title: Multi-detector computer tomography angiography in the initial assessment of patients acutely suspected of having intracranial aneurysm rupture.
abstract: BACKGROUND
  Multi-detector computer tomography angiography (CTA) provides a fast non-invasive assessment of the cerebral vessels, is readily available in an acute setting and can potentially replace invasive digital subtraction angiography (DSA) for the diagnosis of intracranial vascular lesions in an emergency setting. We report our experience in the use of emergent cerebral CTA versus DSA in the assessment of patients presenting acutely with symptoms suspicious of brain aneurysm rupture.
  
  
  METHODS
  Thirty-seven consecutive patients presenting acutely with clinical suspicion of brain aneurysm rupture were evaluated over a 4-month period from January to April 2008. CTA with peripheral intravenous contrast injection was performed on a 32 slice helical scanner. DSA was performed within 48 hours for all cases when CTA was the initial assessment. Studies were assessed via radiology reports using DSA or surgery as the gold standard.
  
  
  RESULTS
  All except for 3 patients had CTA as the initial study. There were 26 cerebral aneurysms detected by CTA in these 37 patients, with 9 negative studies. There were 2 patients with arteriovenous malformations (AVM), 1 with AV fistula (AVF), 1 tumoral bleed, 2 vertebral dissections, and 1 missed sagittal sinus thrombosis (CVT) on CTA. Based solely on CTA assessment, 3 patients had direct surgical clipping of the aneurysm, while 4 proceeded to direct endovascular coiling.
  
  
  CONCLUSIONS
  Emergent CTA is a non-invasive, reliable and viable alternative to emergent DSA for the assessment of the cerebral vessels in the acute assessment of patients presenting with symptoms suspicious of brain aneurysm rupture. Where positive, it can serve as a guide to therapeutic decisions. Review of CTA source data is essential, especially for small lesions and for post-clipping assessment.
authors.affiliation: Department of Neuroradiology, National Neuroscience Institute, Singapore.
authors.forename: Suyash
authors.initials: S
authors.lastname: Mohan
authors.forename: Wickly
authors.initials: W
authors.lastname: Lee
authors.forename: Jau Tsair
authors.initials: JT
authors.lastname: Tan
authors.forename: Liang Kwee
authors.initials: LK
authors.lastname: Wee
authors.forename: Francis K H
authors.initials: FK
authors.lastname: Hui
authors.forename: Yih-Yian
authors.initials: YY
authors.lastname: Sitoh
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D017542:Aneurysm, Ruptured / Q000175:diagnosis*; D015901:Angiography, Digital Subtraction / Q000379:methods; D002533:Cerebral Angiography / Q000295:instrumentation* / Q000379:methods; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D014057:Tomography, X-Ray Computed / Q000379:methods*; D055815:Young Adult