Detection and evaluation of intracranial aneurysms with 16-row multislice CT angiography
Introduction
Intra-arterial digital subtraction angiography (DSA) remains the accepted gold standard for the diagnostic work-up of suspected intracranial aneurysms. Concerns over the small but potentially significant risk of permanent neurological complications associated with DSA has generated growing interest in the use of alternative non-invasive techniques, among which CT angiography (CTA) has emerged as the method of choice.1, 2 The advantages of CTA have been well described previously.2 CTA is safe, relatively inexpensive and can be performed immediately after routine un-enhanced CT of the brain with a single bolus of intravenous contrast medium, thereby allowing rapid diagnosis and treatment decisions. Moreover, images of diagnostic quality can be acquired swiftly in confused or uncooperative patients, obviating the need for intravenous sedation or general anaesthesia for the lengthier DSA. Early studies of CTA using single-slice technology have, however, shown limited diagnostic accuracy in the detection of small aneurysms less than 3 mm in diameter.3, 4, 5, 6, 7 Over the last few years, implementation of multidetector row spiral CT technology has led to considerable improvement in the quality and spatial resolution of 2D and 3D reconstructions, which can now easily be viewed in any direction with commercially available workstations and software. Recent studies reporting on the use of four-detector row multislice CTA have generally shown promisingly high accuracy for the detection of small aneurysms as well as excellent depiction of morphological characteristics and related surgical anatomy.8, 9, 10 The main objective of this study is to report our early experience with 16-detector row multislice spiral CTA in the detection and pretreatment evaluation of intracranial aneurysms compared with DSA or findings at surgery or both, and coiling.
Section snippets
Subjects
Between March and October 2003, consecutive adults who were scheduled for conventional DSA for suspected intracranial aneurysm were prospectively recruited in the study to have a CTA examination. The study was approved by the local ethics committee. Written informed participant consent or relative's assent was obtained in all cases.
Imaging protocols
Conventional four-vessel DSA was performed by one of three attending neuroradiologists, on a digital angiographic unit (Angioskop, Siemens, Erlangen, Germany) via
Population
A total of 57 subjects (26 women, 31 men, mean age 53 years, range 22 to 81 years) was prospectively recruited and completed both examinations. One man was excluded because he refused consent. In another case, the CTA examination was abandoned because extravasation of contrast material caused local pain at the injection site after an intravenous cannula malfunctioned. Clinical indications for DSA were as follows: SAH on CT (n=45), xanthochromia on lumbar puncture (n=7), strong clinical
Discussion
There have been previous concerns regarding the ability of single-slice spiral CTA to detect small aneurysms of less than 3 mm in diameter.3, 4, 5, 6 A systematic review published in 1998, focusing mainly on single-slice spiral CTA, found an alarmingly low sensitivity of 61% for such aneurysms.3 Recent initial reports of first-generation four-detector row multislice CTA have been generally encouraging, although a cut-off of 2 mm has emerged as the size below which aneurysm detection may be
Acknowledgements
We are grateful to H. Szutowicz, M. Varley, T. Lewis, G. Wright, R. Holloway, K. Austen and C. Streater of Addenbrooke's Hospital for their general support and expertise.
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G. Tipper and J.M. U-King-Im are equal first co-authors of this manuscript.