title: Three-dimensional helical computerized tomography angiography in the diagnosis, characterization, and management of middle cerebral artery aneurysms: comparison with conventional angiography and intraoperative findings.
abstract: OBJECTIVE
  Middle cerebral artery (MCA) aneurysms can be difficult to detect and characterize. The authors describe the utility and impact of helical computerized tomography (CT) angiography for the evaluation of aneurysms in this location, and compare this modality with digital subtraction (DS) angiography and intraoperative findings.
  
  
  METHODS
  Two hundred fifty-one patients with suspected cerebral aneurysms underwent CT angiography. Two-dimensional multiplanar reformatted images and three-dimensional CT angiograms were examined by two independent readers in a blinded fashion. Results were compared with findings on DS angiograms to determine the relative efficacy of these modalities in the detection and characterization of aneurysms. Questionnaires completed by neurosurgeons and endovascular therapists were used to determine the impact of CT angiograms on aneurysm management. Twenty-eight patients harboring 31 MCA aneurysms and 26 patients without aneurysms were identified using CT angiography. The sensitivity of CT angiography and DS angiography for MCA aneurysms was 97%; both techniques showed 100% specificity. In 76% of evaluations, the CT angiography studies provided information not available on DS angiography examinations. For the characterization of aneurysms, CT angiography was rated superior (72%) or equal (20%) to DS angiography in 92% of cases evaluated (p < 0.001). Computerized tomography angiography was evaluated as the only study needed for patient triage in 82% of cases (p < 0.001), and as the only study needed for treatment planning in 89% of surgically treated (p < 0.001) and in 63% of endovascularly treated cases (p < 0.001). The information acquired on CT angiograms changed the initial treatment plan in 24 (67%) of these 36 complex lesions (p < 0.01). The aneurysm appearance intraoperatively was identical or nearly identical to that seen on CT angiograms in 17 (89%) of 19 of the surgically treated cases.
  
  
  CONCLUSIONS
  Computerized tomography angiography has unique advantages over DS angiography and is a viable alternative to the latter modality in the diagnosis, triage, and treatment planning in patients with MCA aneurysms.
authors.affiliation: Department of Neurosurgery, University of California at Los Angeles, California, USA. pvillablanca@mednet.ucla.edu
authors.forename: J Pablo
authors.initials: JP
authors.lastname: Villablanca
authors.forename: Parizad
authors.initials: P
authors.lastname: Hooshi
authors.forename: Neil
authors.initials: N
authors.lastname: Martin
authors.forename: Reza
authors.initials: R
authors.lastname: Jahan
authors.forename: Gary
authors.initials: G
authors.lastname: Duckwiler
authors.forename: Sylvester
authors.initials: S
authors.lastname: Lim
authors.forename: John
authors.initials: J
authors.lastname: Frazee
authors.forename: Y Pierre
authors.initials: YP
authors.lastname: Gobin
authors.forename: James
authors.initials: J
authors.lastname: Sayre
authors.forename: John
authors.initials: J
authors.lastname: Bentson
authors.forename: Fernando
authors.initials: F
authors.lastname: Viñuela
mesh_terms: D000328:Adult; D000368:Aged; D015901:Angiography, Digital Subtraction; D015331:Cohort Studies; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional; D002532:Intracranial Aneurysm / Q000000981:diagnostic imaging* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000379:methods*