Multislice Computerized Tomography Angiography In The Evaluation Of Intracranial Aneurysms

Object: Intracranial aneurysm is one of most common diseases inneurosurgery, and the main cause of spontaneous subarachnoid hemorrhage.Now,digital subtraction angiography (DSA) is still frequently used in thediagnosis of intracranial aneurysm, but it is expensive, time consuming,and may lead to complications and permanent neurological deficit.Multislice computerized tomography angiography (MSCTA) is a newtechnique used in diagnosis and treatment of cerebrovascular diseases inrecent years. It was payed close attention for its simple, noninvasion, lowexpense, and the clear display of anatomic structure of aneurysm withperipheral vessels.But the clinical effect of MSCTA was reported diversely.In this study, 32 patients with aneurysmal subarachnoid hemorrhage wereperformed both MSCTA and DSA respectively, to evaluate the value ofmultislice computerized tomography angiography (MSCTA)in thedetection ,treatment and postoperative examination of intracranialaneurysms. Methods: Thirty-two patients with aneurysmal subarachnoidhemorrhage (15 males and 17 females, age range 46-74 years, mean age58.4 years, mean duration 9.61 years, range 0.5-30 years) hospitalized inthe Department of Neurosurgery, the 1st Affiliated Hospital of DalianMedical University participated in the present study. All the patients wereperformed both MSCTA and DSA. The MSCTA was performed with the4-detector row CT (GE Light Speed), and iodinate contrast meterial wasinjected from antecubital vein by using a power injector. Images wereprocessed by the SUN workstation ADW 3.1 or 4.0 edition, andreconstruction typles included shaded surface display (SSD), maximumintensity projection (MIP), volume rederening (VR), and curved planereconstruction (CPR). The DSA was performed using the digital subtractangiography mechine (HM3000, PHILIPS) introduced from Holand.Angiography of bilateral inner carotid and unilateral vertebral artery wereperformed from the right femoral artery pathway with Sedingle technique。Non-iron contrast media ultravist 300 was used. centric position, lateralposition and oblique position images were taken for both inner carotid andvertebral artery. Results: Altogether 38 anuerysms were found in 32 patients withaneurysmal subarachnoid hemorrhage, among which 34 aneurysms werefound by MSCTA, and 35 found by DSA, the accuracy for MSCTA andDSA were 89.5% and 92.1% respectively. MSCTA failed to detect 4 cases,and DSA missed 3 cases, one of which was missed by both methods. Nostatistical significance in differences between these two methods was found(pairedχtest,P≤0.05). MSCTA is advantageous in displaying body andneck of aneurysms, including the two cases of intracranial aneurysmmissed by DSA; Moreover, MSCTA could guide operation by providingprecise characterization of intracranial aneurysms, including size, direction,orientation, and anatomic connections with surrounding structures.Satisfied displays were obtained by MSCTA in all the 12 patients ofaneurysms in postoperative examination. Conclusion: MSCTA is accurate in diagnosis of intracranial aneurysm,as compared with DSA. It can precisely display the size, configuration,direction, and anatomic connection with surrounding vessels and bones,play an important role in guiding operation, especially in emergency setting.It is advantageous in diagnosis of trunk aneurysm, but may missed someterminal aneurysms. It is supplementary to DSA, make up for the shortageof DSA and may replace DSA on certain conditions, especially facilitatedthe postoperative examination of aneurysm patients .