Document Detail


Multislice CT angiography in the selection of patients with ruptured intracranial aneurysms suitable for clipping or coiling.
MedLine Citation:
PMID:  17891387     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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.
Authors:
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:
Type:  Comparative Study; Journal Article     Date:  2007-09-22
Journal Detail:
Title:  Neuroradiology     Volume:  49     ISSN:  0028-3940     ISO Abbreviation:  Neuroradiology     Publication Date:  2007 Dec 
Date Detail:
Created Date:  2007-11-20     Completed Date:  2008-04-25     Revised Date:  2013-06-06    
Medline Journal Info:
Nlm Unique ID:  1302751     Medline TA:  Neuroradiology     Country:  Germany    
Other Details:
Languages:  eng     Pagination:  997-1007     Citation Subset:  IM    
Affiliation:
Department of Radiology, University Medical Center Groningen, Post Box 30.001, Hanzeplein 1, 9700 RB Groningen, The Netherlands. H.E.Westerlaan@rad.umcg.nl
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MeSH Terms
Descriptor/Qualifier:
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:
0/Contrast Media; 0/Triiodobenzoic Acids; 92339-11-2/iodixanol
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