Sivanathan Chandramohan MBBS, Presenter: Nothing to Disclose

Peter Keston MD, Abstract Co-Author: Nothing to Disclose

Philip M White, Abstract Co-Author: Nothing to Disclose

Compare 16-slice multi detector CT cerebral angiography with conventional DSA and 3D rotational angiography (the reference standard). We review our experience and discuss the advantages and pitfalls of both modalities.

22 consecutive patients with acute subarachnoid haemorrhage or symptomatic intracranial aneurysm were included. Initial patient evaluation was by CTA (Siemens Sensation 16 MDCT). CTA images were reported independently by two neuroradiologists prior to performing 4 vessel cerebral DSA. Discrepancies were resolved by consensus review. 3D DSA was used to evaluate any abnormalities.

19 aneurysms were identified in 22 patients. One tiny 1.5mm carotid tip aneurysm and one prominent posterior communicating artery infundibulum were initially missed with CTA, but were present on retrospective review. Otherwise there was complete agreement between the two techniques. The two reviewers agreed in 21/22 cases- the infundibulum was reported by one but not by the other- 3D DSA confirmed its presence. Kappa for interobserver agreement was good at 0.73 (95% CI 0.62-0.84). In one case DSA could not be completed due to bilateral carotid occlusions with bilateral vertebral artery origin stenoses. CTA was well tolerated and high quality in this patient.

16-MDCT angiography is a non-invasive alternative to 4 vessel DSA in the diagnosis of intracranial aneurysms. CTA is well tolerated and diagnostic studies can be obtained even in poorly co-operative patients. There are potential pitfalls in the scanning technique and reporting of these studies. It is imperative to use base images, multiplanar MIP images and VRT to maximize sensitivity.

Chandramohan, S, Keston, P, White, P, Early Experience Comparing 16-slice CT Cerebral Angiography with 2D and 3D DSA in Cerebral Aneurysm Detection.  Radiological Society of North America 2004 Scientific Assembly and Annual Meeting, November 28 - December 3, 2004 ,Chicago IL. http://archive.rsna.org/2004/4409542.html