Comparison of 64 Dedector Cranial CT Angiography with Intra-Arterial DSA For Detection of Intracranial Aneurysms

Year 2014, , 136 - 140, 01.09.2014

Ahmet Peker Elif Peker İlkay Akmangit İlhan Erden

https://doi.org/10.15197/sabad.1.11.58

Abstract

The purpose of our study was to compare findings of 64 detector cranial computed tomographic angiography (CTA) and conventional digital subtraction angiography (DSA) mainly in patients with acute subarachnoid hemorrhage (SAH) headache and diplopia. Between March 2007 and May 2009, 65 consecutive patients were admitted with clinical symptoms and signs of intracranial aneurysm. 44 of 67 detected aneurysms were confirmed during surgery or endovascular embolization. DSA was performed in the 3 days after CTA. CT angiograms and conventional angiographies were studied by two radiologists, who performed aneurysm detection and characterisation of morphological features. Using CTA and DSA, we detected 67 aneurysms in 50 patients. 15 patients did not have any aneurysms in both DSA and CTA. There was no difference between the two modalities in the number of the detected aneurysms. But two aneurysms were falsely located before surgery with CTA. They were located in posterior communicating artery (PcoA) but, had been thought to be located at the internal carotid artery supraclinoid segment at CTA. CTA has an equal sensitivity as DSA in the detection of intracranial aneurysms. It has 100% detection rate in anterior communicating artery and middle cerebral artery bifurcation aneurysms, but aneurysms at some locations, like the ones at PcoA, were hard to detect with CTA. DSA preserves its diagnostic value for detection of posterior circulation aneurysms.

Keywords

Intracranial aneurysm, subarachnoid hemorrhage, multislice computed tomography, digital subtraction angiography

Comparison of 64 Dedector Cranial CT Angiography with Intra-Arterial DSA For Detection of Intracranial Aneurysms

Abstract

Çalışmamızın amacı esas olarak akut subaraknoid kanaması, baş ağrısı ve diplopisi olan hastalarda 64 kesitli kranyal bilgisayarlı tomografi anjiyografi görüntüleri ile konvansiyonel dijital çıkarmalı anjiyografi görüntülerinin karşılaştırılmasıdır. Mart 2007 ve Mayıs 2009 tarihleri arasında intrakranyal anevrizma düşündüren klinik semptom ve bulguları olan 65 hasta kabul edilmiştir. Saptanan 67 anevrizmanın 44’ü cerrahi veya endovasküler tedavi ile doğrulanmıştır. Dijital çıkarmalı anjiyografi incelemesi, bilgisayarlı tomografi anjiyografi yapıldıktan sonraki 3 gün içinde gerçekleştirilmiştir. Bilgisayarlı tomografi anjiyografi ve dijital çıkarmalı anjiyografi incelemeleri iki radyolog tarafından değerlendirilmiştir. Bilgisayarlı tomografi anjiyografi ve dijital çıkarmalı anjiyografi incelemelerinde 50 hastada 67 anevrizma saptanmıştır. 15 hastada bilgisayarlı tomografi anjiyografi ve dijital çıkarmalı anjiyografide anevrizma izlenmemiştir. Saptanan anevrizmaların sayısı bakımından her iki inceleme arasında fark izlenmemiştir. Ancak 2 anevrizma bilgisayarlı tomografi anjiyografi ile yanlış lokalize edilmiştir. Posterior komünikan arter yerleşimli olmalarına rağmen internal karotis arter supraklinoid segment yerleşimli oldukları düşünülmüştür. İntrakranyal anevrizmaların saptanmasında bilgisayarlı tomografi anjiyografinin duyarlılığı dijital çıkarmalı anjiyografi ile eşittir. Anterior komünikan arter ve orta serebral arter bifurkasyon anevrizmalarını saptama oranı %100 iken, posterior komünikan arter gibi bazı bölgelerdeki anevrizmaları bilgisayarlı tomografi anjiyografi ile lokalize etmek güçtür. Dijital çıkarmalı anjiyografinin arka dolaşım anevrizmalarının saptanmasındaki tanısal değeri devam etmektedir

