Marios Psychogios, Presenter: Travel support, Penumbra, Inc

Dorothee Wachter, Abstract Co-Author: Nothing to Disclose

Alexander Mohr MD, Abstract Co-Author: Nothing to Disclose

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

Andreas Frölich, Abstract Co-Author: Nothing to Disclose

Veit Rohde, Abstract Co-Author: Nothing to Disclose

Michael Knauth MD, PhD, Abstract Co-Author: Nothing to Disclose

Important findings, such as aneurysm remnants or major arterial occlusion, can be detected on intra- or postoperative angiography after surgical clipping of intracranial aneurysms. The purpose of this study was to evaluate the feasibility of flat panel computed tomography angiography (ivFPCTA) for the postoperative detection of residual aneurysms and parent vessel patency compared to intraarterial digital subtraction angiography (iaDSA).

Twenty-two patients bearing 27 aneurysms treated with surgical clipping were examined using both iaDSA and ivFPCTA. Both diagnostic procedures were carried out on a flat panel detector equipped angiography system. Postprocessing of ivFPCTA acquisitions was performed on a dedicated workstation producing multiplanar reformations and maximum intensity projections of the clip region and other intracranial arteries. Three interventional neuroradiologists independently evaluated both procedures.

A residual aneurysm was delineated in 10 cases with iaDSA. Sufficient opacification of the intracranial vessels was assigned in 26 ivFPCTA cases. Due to metal artifacts, ivFPCTA images were tagged as “not diagnostic” on 8 occasions. In the other 19 aneurysms, a residual aneurysm was delineated in 6 cases – all 6 being true positive compared to iaDSA - and was excluded in the remaining 13 cases – all true negative. Even small aneurysm remnants with a diameter of 1.5mm were detected with ivFPCTA.

Currently ivFPCTA cannot be recommended as a routine tool for postoperative evaluation of clipped aneurysms due to metal artifacts in 30% of the examinations. These artifacts appear with multiple normal-sized or large clips. In patients with single or multiple small clips ivFPCTA can reliably show aneurysm remnants.

A novel noninvasive examination for neurovascular imaging after surgical clipping.

Psychogios, M, Wachter, D, Mohr, A, Schramm, P, Frölich, A, Rohde, V, Knauth, M, Feasibility of Flat Panel Angiographic Computed Tomography after Intravenous Contrast Agent Application in the Postoperative Evaluation of Patients with Clipped Aneurysms.  Radiological Society of North America 2011 Scientific Assembly and Annual Meeting, November 26 - December 2, 2011 ,Chicago IL. http://archive.rsna.org/2011/11005629.html