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

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

Öz

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

Anahtar Kelimeler

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

Kaynakça

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