Assessment of feasibility of endovascular treatment of ruptured intracranial aneurysms with 16-detector row CT angiography.
BACKGROUND
It is unclear whether 16-detector row CT angiography (CTA) can replace digital subtraction angiography (DSA) to assess the feasibility of endovascular treatment (EVT) in the acute phase after aneurysmal subarachnoid hemorrhage.


METHODS
We studied 80 consecutive patients with aneurysmal subarachnoid hemorrhage, who underwent both CTA and DSA. Two interventional neuroradiologists independently scored CTA and, immediately thereafter, DSA with respect to feasibility of EVT. We determined whether CTA without DSA was sufficient for a definite judgment. We also assessed interobserver agreement.


RESULTS
The 2 readers judged EVT to be feasible in 24 and 37 patients with CTA alone and not feasible in 34 and 20 patients. In these patients, DSA yielded additional information in 6 (reader 1) and 5 patients (reader 2), which did not affect treatment decision. In 19 and 7 patients, DSA was considered inferior to CTA. In the remaining patients (n = 22 and 23, respectively), feasibility of EVT could not be judged with CTA alone, and DSA results were required in addition for a treatment decision. Interobserver agreement on feasibility of EVT was just fair (kappa <0.40).


CONCLUSIONS
In our series of patients, 16-detector row CTA was a reliable investigation to assess feasibility of EVT of ruptured intracranial aneurysms in most patients. Further, we found that interobserver disagreement on feasibility of EVT was considerable.
van der Jagt
Mathieu
M
Department of Neurology, Erasmus MC, Rotterdam, The Netherlands. m.vanderjagt@erasmusmc.nl
Flach
H Zwenneke
HZ
Tanghe
Hervé L J
HL
Bakker
Stef L M
SL
Hunink
M G Myriam
MG
Koudstaal
Peter J
PJ
van der Lugt
Aad
A
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017542:Aneurysm, Ruptured / Q000000981:diagnostic imaging* / Q000209:etiology / Q000601:surgery; D015901:Angiography, Digital Subtraction; D002533:Cerebral Angiography / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000150:complications* / Q000000981:diagnostic imaging / Q000601:surgery; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures; D015588:Observer Variation; D018579:Patient Selection; D011237:Predictive Value of Tests; D011446:Prospective Studies; D013345:Subarachnoid Hemorrhage / Q000000981:diagnostic imaging* / Q000209:etiology / Q000601:surgery; D014057:Tomography, X-Ray Computed; D014656:Vascular Surgical Procedures