Abstract
Four-section multisection CT angiography (MSCTA) accurately detects aneurysms at or more than 4 mm but is less accurate for those less than 4 mm. Our purpose was to determine the accuracy of 64-section MSCTA (64MSCTA) in aneurysm detection versus combined digital subtraction angiography (DSA) and 3D rotational angiography (3DRA). In a retrospective review of patients studied because of acute symptoms suspicious for arising from an intracranial aneurysm, 63 subjects were included who had undergone CT angiography (CTA). Of these, 36 underwent catheter DSA; all but 4 were also studied with 3DRA. The most common indication was subarachnoid hemorrhage (SAH; n = 43). Two neuroradiologists independently reviewed each CTA, DSA, and 3DRA. A total of 41 aneurysms were found in 28 patients. The mean size was 6.09 mm on DSA/3DRA and 5.98 mm on 64MSCTA. kappa was excellent (0.97) between the aneurysm size on 64MSCTA and DSA/3DRA. Ultimately, 37 aneurysms were detected by DSA/3DRA in 25 of the 36 patients who underwent conventional angiography. The reviewers noted four 1- to 1.5-mm sessile outpouchings only on 3DRA; none were considered a source of SAH. One 64MSCTA was false positive, whereas one 2-mm aneurysm was missed by CTA. The sensitivity of CTA for aneurysms less than 4 mm was 92.3%, whereas it was 100% for those 4-10 mm and more than 10 mm, excluding the indeterminate, sessile lesions. In comparison with the available literature, 64MSCTA may have improved the detection of less than 4-mm aneurysms compared with 4- or 16-section CTA. However, the combination of DSA with 3DRA is currently the most sensitive technique to detect untreated aneurysms and should be considered in suspicious cases of SAH where the aneurysm is not depicted by 64MSCTA, because 64MSCTA may occasionally miss aneurysms less than 3-4 mm size.
Highlights
AND PURPOSE: Four-section multisection CT angiography (MSCTA) accurately detects aneurysms at or more than 4 mm but is less accurate for those less than 4 mm
A total of 66 patients (35 women and 31 men; mean age, 54.5 years; age range, 14 –93 years) clinically requiring emergent CTA for intracranial aneurysms presented during the 1-year period; 43 of these presented with subarachnoid hemorrhage (SAH)
Of the remaining 63 patients, a total of 41 aneurysms were suspected based on CTA. Of these 28 patients in whom an aneurysm was suspected on CTA, 25 patients underwent conventional angiography, whereas 37 aneurysms were confirmed by digital subtraction angiography (DSA) or surgery (Table 1)
Summary
In a retrospective review of patients studied because of acute symptoms suspicious for arising from an intracranial aneurysm, 63 subjects were included who had undergone CT angiography (CTA). Patient Selection In a retrospective review of a 1-year period (May 2006 through April 2007), patients who had clinical histories requesting urgent evaluation for intracranial aneurysm via 64MSCTA (n ϭ 66) were identified via CT logs. Three of these 66 patients were excluded who had. Review of Cases The 64MSCTA was typically performed within an hour of presentation or detection of SAH The interpretation of these acute examinations was performed emergently by the combination of an on-call resident physician with the staff neuroradiologist immediately after the procedure. Each CTA’s quality was graded as “good” (diagnostic quality with adequate arterial visualization on 3Dvolume rendered [3D-VR], maximum intensity projection [MIP], and multiplanar reformats [MPRs]); “fair” (mildly limited 3D reconstruction visualization of arterial structure due to contrast bolus or motion, though with adequate MPRs); “poor” (severely limited [but visible] arterial visualization with inadequate MPR images); or “failed” (complete lack of visible arteries)
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