title: Diagnostic accuracy and inter-rater reliability of 64-multislice 3D-CTA compared to intra-arterial DSA for intracranial aneurysms.
abstract: Catheter-based intra-arterial digital subtraction angiography (IADSA) is widely trusted for diagnosing cerebral aneurysms. However, three-dimensional CT angiography (3D-CTA) is evolving. This study compares the diagnostic performance and inter-rater reliability of 64-slice 3D-CTA and IADSA. Nineteen patients with 26 suspected cerebral aneurysms (23 with confirmed aneurysms, three negative controls) underwent both IADSA and 3D-CTA. Two independent reviewers assessed both imaging modalities for the presence of an aneurysm and subsequently described aneurysmal location, size, shape, orientation, and number of emanating arteries. Inter-observer agreement was followed to control for observer bias. The sensitivity of 3D-CTA was 78% and 96%, the negative predictive value (NPV) was 38% and 75%, and the accuracy of 3D-CTA was 81% and 96%. Both reviewers found 100% specificity and 100% positive predictive value (PPV). There was a clear correlation between 3D-CTA and IADSA for describing cerebral aneurysms. The authors conclude that 3D-CTA has equivocal diagnostic advantage but is less reliable for ruling out aneurysm presence. Anatomy, however, is superior with 3D-CTA.
authors.affiliation: Division of Neurosurgery, University of Texas Medical Branch, 301 University Boulevard, Galveston, Texas 77555-0517, USA.
authors.forename: B
authors.initials: B
authors.lastname: Franklin
authors.forename: J
authors.initials: J
authors.lastname: Gasco
authors.forename: T
authors.initials: T
authors.lastname: Uribe
authors.forename: R H A
authors.initials: RH
authors.lastname: VonRitschl
authors.forename: E
authors.initials: E
authors.lastname: Hauck
mesh_terms: D015901:Angiography, Digital Subtraction / Q000379:methods*; D002533:Cerebral Angiography / Q000379:methods*; D003951:Diagnostic Errors; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D011857:Radiographic Image Interpretation, Computer-Assisted; D012680:Sensitivity and Specificity