Accuracy of high resolution computed tomography in direct diagnosis of cerebral aneurysms

With high resolution computed tomography (CT) of the skull, performing rapid series of 1.5 mm slices during an intravenous bolus injection of contrast medium, an angiography-like image (angio-CT) of the basal cerebral arteries can be obtained. From 76 consecutive angiographically or autopsy-verified cerebral aneurysms of various size down to 3 mm in diameter, 74 (97.4%) were shown up by the angio-CT. One ruptured and one incidental aneurysm escaped CT visualization. Besides the correct localization of the aneurysms, angio-CT provides information concerning the size and main direction of the aneurysms and yields, in addition, a coronal view of the aneurysms and their surrounding structures. Pitfalls for mis-diagnosis can be the following: Aneurysms of below 5 mm in diameter, located at the supraclinoid part of the carotid artery, multiple or non-ruptured aneurysms, bony or movement artefacts, poorly contrasted vessels due to wrong injection technique of contrast medium or vasospasm, and incorrect interpretation.