title: Postoperative assessment of clipped aneurysms with 64-slice computerized tomography angiography.
abstract: BACKGROUND
  Multidetector computerized tomography angiography (MDCTA) is now a widely accepted technique for the management of intracranial aneurysms.
  
  
  OBJECTIVE
  To evaluate its accuracy for the postoperative assessment of clipped intracranial aneurysms.
  
  
  METHODS
  We analyzed a consecutive series of 31 patients that underwent direct surgical clipping procedures of 38 aneurysms. A 64 slice MDCT scanner (Aquilion 64, Toshiba) was used and results were compared with digital subtraction angiographies (DSA). Two independent neuroradiologists analyzed the following data: examination quality, artifacts, aneurysm remnant, and patency of collateral branches. Interobserver agreement, sensitivity, and specificity were calculated.
  
  
  RESULTS
  Seventy-nine percent of the aneurysms were located in the anterior circulation. Significant artifacts were found with multiple and cobalt-alloy clips. According to DSA, remnants >2 mm were found in 21% of the cases, and 2 patients had one collateral branch occluded. Sensitivity and specificity of 64-MDCTA for the detection of aneurysm remnants were 50% and 100%, respectively. Sensitivity and specificity of 64-MDCTA for the detection of a significant remnant (>2 mm) and the detection of the occlusion of a collateral branch were, respectively, 67% and 100% and 50% and 100%. No relationship was found with the location, type, shape, size, or number of clips, but missed remnants tended to be larger with cobalt-alloy clips.
  
  
  CONCLUSIONS
  64-MDCTA is a valuable technique to assess the presence of a significant postoperative remnant in single titanium clip application cases and might be useful for long-term follow-up. DSA remains the most accurate postoperative radiological examination.
authors.affiliation: Department of Neurosurgery, Lille University Hospital, Lille, France.
authors.forename: Laurent
authors.initials: L
authors.lastname: Thines
authors.forename: Amir R
authors.initials: AR
authors.lastname: Dehdashti
authors.forename: Peter
authors.initials: P
authors.lastname: Howard
authors.forename: Leodante
authors.initials: L
authors.lastname: Da Costa
authors.forename: M Christopher
authors.initials: MC
authors.lastname: Wallace
authors.forename: Robert A
authors.initials: RA
authors.lastname: Willinsky
authors.forename: Michael
authors.initials: M
authors.lastname: Tymianski
authors.forename: Jean-Paul
authors.initials: JP
authors.lastname: Lejeune
authors.forename: Ronit
authors.initials: R
authors.lastname: Agid
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000295:instrumentation / Q000379:methods*; D017063:Outcome Assessment, Health Care / Q000379:methods*; D011182:Postoperative Care / Q000379:methods*; D014057:Tomography, X-Ray Computed / Q000379:methods*; D014656:Vascular Surgical Procedures / Q000295:instrumentation / Q000379:methods*