The Significance Of Three-Dimensional Digital Subtraction Angiography In Diagnosing And Treating Intracranial Aneurysms

Objective: To compare the effect of the three-dimensional digital subtraction angiography (3D-DSA) with the two-dimensional digital subtraction angiography (2D-DSA) in diagnosis and treatment of intracranial aneurysms.Methods: 68 patients were admitted to neurosurgery department of the First People's Hospital of Changde between Jan.2005 and May 2006 who were diagnosed as subarachnoid hemorrhage by CT and clinically suspected intracranial aneurysms. All of these patients had 3D-DSA and 2D-DSA examination. We studied the results of the DSA and tried to found the difference between 3D-DSA and 2D-DSA, and also tried to found the correlation of 3D-DSA images with surgical findings and embolism findings. The patients with negative by 3D-DSA examination were followed in the next time.Results: 33 cases of intracranial aneurysm were diagnosed by 2D-DSA. Among those suspected cases, we found 36 harbouring aneurysms and the positive rate was 48%. Among them, 5 suspected aneurysms which had 3D-DSA procedure late, we discovered 3 small aneurysms and 2 turns of vessels. 36 cases of intracranial aneurysms were diagnosed by 3D-DSA and we detected 42 aneurysms, the positive rate was 52%. We found that 3D-DSA was superior to 2D-DSA in delineating aneurismal shape, size and neck, and adjacent vascular structures. The findings of aneurysms by 3D-DSA were significantly correlated with surgical findings in 22 of the 24 operated cases, the accordance rate was 92%. However, only two operated cases, which we found the size, shape and vascular relationship adjacent to the aneurysm, were found overestimated by 3D-DSA comparing with operative views. No patients died in this group. 10 cases were embolized by coils, in which the 3D-DSA can provide the correct information of aneurysms and appropriate working view which completely accorded with the practical working view. All of the patients were followed up by 3D-DSA after 1 month and no recurrent aneurysms were found.Conclusion: 3D-DSA had higher positive rate of detecting aneurysm than 2D-DSA. 3D-DSA was so reliable in clearly delineating configuration and adjacent vascular anatomy of intracranial aneurisms, which would facilitate the diagnosis and therapeutic strategy of intracranial aneurysms with more credible evidence.