PURPOSE: To examine whether computed tomography angiography (CTA) is comparable to digital subtraction angiography (DSA) in assessing clipped intracranial aneurysms. MATERIALS AND METHODS: Retrospective collection of clipped aneurysms that had both CTA and DSA within 2 months of one another. Computed tomography angiograms were independently reviewed by 2 blinded neuroradiologists; rereviewed by one at least 4 months later. Each was classified as complete obliteration, neck remnant, or residual aneurysm. Parent vessel was classified as patent or occluded. Digital subtraction angiograms were reviewed in a similar manner by a third blinded neuroradiologist. RESULTS: Forty-eight patients with 53 clipped aneurysms were collected. On DSA, 35 were completely obliterated, 10 neck remnants, and 8 residual aneurysms. The ability of CTA to detect residual aneurysms versus complete obliterations or neck remnants was excellent (mean sensitivity, 88%; specificity, 100%; positive predictive value [PPV], 100%; negative predictive value [NPV], 98%). The ability of CTA to detect neck remnants versus complete obliterations was poor (mean sensitivity, 20%; specificity, 99%; PPV, 83%; NPV, 81%). The CTAs were good at detecting parent vessel occlusion (mean sensitivity, 88%; specificity, 97%; PPV, 75%; NPV, 99%). Interrater and intrarater agreement was good to excellent for aneurysm and parent vessel assessment, with kappa values ranging from 0.6 to 1.0. CONCLUSIONS: Computed tomography angiography has high sensitivity and specificity for residual aneurysm detection and parent vessel occlusion. It is not accurate in neck remnant detection, although these were small and of uncertain clinical significance. This suggests that CTA is useful for follow-up of clipped aneurysms. However, given the potential to miss neck remnants or small residual aneurysms, it is recommended to perform initial DSA and CTA to select cases in which CTA follow-up is appropriate.
PURPOSE: To examine whether computed tomography angiography (CTA) is comparable to digital subtraction angiography (DSA) in assessing clipped intracranial aneurysms. MATERIALS AND METHODS: Retrospective collection of clipped aneurysms that had both CTA and DSA within 2 months of one another. Computed tomography angiograms were independently reviewed by 2 blinded neuroradiologists; rereviewed by one at least 4 months later. Each was classified as complete obliteration, neck remnant, or residual aneurysm. Parent vessel was classified as patent or occluded. Digital subtraction angiograms were reviewed in a similar manner by a third blinded neuroradiologist. RESULTS: Forty-eight patients with 53 clipped aneurysms were collected. On DSA, 35 were completely obliterated, 10 neck remnants, and 8 residual aneurysms. The ability of CTA to detect residual aneurysms versus complete obliterations or neck remnants was excellent (mean sensitivity, 88%; specificity, 100%; positive predictive value [PPV], 100%; negative predictive value [NPV], 98%). The ability of CTA to detect neck remnants versus complete obliterations was poor (mean sensitivity, 20%; specificity, 99%; PPV, 83%; NPV, 81%). The CTAs were good at detecting parent vessel occlusion (mean sensitivity, 88%; specificity, 97%; PPV, 75%; NPV, 99%). Interrater and intrarater agreement was good to excellent for aneurysm and parent vessel assessment, with kappa values ranging from 0.6 to 1.0. CONCLUSIONS: Computed tomography angiography has high sensitivity and specificity for residual aneurysm detection and parent vessel occlusion. It is not accurate in neck remnant detection, although these were small and of uncertain clinical significance. This suggests that CTA is useful for follow-up of clipped aneurysms. However, given the potential to miss neck remnants or small residual aneurysms, it is recommended to perform initial DSA and CTA to select cases in which CTA follow-up is appropriate.
Authors: Hye Jeong Kim; Dae Young Yoon; Eun Soo Kim; Eun Joo Yun; Hong Jun Jeon; Jong Young Lee; Byung-Moon Cho Journal: Eur Radiol Date: 2019-12-16 Impact factor: 5.315
Authors: Airton Leonardo de Oliveira Manoel; Ann Mansur; Amanda Murphy; David Turkel-Parrella; Matt Macdonald; R Loch Macdonald; Walter Montanera; Thomas R Marotta; Aditya Bharatha; Khaled Effendi; Tom A Schweizer Journal: Crit Care Date: 2014-11-13 Impact factor: 9.097
Authors: Allison Park; Chris Chute; Pranav Rajpurkar; Joe Lou; Robyn L Ball; Katie Shpanskaya; Rashad Jabarkheel; Lily H Kim; Emily McKenna; Joe Tseng; Jason Ni; Fidaa Wishah; Fred Wittber; David S Hong; Thomas J Wilson; Safwan Halabi; Sanjay Basu; Bhavik N Patel; Matthew P Lungren; Andrew Y Ng; Kristen W Yeom Journal: JAMA Netw Open Date: 2019-06-05