Abstract
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 the CTA was “weak” regarding the neck diameter, and ranged from “strong” (2D-CTA) to “very-strong” (3D-CTA) regarding the sac measurements. Based on DSA readings, the 2D-CTA was more precise than 3D-CTA regarding the neck (overestimated by 0.91 mm and 0.94 mm, respectively) and the sac diameters (overestimated by 0.49 and 0.51 mm, respectively). Accordingly, the mean normalised smallest detectable differences (MNSDD) of 2D-CTA were 0.93 mm and 0.41 mm for the neck and sac, respectively. Likewise, the MNSDD regarding 3D-CTA were 0.93 mm and 0.36 mm for the neck and sac, respectively. Conclusions: CTA is an imaging modality, which seems to describe the size of a ruptured IA sac accurately, but fails to delineate the morphology of the aneurysmal neck. CTA seems to overestimate the aneurysm neck, and thus, it is probably inferior to DSA in the decision-making process for the management of ruptured IAs of the anterior circulation.
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