title: Automatic bone removal dual-energy CT angiography for the evaluation of intracranial aneurysms.
abstract: OBJECTIVE
  To evaluate the diagnostic accuracy of dual-energy computed tomographic angiography (DE-CTA) in the detection of intracranial aneurysms and to determine whether DE-CTA provides adequate information to guide treatment choice.
  
  
  METHODS
  Eighty patients (31 men and 49 women; mean [SD] ages of 52 [9] years) with spontaneous subarachnoid hemorrhage underwent DE-CTA. The performance of DE-CTA was compared with conventional CTA created from average weighted images and digital subtraction angiography (DSA). Sensitivity and specificity for aneurysm detection were determined on a per-patient and per-aneurysm basis. The treatment choice was assessed on the basis of aneurysm neck size and/or the dome/neck ratio.
  
  
  RESULTS
  With DSA as reference standard (n = 61; 47 aneurysms in 41 patients), DE-CTA correctly detected 45 aneurysms in 41 patients corresponding to sensitivity and specificity of 100% and 95.0% on a per-patient basis versus 95.7% and 95.0% on a per-aneurysm basis, whereas conventional CTA correctly detected 43 aneurysms in 39 patients corresponding to sensitivity and specificity of 95.1% and 95.0% on a per-patient basis versus 91.5% and 95.0% on a per-aneurysm basis. No statistical difference between DE-CTA and conventional CTA was found for the diagnostic evaluation of intracranial aneurysms. Surgery was performed to treat 38 aneurysms, coiling in 26 aneurysms, stent in one patient, and follow-up in the remaining 5 aneurysms. Dual-energy CTA correctly predicted treatment choice in 44 aneurysms, with 15 aneurysms coiled and 29 aneurysms clipped.
  
  
  CONCLUSIONS
  Compared with DSA, DE-CTA had a comparable diagnostic accuracy for the detection of intracranial aneurysms, visualization of the morphology of aneurysms at the skull base, and prediction of aneurysm treatment choice in most patients with spontaneous subarachnoid hemorrhage based on this study.
authors.affiliation: Department of Medical Imaging, Jinling Hospital, Clinical School of Medical College, Nanjing University, Nanjing, Jiangsu, China.
authors.forename: Long-Jiang
authors.initials: LJ
authors.lastname: Zhang
authors.forename: Sheng-Yong
authors.initials: SY
authors.lastname: Wu
authors.forename: Colin S
authors.initials: CS
authors.lastname: Poon
authors.forename: Yan-E
authors.initials: YE
authors.lastname: Zhao
authors.forename: Xue
authors.initials: X
authors.lastname: Chai
authors.forename: Chang-Sheng
authors.initials: CS
authors.lastname: Zhou
authors.forename: Guang-Ming
authors.initials: GM
authors.lastname: Lu
mesh_terms: D015901:Angiography, Digital Subtraction; D002533:Cerebral Angiography / Q000379:methods*; D003657:Decision Making; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000000981:diagnostic imaging* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011857:Radiographic Image Interpretation, Computer-Assisted; D012680:Sensitivity and Specificity; D013345:Subarachnoid Hemorrhage / Q000000981:diagnostic imaging* / Q000601:surgery*; D014057:Tomography, X-Ray Computed