Postoperative assessment of clipped aneurysms with 64-slice computerized tomography angiography.
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.
Thines
Laurent
L
Department of Neurosurgery, Lille University Hospital, Lille, France.
Dehdashti
Amir R
AR
Howard
Peter
P
Da Costa
Leodante
L
Wallace
M Christopher
MC
Willinsky
Robert A
RA
Tymianski
Michael
M
Lejeune
Jean-Paul
JP
Agid
Ronit
R
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*