Related Experiment Videos
Volume-rendered helical computerized tomography angiography in the detection and characterization of intracranial
J P Villablanca1, N Martin, R Jahan
1Department of Neurosurgery, Radiological Sciences, University of California, Los Angeles 90095, USA. pablo@ucla.edu
Insights
Volume-rendered helical computerized tomography (CT) angiography is as effective as digital subtraction (DS) angiography for detecting brain aneurysms. CT angiography surpasses DS and MR angiography in characterizing aneurysms, significantly impacting patient management.
Area of Science:
- Neuroradiology
- Medical Imaging
- Neurosurgery
Background:
- Intracranial aneurysms pose significant risks, necessitating accurate diagnostic imaging.
- Evaluating the efficacy of advanced imaging techniques is crucial for optimal patient care.
Purpose of the Study:
- To assess the diagnostic utility of volume-rendered helical CT angiography for intracranial aneurysms.
- To compare CT angiography with digital subtraction (DS) angiography and MR angiography in aneurysm characterization.
Main Methods:
- Helical CT angiography with volume-rendered multiplanar reformatted (MPR) images was performed on 45 patients.
- DS angiography and MR angiography were also conducted and all studies were interpreted in a blinded manner.
- Neurosurgeons and neuroradiologists graded the utility of CT angiography for aneurysm characterization.
Main Results:
- CT angiography was superior to DS and MR angiography in evaluating aneurysm neck geometry, arterial branching, and mural characteristics (thrombus, calcification).
- CT angiography significantly impacted treatment decisions, including surgical approach and clip/coil selection.
- CT angiography provided unique, valuable information for 81% of evaluated aneurysms, with sensitivity and specificity of 1 compared to DS angiography.
Conclusions:
- Volume-rendered helical CT angiography is a valuable tool for intracranial aneurysm diagnosis and characterization.
- CT angiography demonstrates parity with DS angiography in detection and superiority in characterization, influencing clinical management.
Object:
The goal of this study was to evaluate the utility of volume-rendered helical computerized tomography (CT) angiography in patients with intracranial aneurysms. The authors compared the abilities of CT angiography, digital subtraction (DS) angiography, and three-dimensional time-of-flight magnetic resonance (MR) angiography to characterize aneurysms.
Methods:
Helical CT angiography was performed in 45 patients with suspected intracranial aneurysms by using volume-rendered multiplanar reformatted (MPR) images. Digital subtraction angiography was performed using biplane angiography. These studies and those performed using MR angiography were interpreted in a blinded manner. Two neurosurgeons and two interventional neuroradiologists independently graded the utility of CT angiography with respect to aneurysm characterization. Fifty-five aneurysms were detected. Of these, 48 were evaluated for treatment. Computerized tomography angiography was judged to be superior to both DS and MR angiography in the evaluation of the arterial branching pattern at the aneurysm neck (compared with DS angiography, p = 0.001, and with MR angiography, p = 0.007), aneurysm neck geometry (compared with DS angiography, p = 0.001, and with MR angiography, p = 0.001), arterial branch incorporation (compared with DS angiography, p = 0.021, and with MR angiography, p = 0.001), mural thrombus (compared with DS angiography, p < 0.001), and mural calcification (compared with DS angiography, p < 0.001, and with MR angiography, p < 0.001). For surgical cases, CT angiography had a significant impact on treatment path (p = 0.001), operative approach (p = 0.001), and preoperative clip selection (p < 0.001). For endovascular cases, CT angiography had an impact on treatment path (p < 0.02), DS angiography study time (p = 0.01), contrast agent usage (p = 0.01), and coil selection (p = 0.02). Computerized tomography angiography provided unique information about 39 (81%) of 48 aneurysms, especially when compared with DS angiography (p = 0.003). The sensitivity and specificity of CT angiography compared with DS angiography was 1. The sensitivity and specificity of CT and DS angiography studies compared with operative findings were 0.98 and 1, respectively.
Conclusions:
Computerized tomography angiography is equal to DS angiography in the detection and superior to DS angiography and MR angiography in the characterization of brain aneurysms. Information contained in volume-rendered CT angiography images had a significant impact on case management.