| Multislice CT angiography in the selection of patients with ruptured intracranial aneurysms suitable for clipping or coiling. | |
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MedLine Citation:
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PMID: 17891387 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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INTRODUCTION: We sought to establish whether CT angiography (CTA) can be applied to the planning and performance of clipping or coiling in ruptured intracranial aneurysms without recourse to intraarterial digital subtraction angiography (IA-DSA). METHODS: Over the period April 2003 to January 2006 in all patients presenting with a subarachnoid haemorrhage CTA was performed primarily. If CTA demonstrated an aneurysm, coiling or clipping was undertaken. IA-DSA was limited to patients with negative or inconclusive CTA findings. We compared CTA images with findings at surgery or coiling in patients with positive CTA findings and in patients with negative and inconclusive findings in whom IA-DSA had been performed. RESULTS: In this study, 224 consecutive patients (mean age 52.7 years, 135 women) were included. In 133 patients (59%) CTA demonstrated an aneurysm, and CTA was followed directly by neurosurgical (n = 55) or endovascular treatment (n = 78). In 31 patients (14%) CTA findings were categorized as inconclusive, and in 60 (27%) CTA findings were negative. One patient received surgical treatment on the basis of false-positive CTA findings. In 17 patients in whom CTA findings were inconclusive, IA-DSA provided further diagnostic information required for correct patient selection for any therapy. Five ruptured aneurysms in patients with a nonperimesencephalic SAH were negative on CTA, and four of these were also false-negative on IA-DSA. On a patient basis the positive predictive value, negative predictive value, sensitivity, specificity and accuracy of CTA for symptomatic aneurysms were 99%, 90%, 96%, 98% and 96%, respectively. CONCLUSION: CTA should be used as the first diagnostic modality in the selection of patients for surgical or endovascular treatment of ruptured intracranial aneurysms. If CTA renders inconclusive results, IA-DSA should be performed. With negative CTA results the complementary value of IA-DSA is marginal. IA-DSA is not needed in patients with negative CTA and classic perimesencephalic SAH. Repeat IA-DSA or CTA should still be performed in patients with a nonperimesencephalic SAH. |
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Authors:
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H E Westerlaan; J Gravendeel; D Fiore; J D M Metzemaekers; R J M Groen; J J A Mooij; M Oudkerk |
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Publication Detail:
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Type: Comparative Study; Journal Article Date: 2007-09-22 |
Journal Detail:
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Title: Neuroradiology Volume: 49 ISSN: 0028-3940 ISO Abbreviation: Neuroradiology Publication Date: 2007 Dec |
Date Detail:
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Created Date: 2007-11-20 Completed Date: 2008-04-25 Revised Date: 2013-06-06 |
Medline Journal Info:
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Nlm Unique ID: 1302751 Medline TA: Neuroradiology Country: Germany |
Other Details:
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Languages: eng Pagination: 997-1007 Citation Subset: IM |
Affiliation:
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Department of Radiology, University Medical Center Groningen, Post Box 30.001, Hanzeplein 1, 9700 RB Groningen, The Netherlands. H.E.Westerlaan@rad.umcg.nl |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Adult Aged Aneurysm, Ruptured / radiography*, surgery Angiography, Digital Subtraction Cerebral Angiography / methods* Contrast Media Female Humans Intracranial Aneurysm / radiography*, surgery Male Middle Aged Patient Selection Predictive Value of Tests Radiographic Image Interpretation, Computer-Assisted Sensitivity and Specificity Tomography, X-Ray Computed* Triiodobenzoic Acids / diagnostic use |
| Chemical | |
Reg. No./Substance:
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0/Contrast Media; 0/Triiodobenzoic Acids; 92339-11-2/iodixanol |
| Comments/Corrections | |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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