Απεικόνιση των ενδοκρανιακών αγγείων με την ψηφιακή αγγειογραφία (DSA) συγκριτικά με την ελικοειδή CT αγγειογραφία (CTA)

Abstract

Cerebral CT angiography is an established method applied to both the detection and treatment planning of intracranial aneurysms. The aim of our study was to compare DSA to CTA findings and with the surgical results mainly in patients with acute SAH and to evaluate the clinical usefulness of CTA. During the last three years, 82 consecutive patients were admitted under clinical symptoms and signs suggestive of harbouring an intracranial aneurysm. CT angiography performed immediately afterwards the plain CT, while DSA was performed within the first 48 hours 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. 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%. Consequently, the sensitivity of DSA was 87.8%, the specificity 98%, the PPV 97.7%, the NPV 89.1% and the accuracy 92.9%. Considering the aneurysms ≥ 3 mm, CTA showed a sensitivity ranging from 93.3% to 100%, equal to that of DSA. Cerebral CT angiography has an equal sensitivity to DSA in the detection of intracranial aneurysms greater than 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. A supplement to the above work is our effort to describe a technique for simulating the surgical view of ruptured intracranial aneurysms, using volume 82 rendering techniques in spiral CT angiography data. The 3D rendered images were assessed by a team consisted of four radiologists, one neurosurgeon and one medical physicist. The resultant ‘surgical view’ image was standardized in space using a three-dimensional coordinate system, which allowed for its reproduction in the operating theatre. The surgical views are easily reproducible and αποτeλούν a useful tool for the surgical planning of intracranial aneurysms.