Keywords

İntrakranyal anevrizma, subaraknoid kanama, çok kesitli bilgisayarlı tomografi, dijital çıkarmalı anjiyografi

References

• Karamessini MT, Kagadis GC, Petsas T, et al. CT angiog- raphy with three-dimensional techniques for the early diagnosis of intracranial aneurysms. Comparison with intra-arterial DSA and the surgical findings. Eur J Radiol 2004; 49:212-223.
• Boet R, Poon WS, Lam JMK, Yu SCH. The surgical treat- ment of intracranial aneurysms based on computer tomo- graphic angiography alone-streamlinig the acute amange- ment of symptomatic aneurysms. Acta Neurochir 2003; 145:101-105.
• Amagasaki K, Sato T, Kakizawa T, Shimizu T. Treat ment of ruptured anterior circulation aneurysm based on comput- erized angiography: surgical results and indications for additonal digital subtraction angiography. J Clin Neurosci 2002; 9(1):22-29.
• Velthuis BK, Rinkel GJE, Ramos LMP, et al. Subarachnoid hemorrhage: aneurysm detection-preoperative evalu- ation with CT angiography. Radiology 1998; 208(2):423- 430.
• Anderson GB, Findlay JM, Steinke DE, Ashforth R. Experience with computed tomographic angiography for the detection of intracranial aneurysms in the setting of acute subarachnoid hemorrhage. Neurosurgery 1997; 41(3):522-527.
• Anderson GB, Steinke DE, Petruk KC, Ashforth R. Findlay JM. Computed tomographic angiography versus digital subtraction angiography for the diagnosis and early treat- ment of ruptured intracranial aneurysms. Neurosurgery 1999; 45(6):1315-1320.
• Korogi Y, Takahashi M, Katada K, et al. Intracranial an- eurysms: detection with three-dimensional CT angiog- raphy with volume rendering-comparison with conven- tional angiographic and surgical findings. Radiology 1999; 211(2):497-506.
• Villablanca JP, Jahan R, Hooshi P, et al. Detection and characterization of very small cerebral aneurysms by using 2D and 3D helical CT angiography. AJNR Am J Neuroradiol 2002; 23(7):1187-1198.
• White PM, Teasdale EM, Wardlaw JM, Easton V. Intracranial aneurysms: CT Angiography and MR angiog- raphy for detection-prospective blinded comparison in a large patient cohort. Radiology 2001; 219:739-749.
• Hankey GJ, Warlow CP, Sellar RJ. Cerebral angiographic risk in mild cerebrovascular disease. Stroke 1990; 21:209- 222.
• Jayaraman MV, Mayo-Smith WW, Tung GA, et al. Detection of intracranial aneurysms: multi-detector row CT angiog- raphy compared with DSA. Radiology 2004; 230:510-518.
• Alberico RA, Patel M, Casey S, Jacobs B, Maguire W, Decker R. Evaluation of the circle of willis with three- dimensional CT angiography in patients with suspected intracranial aneurysms. AJNR Am J Neuroradiol 1995; 16:1571-1578.
• Teksam M, McKinney A, Casey S, Asis M, Kieffer T, Truwit CL. Multi-section CT angiography for detection of cere- bral aneurysms. AJNR Am J Neuroradiol 2004; 25:1485- 1492.
• Hochmuth A, Spetzger U, Schumacher M. Comparison of 3-dimensional rotational angiography with digital subtraction angiography in the assesment of ruptured intracranial aneurysms. AJNR Am J Neuroradiol 2002; 23(7):1199-1205.
• Hirai T, Korogi Y, Ono K, et al. Preoperative evaluation of intracranial aneurysms: usefulness of intraarterial 3D CT angiography and conventional angiography with a com- bined unit-initial experience. Radiology 2001; 220:499- 505.
• Waugh JR, Sacharias N. Arteriographic complications in the DSA era. Radiology 1992; 182:243-246.
• Shrier DA, Tanaka H, Numaguchi Y, Konno S, Patel U, Shibata D. CT angiography in the evaluation of acute stroke. AJNR Am J Neuroradiol 1997; 18:1011-1020.