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Detection of intracranial aneurysms: multi-detector row CT angiography compared with DSA
Mahesh V Jayaraman1, William W Mayo-Smith, Glenn A Tung
1Department of Diagnostic Imaging, Rhode Island Hospital/Brown Medical School, Providence, USA. maheshj@stanford.edu
Insights
Multi-detector row CT angiography effectively detects intracranial aneurysms in patients with subarachnoid hemorrhage. This advanced imaging technique shows high sensitivity and specificity, even for small aneurysms.
Area of Science:
- Radiology
- Neuroimaging
- Vascular Imaging
Background:
- Nontraumatic acute subarachnoid hemorrhage (SAH) is a critical condition often caused by intracranial aneurysms.
- Early and accurate detection of aneurysms is crucial for timely treatment and improved patient outcomes.
- Conventional intraarterial digital subtraction angiography (DSA) is a gold standard but is invasive.
Purpose of the Study:
- To prospectively compare the diagnostic effectiveness of multi-detector row computed tomographic (CT) angiography against conventional intraarterial digital subtraction angiography (DSA).
- To evaluate the ability of multi-detector row CT angiography to detect intracranial aneurysms in patients presenting with acute subarachnoid hemorrhage.
Main Methods:
- A prospective study involving 35 adult patients with acute subarachnoid hemorrhage.
- All patients underwent both multi-detector row CT angiography and DSA within 12 hours.
- Image interpretation was performed by independent radiologists in a blinded fashion, with DSA serving as the reference standard.
Main Results:
- A total of 26 aneurysms were identified in 21 patients via DSA.
- Multi-detector row CT angiography demonstrated high sensitivity (90% and 81%) and specificity (93% for both readers).
- The technique successfully detected small aneurysms, with the smallest identified being 2.2 mm in diameter.
Conclusions:
- Multi-detector row CT angiography is a highly sensitive and specific imaging modality for detecting intracranial aneurysms.
- This technique is effective even for identifying small aneurysms in the context of acute subarachnoid hemorrhage.
- CT angiography offers a valuable non-invasive alternative for aneurysm detection in SAH patients.
Purpose:
To prospectively compare the effectiveness of multi-detector row computed tomographic (CT) angiography with that of conventional intraarterial digital subtraction angiography (DSA) used to detect intracranial aneurysms in patients with nontraumatic acute subarachnoid hemorrhage.
Materials And Methods:
Thirty-five consecutive adult patients with acute subarachnoid hemorrhage were recruited into the institutional review board-approved study and gave informed consent. All patients underwent both multi-detector row CT angiography and DSA no more than 12 hours apart. CT angiography was performed with a multi-detector row scanner (four detector rows) by using collimation of 1.25 mm and pitch of 3. Images were interpreted at computer workstations in a blinded fashion. Two radiologists independently reviewed the CT images, and two other radiologists independently reviewed the DSA images. The presence and location of aneurysms were rated on a five-point scale for certainty. Sensitivity and specificity were calculated independently for image interpretation performed by the two CT image readers and the second DSA image reader by using the first DSA reader's interpretation as the reference standard.
Results:
A total of 26 aneurysms were detected at DSA in 21 patients, and no aneurysms were detected in 14 patients. Sensitivity and specificity for CT angiography were, respectively, 90% and 93% for reader 1 and 81% and 93% for reader 2. The mean diameter of aneurysms detected on CT angiographic images was 4.4 mm, and the smallest aneurysm detected was 2.2 mm in diameter. Aneurysms that were missed at initial interpretation of CT angiographic images were identified at retrospective reading.
Conclusion:
Multi-detector row CT angiography has high sensitivity and specificity for detection of intracranial aneurysms, including small aneurysms, in patients with nontraumatic acute subarachnoid hemorrhage.