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Computed tomographic angiography as an adjunct to digital subtraction angiography for the pre-operative assessment of cerebral aneurysms.

Farsad K, Mamourian AC, Eskey CJ, Friedman JA - Open Neurol J (2009)

Bottom Line: In 14 aneurysms (39%), CTA provided clinically valuable anatomic detail not demonstrated on DSA, largely due to better visualization of parent and perforating vessel relationships at the aneurysm neck.There were no instances where a lesion was seen on DSA but missed on CTA.We advocate routine use of CTA in all patients in whom surgical aneurysm repair is planned, even when DSA has already been performed.

View Article: PubMed Central - PubMed

Affiliation: Section of Neurosurgery, Dartmouth-Hithchcock Medical Center, Lebanon, NH, USA.

ABSTRACT

Objectives: Computerized tomographic angiography (CTA) has emerged as a valuable diagnostic tool for the management of patients with cerebrovascular disease. The use of CTA in lieu of, or as an adjunct to, conventional cerebral angiography in the management of cerebral aneurysms awaits further experience. In this study, we evaluated the role of CTA specifically for the pre-operative assessment and planning of cerebral aneurysm surgery.

Patients and methods: We reviewed the relevant neuroimaging of all patients treated at Dartmouth Hitchcock Medical Center between January, 2001 and December, 2004 with a diagnosis of cerebral aneurysm and diagnostic evaluation with both CTA and conventional digital subtraction angiography (DSA) using standard imaging protocols. 32 patients underwent both CTA and DSA during the study period for a total of 36 aneurysms. Images were independently re-assesed by two neurosurgeons for information valuable for pre-operative surgical planning.

Results: In 26 of 36 aneurysms (72%), the CTA was felt to provide the best image quality in defining the morphology of the aneurysm. In 14 aneurysms (39%), CTA provided clinically valuable anatomic detail not demonstrated on DSA, largely due to better visualization of parent and perforating vessel relationships at the aneurysm neck. There were no instances where a lesion was seen on DSA but missed on CTA. The DSA was of most clinical value in determining flow dynamics, such as the arterial supply of an anterior communicating artery aneurysm and distal anterior cerebral branches via the two A1 segments.

Conclusion: CTA with three-dimensional reconstructions is a valuable adjunct to the preoperative evaluation of cerebral aneurysms. We advocate routine use of CTA in all patients in whom surgical aneurysm repair is planned, even when DSA has already been performed.

No MeSH data available.


Related in: MedlinePlus

Right superior cerebellar artery aneurysm as visualized by conventional digital subtraction angiography (DSA, left) compared with the same aneurysm visualized by computerized tomographic angiography (CTA, right). Note the high degree of anatomic resolution and the imaging detail of the parent/daughter vessel relationships at the aneurysm neck.
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Figure 1: Right superior cerebellar artery aneurysm as visualized by conventional digital subtraction angiography (DSA, left) compared with the same aneurysm visualized by computerized tomographic angiography (CTA, right). Note the high degree of anatomic resolution and the imaging detail of the parent/daughter vessel relationships at the aneurysm neck.

Mentions: In fourteen aneurysms (39%), the CTA provided clinically valuable anatomic detail not demonstrated on DSA (Table 2). In nine out of these fourteen aneurysms (64%), there was preoperative clinical utility in better visualization of parent and perforating vessel relationships at the aneurysm neck (Fig. 1). For example, in two cases of a posterior inferior cerebellar artery (PICA) aneurysm in our case series, the CTA provided clinically important information regarding the relationship of the aneurysm to the vertebral and basilar arteries, including the best representation of the take-off of the PICA from the aneurysm neck. In one case, the right vertebral artery was unable to be selectively catheterized for DSA (Fig. 2). The relationship of the aneurysm to the parent and perforating arteries was poorly demonstrated on the innominate vessel injection, but was clearly seen on CTA (Fig. 2). Furthermore, in five out of the fourteen aneurysms (36%), the CTA revealed markedly improved details of a daughter sac and of the lobular/saccular pattern of the aneurysm (Fig. 3). In addition, the relationship to the brainstem and skull base was better appreciated with CTA in three (21%) aneurysms (Fig. 4).


