Multislice CTA gains edge over DSA for brain aneurysm detection

Multislice CT angiography is highly accurate for depicting intracranial aneurysms and can be used to quickly assess the feasibility of minimally invasive treatment.

A study completed by Dr. Karsten Papke and colleagues at the Hospital of Duisburg in Germany used 16-detector CTA and digital subtraction angiography to study 87 patients suspected of having subarachnoid hemorrhage. MSCTA correctly identified 62 of 63 patients with 80 of 84 aneurysms and correctly ruled out aneurysms in 24 patients. DSA identified 62 patients with 79 aneurysms and ruled out aneurysms in 23 patients, giving MSCTA a slight edge in diagnostic accuracy.

Data on each ruptured aneurysm found with MSCTA were used to determine whether the aneurysm was suitable for endovascular coil placement or if a neurosurgical procedure was necessary. Based on actual treatment performed after workups, the possibility of coil placement was correctly assessed in 69 of 74 (93%) of targeted aneurysms.

The study also demonstrated that MSCTA helped diagnose aneurysms more quickly than DSA and provided virtually unlimited viewing angles that helped the radiologist identify the optimal choice for aneurysm therapy, Papke said. Its advantages over DSA could be seen in suspected cases of subarachnoid hemorrhage because MSCTA was easily added to the standard head CT with little extra exam time. It can provide a wide variety of 3D viewing angles.

"An important advantage of MSCT angiography is that information about the presence and characteristics of aneurysms is available at the earliest possible time," Papke said. "The capability to view different 3D data sets obtained with MSCT also yields additional anatomic information that is difficult or time-consuming to achieve with DSA."

The study was published in the August issue of Radiology.

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