© Turkish Society of Radiology 2005
Spiral CT angiography in diagnosis of cerebralaneurysms of cases with acute subarachnoidhemorrhage
Ender Uysal, Barış Yanbuloğlu, Mehmet Ertürk, Bekir M. Kılınç, Muzaffer Başak
From the Departments of Radiology (E.U.
, B.Y., M.E., M.B.), and Neurosurgery (B.M.K.), ŞişliEtfal Training and Research Hospital, İstanbul, Turkey.
Received 2 January 2004; rst revision requested 2 June 2004;rst revision received 10 October 2004; second revision requested17 January 2005; second revision received 25 January 2005;accepted 28 January 2005.
ortality is high in subarachnoid hemorrhages (SAH) due torupture of aneurysms. Most deaths occur due to the firstbleeding or repetitive bleeding (1, 2). For this reason, fast andaccurate evaluation of the patients is of great importance in planningthe therapeutic interventions. For the time being, selective digital sub-traction angiography (DSA) is used as the standard method in diagnosisand preoperative evaluation of cerebral aneurysms. Although the per-manent neurologic complication risk is low (0.07%-0.5%) in DSA examsperformed in cases with suspected cerebral aneurysms, this method isinvasive, time consuming and expensive (3). DSA has high sensitivityand specificity values in diagnosis of cerebral aneurysms while falsenegative results ranging from 5% to 10% have been reported in theliterature (4). The main reason for this is, not being able to obtain theoptimal projections necessary for diagnosis of some aneurysms due tophysical limitations rather than the insufficiency of spatial resolution of the angiography machine (5). When compared to DSA, spiral CT angi-ography (CTA) is a faster and a more easily applied method. In contrastto another non-invasive imaging method, magnetic resonance angiog-raphy (MRA), spiral CTA enables faster acquisition of three dimensionalimages related to the cerebral vascular anatomy without patient motionartifacts or artifacts due to flow rate. Another advantage of CTA is itsapplicability following routine non-enhanced cranial computed tom-ography (CT) in patients with suspected SAH in emergency conditions.In this study, we aimed to compare the effectiveness of single detectorspiral CTA to DSA in diagnosis and evaluation of intracranial aneurysmsin cases with acute SAH.
Materials and methods
Thirty-two cases who had CTAs and DSAs with suspicion of aneurysmdue to SAH detected by non-enhanced cranial CT between September2002 and May 2004 were included in the study. There were 17 womenand 15 men, ages ranging from 32-75 (mean, 45.5) years. All CTA exami-nations were performed with spiral technique by a single row detectorCT machine (General Electric Hi-Speed, Milwaukee, WI, USA). After de-tection of the location from lateral scanogram, slices parallel to orbito-meatal line were obtained in caudo-cranial direction starting from 1 cmbelow the base of sella turcica up to the level of lateral ventricles. SpiralCTA was obtained with 1 mm collimation, 1.5:1 pitch, 120 kV, 150 mAsand 25 cm field-of-view. Slice reconstruction thickness was 0.5 mm. Onehundred and twenty ml non-ionic iodinated contrast (Iomeron 400,Bracco Diagnostic, Milan, Italy) was administered through a 20 G needlefrom the antecubital vein with a rate of 3 ml/second. Acquisition of im-ages started after 15 seconds and examination lasted for about 40-60 sec-onds. No allergic reaction occurred in any cases. Spiral CTA images were
PURPOSETo investigate the diagnostic accuracy of spiral CT angi-ography (CTA) in detection of cerebral aneurysms in caseswith acute subarachnoid hemorrhage (SAH).MATERIALS AND METHODSSpiral CT angiography and DSA examinations wereperformed in 32 cases due to non-traumatic SAH. CTAdata were obtained by maximum intensity projection(MIP) method. CTA and DSA ndings were evaluatedand compared in terms of existence of aneurysm, sizeand location.RESULTSIn 32 patients, DSA detected 34 aneurysms with di-ameters ranging from 3 to 13 mm while four caseswere free of aneurysms. With CTA, an aneurysm atanterior communicating artery location could not bedemonstrated. In all other cases CTA correlated wellwith DSA in detecting the site, size and orientation of the aneurysms. It was found that CTA sensitivity was97% and specicity was 100% in diagnosis of intrac-ranial aneurysms.CONCLUSIONSpiral CTA is a highly accurate, cheap and non-in-vasive imaging method in diagnosis of intracranialaneurysms in cases with SAH and can be used as a safealternative method to DSA when emergency surgeryis needed.
Key words: • intracranial aneurysm • subarachnoid hemorrhage • tomography, spiral computed
Diagn Interv Radiol 2005; 11:77-82