 were visible in retrospect, 10 with increased size and 33 with stable size. De novo aneurysms were mainly < or =5 mm (95%) and located at the middle cerebral artery (63%). For aneurysms visible in retrospect, the most frequent location was the posterior communicating artery (21%). There was no relation between the development of de novo aneurysms or enlargement and the duration of follow-up or between enlargement and the initial size of the aneurysm. Of aneurysms detected at screening, one third were de novo and two thirds were missed at the time of the initial hemorrhage. One quarter of initially small aneurysms had enlarged during follow-up.
Neurosurgery, 1999
Background Computed tomographic angiography (CTA) has recently emerged as a non-invasive alternative to digital subtraction angiography (DSA) for the detection of residual cerebral aneurysms (RA). Objective To compare the diagnostic accuracy of CTA with the current 'gold standard', DSA, in the postoperative detection of RA. Methods Patient data from this single institution were prospectively gathered, and imaging results retrospectively blinded and analyzed. Between 2001 and 2005 eligible patients received microsurgical repair of cerebral aneurysms and were evaluated postoperatively by DSA and CTA. These single-institutional data were compiled with qualified studies published from 1997 to 2009, and a meta-analysis was performed. Results This institutional series reports sensitivity, specificity, positive (PPV) and negative predictive values (NPV) of 100%. Eleven studies met the inclusion criteria for the meta-analysis. A total of 427 patients with 513 aneurysms were included, with 61 RA detected by DSA and 40 detected by CTA. Unweighted analysis resulted in pooled sensitivity of 73.8%, specificity of 96.3%, PPV of 91.0% and NPV of 86.1%. Stratified analysis of studies using 16-slice CTA versus 2D DSA reported pooled sensitivity of 92.6%, specificity of 99.3%, PPV of 95.8%, and NPV of 97.8%. Conclusions This meta-analysis supports CTA as an acceptable modality for postoperative detection of RA, although DSA remains the gold standard. By implementing multidetector CTA technology in experienced centers, the sensitivity and specificity of CTA may approach that of traditional DSA for detecting RA. As a cost-effective, non-invasive modality, CTA is a promising alternative to DSA for initial and long-term evaluation of RA.
Acta Neurochirurgica, 2003
Background. Computed tomography (CT) is the ''gold standard'' for detecting subarachnoid haemorrhage (SAH) and digital subtraction angiography (DSA) for visualising the vascular pathology. We studied retrospectively 180 patients with subarachnoid haemorrhage (SAH) who underwent first non-enhanced computed tomography (CT), then digital subtraction angiography (DSA) and finally operative aneurysm clipping. Our aim was to assess if the location of the ruptured aneurysm could be predicted on the basis of the quantity and distribution of haemorrhage on the initial CT scan.
Computed Tomographic Angiography for the Evaluation of Aneurysmal Subarachnoid Hemorrhage
Academic Emergency Medicine, 2006
Objectives: Computed tomography (CT) followed by lumbar puncture (LP) is currently the criterion standard for diagnosing subarachnoid hemorrhage (SAH) in the emergency department (ED); however, this is based on studies involving a limited number of patients. The authors sought to assess the ability of CT angiography (CTA), a new diagnostic modality, in conjunction with CT/LP to detect SAH. Methods: Consecutive patients presenting to the ED with symptoms concerning for SAH were approached. All patients had an intravenous catheter placed and underwent a noncontrast head CT followed by CTA. Patients whose CT did not reveal evidence of SAH or other pathology underwent LP in the ED. CTAs were read within 24 hours by a neuroradiologist blinded to the patient's history. Results: A total of 131 patients were approached, 116 were enrolled, and 106 completed the study. In six of 116 patients (5.1%), aneurysm was found on CTA with normal CT and positive findings on LP; three had a positive CTA with normal CT and LP findings (one of which had a negative cerebral angiogram), and there was one false-positive CTA. Follow-up of all 131 patients showed no previously undiagnosed intracranial pathology. In this patient population, 4.3% (5/116) were ultimately found to have an SAH and/or aneurysm. Conclusions: In this pilot study, CTA was found to be useful in the detection of cerebral aneurysms and may be useful in the diagnosis of aneurysmal SAH. A larger multicenter study would be useful to confirm these results.