Lorenzo Testaverde MD, Presenter: Nothing to Disclose

Laura Caporali MD, Abstract Co-Author: Nothing to Disclose

Giuseppe Pelle MD, Abstract Co-Author: Nothing to Disclose

Adelchi Saltarelli, Abstract Co-Author: Nothing to Disclose

Paolo Rabuffi, Abstract Co-Author: Nothing to Disclose

Roberto Cianni, Abstract Co-Author: Nothing to Disclose

The purpose of this study was to evaluate the diagnostic accuracy of dual-energy computed tomographic angiography (DE-CTA) in the detection of intracranial aneurysms in patients with spontaneous subarachnoid hemorrhage, compared with 3D rotational digital subtraction angiography (DSA) and assess its value in pre-operative staging

40 patients (30 female, 10 male) with spontaneous subarachnoid hemorrhage (SAH) underwent dual energy (DE) CTA (Somatom Definition, Siemens, Germany) and 3D DSA (Zeego Artis, Siemens, Germany) . The contrast enhanced CT scan in DE mode was obtained after injection of 50ml of iomeprolo (Iomeron 400mg, Bracco, Italy) followed by 50 ml of saline solution at range of 5ml/sec. The DE CT images at 140 and 80-Kv were transferred to a workstation (Leonardo, Siemens, Germany) in order to underwent post-processing: using dedicated software automatic-bone-removal maximum intensity projection (MIP) and volume rendering (VR) images were obtained to evaluate the presence and the type of aneurysm and best angle for planning DSA road map, if the aneurysm was judged suitable for coiling. Patients with other causes of SAH were excluded from the study as like as patient with aneurysm judged not suitable for coiling (transferred to the neurosurgery ward). Sensitivity and specificity for aneurysm detection were determined on a per-patient and per-aneurysm basis, comparing DECTA an DSA

Three dimensional DSA showed  62 aneurysms in 40 patients. With DE-CTA, 58 aneurysms in 40 patients were correctly detected and 4 aneurysms in 4 patients were missed. With 3D DSA as reference standard, the sensitivity, specfifcity, and positive and negative predictive values of DE-CTA in detection of intracranial aneurysm were respectively >95%  on a per-patient basis and >90% on a per-aneurysm basis.

DECTA shows high diagnostic accuracy compared with 3D DSA in the detection of intracranial aneurysms and can be used as pre-interventional exam: MIP images obtained at DECTA were used to determinate best angle for planning road map in rotational DSA; this consents great time-saving during the procedure and reduces necessity for a diagnostic DSA before the interventional DSA

DECTA can be used, in emergency, as one-stop-exam in case of intracranial aneurysm, correctly determinating if it's suitable for coiling, giving useful planning information for rotational DSA.

Testaverde, L, Caporali, L, Pelle, G, Saltarelli, A, Rabuffi, P, Cianni, R, Evaluation and Treatment of Intracranial Aneurysms Using Dual-Energy CT Angiography (DECTA) and Rotational Digital Subtraction Angiography (DSA).  Radiological Society of North America 2011 Scientific Assembly and Annual Meeting, November 26 - December 2, 2011 ,Chicago IL. http://archive.rsna.org/2011/11015357.html