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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

Fusiform basilar artery aneurysm with a saccular aneurysm at the left vertebrobasilar junction. Note how this aneurysm is poorly seen on DSA (A and C, arrow shows probable location) and was initially missed using this modality, whereas it is unequivocally visualized on CTA (B and D, arrows). A and B represent anterior-posterior (AP) views, C and D represent lateral views.
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Figure 5: Fusiform basilar artery aneurysm with a saccular aneurysm at the left vertebrobasilar junction. Note how this aneurysm is poorly seen on DSA (A and C, arrow shows probable location) and was initially missed using this modality, whereas it is unequivocally visualized on CTA (B and D, arrows). A and B represent anterior-posterior (AP) views, C and D represent lateral views.

Mentions: In this subset of cases, there were no instances where an aneurysm was seen on DSA but not visualized on CTA. In fact, one aneurysm initially missed on angiography was demonstrated on subsequent CTA. This was a vertebrobasilar junction aneurysm at the base of a fusiform basilar artery dilation, and it was poorly appreciated on DSA due to a masking of the aneurysm along the parent vessel (Fig. 5A and C). The presence of the aneurysm was clearly demonstrated by CTA (Fig. 5B and D). This yielded a sensitivity and specificity for CTA of 100%, based on a gold standard set by DSA and intra-operative findings.


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)

Fusiform basilar artery aneurysm with a saccular aneurysm at the left vertebrobasilar junction. Note how this aneurysm is poorly seen on DSA (A and C, arrow shows probable location) and was initially missed using this modality, whereas it is unequivocally visualized on CTA (B and D, arrows). A and B represent anterior-posterior (AP) views, C and D represent lateral views.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 5: Fusiform basilar artery aneurysm with a saccular aneurysm at the left vertebrobasilar junction. Note how this aneurysm is poorly seen on DSA (A and C, arrow shows probable location) and was initially missed using this modality, whereas it is unequivocally visualized on CTA (B and D, arrows). A and B represent anterior-posterior (AP) views, C and D represent lateral views.
Mentions: In this subset of cases, there were no instances where an aneurysm was seen on DSA but not visualized on CTA. In fact, one aneurysm initially missed on angiography was demonstrated on subsequent CTA. This was a vertebrobasilar junction aneurysm at the base of a fusiform basilar artery dilation, and it was poorly appreciated on DSA due to a masking of the aneurysm along the parent vessel (Fig. 5A and C). The presence of the aneurysm was clearly demonstrated by CTA (Fig. 5B and D). This yielded a sensitivity and specificity for CTA of 100%, based on a gold standard set by DSA and intra-operative findings.

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