title: Detection of pulsation in unruptured cerebral aneurysms by ECG-gated 3D-CT angiography (4D-CTA) with 320-row area detector CT (ADCT) and follow-up evaluation results: assessment based on heart rate at the time of scanning.
abstract: OBJECTIVE
  Many epidemiological studies on unruptured cerebral aneurysms have reported that the larger the aneurysm, the higher the risk of rupture. However, many ruptured aneurysms are not large. Electrocardiography (ECG)-gated 3D-computed tomography angiography (4D-CTA) was used to detect pulsation in unruptured cerebral aneurysms. The differences in the clinical course of patients in whom pulsation was or was not detected were then evaluated.
  
  
  METHODS
  Forty-two patients with 62 unruptured cystiform cerebral aneurysms who underwent 4D-CTA and follow-up 3D-CTA more than 120 days later were studied. The tube voltage, tube current, and rotation speed were 120 kV, 270 mA, and 0.35 s/rot., respectively. ECG-gated reconstruction was performed, with the cardiac cycle divided into 20 phases. Patients with heart rates higher than 80 bpm were excluded, so 37 patients with 56 aneurysms were analyzed.
  
  
  RESULTS
  Pulsation was detected in 20 of the 56 unruptured aneurysms. Of these 20 aneurysms, 6 showed a change in shape at the time of follow-up. Of the 36 aneurysms in which pulsation was not detected, 2 showed a change in shape at follow-up. There was no significant difference in the follow-up interval between the two groups. The aneurysms in which pulsation was detected were significantly more likely to show a change in shape (P = 0.04), with a higher odds ratio of 7.286.
  
  
  CONCLUSIONS
  Unruptured aneurysms in which pulsation was detected by 4D-CTA were more likely to show a change in shape at follow-up, suggesting that 4D-CTA may be useful for identifying aneurysms with a higher risk of rupture.
authors.affiliation: Department of Neurosurgery, School of Medicine, Fujita Health University, Toyoake, 470-1192, Aichi, Japan, hayakawa@fujita-hu.ac.jp.
authors.forename: M
authors.initials: M
authors.lastname: Hayakawa
authors.forename: T
authors.initials: T
authors.lastname: Tanaka
authors.forename: A
authors.initials: A
authors.lastname: Sadato
authors.forename: K
authors.initials: K
authors.lastname: Adachi
authors.forename: K
authors.initials: K
authors.lastname: Ito
authors.forename: N
authors.initials: N
authors.lastname: Hattori
authors.forename: T
authors.initials: T
authors.lastname: Omi
authors.forename: M
authors.initials: M
authors.lastname: Oheda
authors.forename: K
authors.initials: K
authors.lastname: Katada
authors.forename: K
authors.initials: K
authors.lastname: Murayama
authors.forename: Y
authors.initials: Y
authors.lastname: Kato
authors.forename: Y
authors.initials: Y
authors.lastname: Hirose
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017542:Aneurysm, Ruptured / Q000000981:diagnostic imaging; D055424:Cardiac-Gated Imaging Techniques / Q000379:methods*; D002533:Cerebral Angiography / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D056973:Four-Dimensional Computed Tomography / Q000379:methods*; D006339:Heart Rate; D006801:Humans; D002532:Intracranial Aneurysm / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography / Q000379:methods; D011379:Prognosis; D011673:Pulsatile Flow; D011856:Radiographic Image Enhancement / Q000379:methods; D011857:Radiographic Image Interpretation, Computer-Assisted / Q000379:methods; D015203:Reproducibility of Results; D018570:Risk Assessment; D012680:Sensitivity and Specificity
references.citation: Stroke. 2012 May;43(5):1436-9
references.pmid: 22363053
references.citation: Neurosurgery. 1999 Jul;45(1):119-29; discussion 129-30
references.pmid: 10414574
references.citation: Stroke. 1993 Nov;24(11):1649-54
references.pmid: 8236337
references.citation: Radiology. 2008 Sep;248(3):1013-7
references.pmid: 18632531
references.citation: J Neurosurg. 2005 Oct;103(4):662-80
references.pmid: 16266049
references.citation: Lancet. 2003 Jul 12;362(9378):103-10
references.pmid: 12867109
references.citation: J Neurosurg. 2008 May;108(5):1052-60
references.pmid: 18447733
references.citation: J Neurosurg. 2002 Nov;97(5):1023-8
references.pmid: 12450022
references.citation: AJNR Am J Neuroradiol. 2005 Nov-Dec;26(10):2550-9
references.pmid: 16286400
references.citation: Stroke. 2007 Apr;38(4):1404-10
references.pmid: 17332442
references.citation: Stroke. 2009 Jan;40(1):313-6
references.pmid: 18845802
references.citation: Neurosurgery. 2011 Oct;69(4):843-51; discussion 851
references.pmid: 21623246
references.citation: J Neurosurg. 2002 Jan;96(1):64-70
references.pmid: 11794606
references.citation: J Neurosurg. 2004 Oct;101(4):676-81
references.pmid: 15481725
references.citation: Neurosurgery. 2007 Feb;60(2):213-25; discussion 225-6
references.pmid: 17290171
references.citation: J Neurosurg. 2012 Jul;117(1):20-5
references.pmid: 22540400
references.citation: Neurosurgery. 2006 Jun;58(6):1047-53; discussion 1047-53
references.pmid: 16723883
references.citation: Surg Neurol. 2006 Jan;65(1):18-25; discussion 25-7
references.pmid: 16378842
references.citation: Neurosurgery. 2005 Oct;57(4):676-83; discussion 676-83
references.pmid: 16239879
references.citation: Stroke. 2010 Sep;41(9):1969-77
references.pmid: 20671254
references.citation: Stroke. 1989 Jun;20(6):718-24
references.pmid: 2728035
references.citation: Stroke. 2004 Nov;35(11):2500-5
references.pmid: 15514200