title: Flat panel angiography images in the post-operative follow-up of surgically clipped intracranial aneurysms.
abstract: Cerebral aneurysms must be monitored for varying periods after surgical and/or endovascular treatment and the duration of follow-up will depend on the type of therapy and the immediate post-operative outcome. Surgical clipping for intracranial aneurysms is a valid treatment but the metal clips generate artefacts so that follow-up monitoring still relies on catheter angiography. This study reports our preliminary experience with volumetric angiography using a Philips Allura Xper FD biplane system in the post-operative monitoring of aneurysm residues or major vascular changes following the surgical clipping of intracranial aneurysms. Volumetric angiography yields not only volume-rendered (VR) images, but a volume CT can also be reconstructed at high spatial and contrast resolution from a single acquisition, significantly enhancing the technique's diagnostic power. Between August 2012 and April 2013, we studied 19 patients with a total of 26 aneurysms treated by surgical clipping alone or in combination with endovascular treatment. All patients underwent standard post-operative angiographic follow-up including a rotational volumetric acquisition. Follow-up monitoring disclosed eight aneurysm residues whose assessment was optimal after surgical clipping both in patients with one metal clip and in those with two or more clips. In addition, small residues (1.3 mm) could be monitored together with any change in the calibre or course of vessels located adjacent to the clips. In conclusion, flat panel volume CT is much more reliable than the old 3D acquisitions that yielded only VR images. This is particularly true in patients with small aneurysm residues or lesions with multiple metal clips.
authors.affiliation: Neuroradiology Department, IRCCS Institute of Neurological Sciences of Bologna; Bologna, Italy - gigicirri@libero.it.
authors.forename: Caterina
authors.initials: C
authors.lastname: Budai
authors.affiliation: Neuroradiology Department, IRCCS Institute of Neurological Sciences of Bologna; Bologna, Italy - Department of Experimental, Diagnostic and Specialty Medicine (DIMES), University of Bologna; Bologna, Italy.
authors.forename: Luigi
authors.initials: L
authors.lastname: Cirillo
authors.affiliation: Neuroradiology Department, IRCCS Institute of Neurological Sciences of Bologna; Bologna, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Patruno
authors.affiliation: Neuroradiology Department, IRCCS Institute of Neurological Sciences of Bologna; Bologna, Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Dall'olio
authors.affiliation: Neuroradiology Department, IRCCS Institute of Neurological Sciences of Bologna; Bologna, Italy.
authors.forename: Ciro
authors.initials: C
authors.lastname: Princiotta
authors.affiliation: Neuroradiology Department, IRCCS Institute of Neurological Sciences of Bologna; Bologna, Italy - Department of Experimental, Diagnostic and Specialty Medicine (DIMES), University of Bologna; Bologna, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Leonardi
mesh_terms: D000328:Adult; D000368:Aged; D016477:Artifacts; D002533:Cerebral Angiography / Q000379:methods* / Q000592:standards*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D002532:Intracranial Aneurysm / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000000981:diagnostic imaging*; D011184:Postoperative Period; D015203:Reproducibility of Results; D013525:Surgical Instruments; D014057:Tomography, X-Ray Computed / Q000379:methods* / Q000592:standards*
keywords: cerebral aneurysms; clipping; flat panel volume CT; follow-up
references.citation: J Neurosurg. 1999 Sep;91(3):396-401
references.pmid: 10470813
references.citation: Br J Neurosurg. 2005 Jun;19(3):225-8
references.pmid: 16455522
references.citation: Stroke. 2008 Jan;39(1):120-5
references.pmid: 18048860
references.citation: Neuroradiology. 2002 Sep;44(9):755-8
references.pmid: 12221447
references.citation: Stroke. 2001 May;32(5):1191-4
references.pmid: 11340232
references.citation: Lancet Neurol. 2009 May;8(5):427-33
references.pmid: 19329361
references.citation: AJNR Am J Neuroradiol. 2010 Aug;31(7):1226-31
references.pmid: 20360343
references.citation: AJNR Am J Neuroradiol. 2011 Nov-Dec;32(10):1956-62
references.pmid: 21852377
references.citation: AJNR Am J Neuroradiol. 2006 Jan;27(1):60-6
references.pmid: 16418357
references.citation: AJNR Am J Neuroradiol. 2010 Nov;31(10):1886-91
references.pmid: 20634309
references.citation: AJNR Am J Neuroradiol. 2007 Aug;28(7):1207-12
references.pmid: 17698518