Sixty-Four-Row Multisection CT Angiography for Detection and Evaluation of Ruptured Intracranial Aneurysms: Interobserver and Intertechnique Reproducibility (original) (raw)
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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.
Egyptian Journal of Neurology, Psychiatry and Neurosurgery
Background: Accurate localization of intracranial aneurysms is crucial for determining the appropriate treatment. Objective: To emphasize on the accuracy of evaluation of intracranial aneurysms using CT angiography (CTA) technique. Methods: Twenty two patients with intracranial aneurysms were included in this study. They were evaluated clinically and radiologically using multislice CT angiography of the brain. Digital subtraction angiography was performed for 6 patients. Surgical clipping was performed for treatment. Results: Twenty four aneurysms were found in 22 patients with subarachnoid hemorrhage: 23 were clipped surgically. The site of aneurysms included: 11 anterior communicating artery, 8 middle cerebral artery, 2 posterior communicating artery, 1 posterior cerebral artery, and 1 carotid bifurcation aneurysms. The sensitivity and positive predictive value of detection of aneurysms >3mm was 100% compared to surgical findings. One aneurysm, 2.7mm in diameter, was suspicious...
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 ...
European Journal of Radiology, 2004
Introduction: Cerebral CT angiography (CTA) is an established method applied to both the detection and treatment planning of intracranial aneurysms. The aim of our study was to compare CTA and digital subtraction angiography (DSA) findings with the surgical results mainly in patients with acute SAH and to evaluate the clinical usefulness of CTA. Materials and methods: During the last 2 years, 82 consecutive patients were admitted under clinical symptoms and signs suggestive of harboring an intracranial aneurysm. CT angiography performed immediately afterwards the plain CT, while DSA was performed within the first 48 h of admission. All aneurysms detected were confirmed during surgery or endovascular embolization. Repeat DSA was performed in all patients having both the initial CTA and the DSA 15 days after the onset of symptoms negative. CT angiograms and conventional angiographies were studied by a consensus of two radiologists for each technique, who performed aneurysm detection, morphological features characterization and evaluation of the technique. Results: Surgical or/and endovascular treatment was performed in 45 patients and 53 aneurysms were confirmed. Using 3D-CT angiography, we detected 47 aneurysms in 42 patients. Conventional angiography depicted 43 aneurysms in 39 patients. The sensitivity of CTA for the detection of all aneurysms versus surgery was 88.7%, the specificity 100%, the positive predictive value (PPV) 100%, the negative predictive value (NPV) 80.7% and the accuracy 92.3%. Accordingly, the sensitivity of DSA was 87.8%, the specificity 98%, the PPV 97.7%, the NPV 89.1% and the accuracy 92.9%. Considering aneurysms ≥3 mm, CTA showed a sensitivity ranging from 93.3 to 100%, equal to that of DSA. Conclusion: Cerebral CT angiography has an equal sensitivity to DSA in the detection of intracranial aneurysms >3 mm. It has also 100% detection rate in AcoA and MCA bifurcation aneurysms, while some locations, like posterior communicating artery aneurysms, remain problematic. The delineating features of each aneurysm are better depicted with CTA due to 3D visualization. The use of digital subtraction angiography as a diagnostic tool can be limited in equivocal cases.
Neuroradiology, 2007
Introduction We sought to establish whether CT angiography (CTA) can be applied to the planning and performance of clipping or coiling in ruptured intracranial aneurysms without recourse to intraarterial digital subtraction angiography (IA-DSA). Methods Over the period April 2003 to January 2006 in all patients presenting with a subarachnoid haemorrhage CTA was performed primarily. If CTA demonstrated an aneurysm, coiling or clipping was undertaken. IA-DSA was limited to patients with negative or inconclusive CTA findings. We compared CTA images with findings at surgery or coiling in patients with positive CTA findings and in patients with negative and inconclusive findings in whom IA-DSA had been performed. Results In this study, 224 consecutive patients (mean age 52.7 years, 135 women) were included. In 133 patients (59%) CTA demonstrated an aneurysm, and CTA was followed directly by neurosurgical (n=55) or endovascular treatment (n=78). In 31 patients (14%) CTA findings were categorized as inconclusive, and in 60 (27%) CTA findings were negative. One patient received surgical treatment on the basis of false-positive CTA findings. In 17 patients in whom CTA findings were inconclusive, IA-DSA provided further diagnostic information required for correct patient selection for any therapy. Five ruptured aneurysms in patients with a nonperimesencephalic SAH were negative on CTA, and four of these were also false-negative on IA-DSA. On a patient basis the positive predictive value, negative predictive value, sensitivity, specificity and accuracy of CTA for symptomatic aneurysms were 99%, 90%, 96%, 98% and 96%, respectively. Conclusion CTA should be used as the first diagnostic modality in the selection of patients for surgical or endovascular treatment of ruptured intracranial aneurysms. If CTA renders inconclusive results, IA-DSA should be performed. With negative CTA results the complementary value of IA-DSA is marginal. IA-DSA is not needed in patients with negative CTA and classic perimesencephalic SAH. Repeat IA-DSA or CTA should still be performed in patients with a nonperimesencephalic SAH.
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.