title: Anterior communicating artery aneurysm: Accuracy of CT angiography in determination of inflow dominance.
abstract: BACKGROUND
  Preoperative assessment of anterior communicating artery (AcoA) aneurysms with cerebral angiography is common, but not without risk. Computed tomography angiography (CTA) is a widely available imaging modality that provides quick acquisition, low morbidity, and low cost. One disadvantage is that it does not provide dynamic information. In this study, the authors sought to determine whether CTA alone can reliably predict the inflow dominance to an AcoA aneurysm.
  
  
  METHODS
  Eighty-three patients with ruptured AcoA aneurysms were reviewed retrospectively. Only those patients with both preoperative CTA and cerebral angiogram were included, thus excluding six patients. Four independent observers reviewed the CTAs and attempted to identify the dominant A1. Additionally, three mathematical models were created to identify the dominant A1. These responses were compared to cerebral angiograms.
  
  
  RESULTS
  Four observers were correct in judging the dominant A1 an average of 93% of the time. Seventeen cases were read incorrectly by only one of four observers, and three cases were read incorrectly by two observers. For cases with incorrect readings, the average percentage difference in A1 sizes was 19.6%. For cases read unanimously correct, the average percentage difference in A1 sizes was 42.7%. Mathematical model #3 correctly evaluated the dominant A1 in 97% of the cases.
  
  
  CONCLUSIONS
  This study found CT angiograms can be reliable in predicting the inflow dominance to the majority of AcoA aneurysms.
authors: Department of Neurosurgery, Louisiana State University Health Sciences Center, USA oahmed@lsuhsc.edu.
authors: Osama
authors: O
authors: Ahmed
authors: Department of Neurosurgery, Louisiana State University Health Sciences Center, USA.
authors: Shihao
authors: S
authors: Zhang
authors: Department of Neurosurgery, Mayo Clinic, USA.
authors: Benjamin L
authors: BL
authors: Brown
authors: Department of Neurosurgery, Virginia Commonwealth University, USA.
authors: Jaime
authors: J
authors: Toms
authors: Department of Radiology, Neurology, and Anesthesiology, Louisiana State University Health Sciences Center, USA.
authors: Eduardo
authors: E
authors: Gonzalez-Toledo
authors: Associate Professor, Director of Skull Base Research, Department of Neurosurgery, Louisiana State University Health Sciences Center, Shreveport, LA, USA.
authors: Bharat
authors: B
authors: Guthikonda
authors: Associated Professor of Neurosurgery, Director of Neurointerventional Surgery, Department of Neurosurgery, Louisiana State University Health Sciences Center, Shreveport, LA, USA.
authors: Hugo
authors: H
authors: Cuellar
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017542:Aneurysm, Ruptured / Q000000981:diagnostic imaging*; D002533:Cerebral Angiography; D002560:Cerebrovascular Circulation; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013345:Subarachnoid Hemorrhage / Q000000981:diagnostic imaging*; D014057:Tomography, X-Ray Computed / Q000379:methods*
keywords: Aneurysm; anterior communicating artery; computed tomography angiography; subarachnoid hemorrhage