Saravanan Kokila Krishnamoorthy MD, Presenter: Nothing to Disclose

Jeffrey R Brace MD, Abstract Co-Author: Nothing to Disclose

Siobhan M Flanagan BS, Abstract Co-Author: Nothing to Disclose

Alexander M McKinney MD, Abstract Co-Author: Nothing to Disclose

Mehmet Teksam MD, Abstract Co-Author: Nothing to Disclose

Charles Loeb Truwit MD, Abstract Co-Author: Nothing to Disclose

Intracranial aneurysms are among the most common cause of the intracranial hemorrhage and the associated mortality and morbidity. Proper intervention for aneurysms requires accurate detection. Digital subtraction angiography (DSA) is the gold standard. However, it has deficiencies. Rotational 3-dimensional (3D) DSA offers the potential to overcome some of these issues, while multi-section CT angiography (CTA) is a non-invasive method. We detail our experience with these 3 modalities.

Forty patients underwent DSA, rotational 3D DSA, and/or multi-section CTA for evaluation of intracranial aneurysms. Results for each modality were evaluated independently by neuroradiologists who detected the location, size, and characteristics of the aneurysms. The gold standard was DSA, or when available, surgery.

In 18 of 40 patients, 29 intracranial aneurysms were detected with DSA, the gold standard. A total of 31 aneurysms were found with rotational 3D DSA, with 2 aneurysms missed by DSA. There were no false negatives. The overall sensitivity of rotational 3D DSA was 100% and specificity was 90%. With CTA, only 23 aneurysms were detected, with 2 aneurysms missed by DSA and 1 missed by 3D rotational DSA. There were 11 false negatives. The overall sensitivity and specificity were 67% and 90%.

Intracranial aneurysms are commonly evaluated with DSA. However, with this modality, specific views must be taken to obtain further details for diagnostic and therapeutic purposes. Three-dimensional rotational DSA allows viewing of aneurysms from various angles and guidance for intervention. However, coning a vessel for 3D evaluation can be a limitation. Therefore, 3D rotational evaluation, rather than providing a screening tool, is a supplement to traditional DSA. CTA, on the other hand, has poor resolution, especially for aneurysms less than 4 mm in size. In addition, aseurysms adjacent to bony structures, such as the clinoid process, are often missed. Yet its advantage lies in detecting thrombosed vessels.

Krishnamoorthy, S, Brace, J, Flanagan, S, McKinney, A, Teksam, M, Truwit, C, Comparison of 3D Rotational Digital Subtraction Angiography, CT Angiography, and Digital Subtraction Angiography in the Evaluation of Intracranial Aneurysms.  Radiological Society of North America 2005 Scientific Assembly and Annual Meeting, November 27 - December 2, 2005 ,Chicago IL. http://archive.rsna.org/2005/4408711.html