Computed tomographic angiography as an adjunct to digital subtraction angiography for the pre-operative assessment of cerebral aneurysms.

Farsad K, Mamourian AC, Eskey CJ, Friedman JA - Open Neurol J (2009)

Right superior cerebellar artery aneurysm as visualized by conventional digital subtraction angiography (DSA, left) compared with the same aneurysm visualized by computerized tomographic angiography (CTA, right). Note the high degree of anatomic resolution and the imaging detail of the parent/daughter vessel relationships at the aneurysm neck.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2682841&req=5

Figure 1: Right superior cerebellar artery aneurysm as visualized by conventional digital subtraction angiography (DSA, left) compared with the same aneurysm visualized by computerized tomographic angiography (CTA, right). Note the high degree of anatomic resolution and the imaging detail of the parent/daughter vessel relationships at the aneurysm neck.
Mentions: In fourteen aneurysms (39%), the CTA provided clinically valuable anatomic detail not demonstrated on DSA (Table 2). In nine out of these fourteen aneurysms (64%), there was preoperative clinical utility in better visualization of parent and perforating vessel relationships at the aneurysm neck (Fig. 1). For example, in two cases of a posterior inferior cerebellar artery (PICA) aneurysm in our case series, the CTA provided clinically important information regarding the relationship of the aneurysm to the vertebral and basilar arteries, including the best representation of the take-off of the PICA from the aneurysm neck. In one case, the right vertebral artery was unable to be selectively catheterized for DSA (Fig. 2). The relationship of the aneurysm to the parent and perforating arteries was poorly demonstrated on the innominate vessel injection, but was clearly seen on CTA (Fig. 2). Furthermore, in five out of the fourteen aneurysms (36%), the CTA revealed markedly improved details of a daughter sac and of the lobular/saccular pattern of the aneurysm (Fig. 3). In addition, the relationship to the brainstem and skull base was better appreciated with CTA in three (21%) aneurysms (Fig. 4).

Bottom Line: In 14 aneurysms (39%), CTA provided clinically valuable anatomic detail not demonstrated on DSA, largely due to better visualization of parent and perforating vessel relationships at the aneurysm neck.There were no instances where a lesion was seen on DSA but missed on CTA.We advocate routine use of CTA in all patients in whom surgical aneurysm repair is planned, even when DSA has already been performed.

View Article: PubMed Central - PubMed

Affiliation: Section of Neurosurgery, Dartmouth-Hithchcock Medical Center, Lebanon, NH, USA.

ABSTRACT

Objectives: Computerized tomographic angiography (CTA) has emerged as a valuable diagnostic tool for the management of patients with cerebrovascular disease. The use of CTA in lieu of, or as an adjunct to, conventional cerebral angiography in the management of cerebral aneurysms awaits further experience. In this study, we evaluated the role of CTA specifically for the pre-operative assessment and planning of cerebral aneurysm surgery.

Patients and methods: We reviewed the relevant neuroimaging of all patients treated at Dartmouth Hitchcock Medical Center between January, 2001 and December, 2004 with a diagnosis of cerebral aneurysm and diagnostic evaluation with both CTA and conventional digital subtraction angiography (DSA) using standard imaging protocols. 32 patients underwent both CTA and DSA during the study period for a total of 36 aneurysms. Images were independently re-assesed by two neurosurgeons for information valuable for pre-operative surgical planning.

Results: In 26 of 36 aneurysms (72%), the CTA was felt to provide the best image quality in defining the morphology of the aneurysm. In 14 aneurysms (39%), CTA provided clinically valuable anatomic detail not demonstrated on DSA, largely due to better visualization of parent and perforating vessel relationships at the aneurysm neck. There were no instances where a lesion was seen on DSA but missed on CTA. The DSA was of most clinical value in determining flow dynamics, such as the arterial supply of an anterior communicating artery aneurysm and distal anterior cerebral branches via the two A1 segments.

Conclusion: CTA with three-dimensional reconstructions is a valuable adjunct to the preoperative evaluation of cerebral aneurysms. We advocate routine use of CTA in all patients in whom surgical aneurysm repair is planned, even when DSA has already been performed.

No MeSH data available.


Related in: MedlinePlus