title: Diagnostic Impact of Bone-Subtraction CT Angiography for Patients with Acute Subarachnoid Hemorrhage.
abstract: OBJECTIVE
  Detection and evaluation of ruptured aneurysms is critical for choosing an appropriate endovascular or neurosurgical intervention. Our aim was to assess whether bone-subtraction CTA is capable of guiding treatment for cerebral aneurysms in patients with acute SAH and could replace DSA.
  
  
  METHODS
  We prospectively studied 116 consecutive patients with SAH with 16-detector row bone-subtraction CTA and DSA before intracranial aneurysm treatment. Two independent neuroradiologists reviewed the bone-subtraction CTA blinded to DSA (reference standard). We determined the accuracy of bone-subtraction CTA for aneurysm detection and the measurement of aneurysm dimensions and compared the radiation doses of the 2 imaging modalities.
  
  
  RESULTS
  Seventy-one patients (61%) had 74 aneurysms on DSA. Bone-subtraction CTA detected 73 of these aneurysms, but it detected 1 additional aneurysm. On a per-aneurysm basis, sensitivity, specificity, and positive and negative predictive values for bone-subtraction CTA were 99%, 98%, and 99% and 98%, respectively. For aneurysms of ≤3 mm, sensitivity was 94% (95% CI, 73%-99%). Bone-subtraction CTA slightly overestimated neck and dome diameters by <0.2 mm and overestimated the dome-to-neck ratios by 2% on average. Dose-length product was 565 ± 201 mGy × cm for bone-subtraction CTA and 1609 ± 1300 mGy × cm for DSA.
  
  
  CONCLUSIONS
  Bone-subtraction CTA is as accurate as DSA in detecting cerebral aneurysms after SAH, provides similar information about aneurysm configuration and measures, and reduces the average effective radiation dose for vascular diagnostics by 65%. Diagnostic equivalence in association with dose reduction suggests replacing DSA with bone-subtraction CTA in the diagnostic work-up of spontaneous SAH.
authors.affiliation: From the Department of Neuroradiology (P.A., K.E., K.H., R.v.K.), University Hospital Carl Gustav Carus, Technische Universität, Dresden, Germany.
authors.forename: P
authors.initials: P
authors.lastname: Aulbach
authors.affiliation: Department of Neuroradiology (D.M.), Heinrich Braun Hospital, Zwickau, Germany.
authors.forename: D
authors.initials: D
authors.lastname: Mucha
authors.affiliation: From the Department of Neuroradiology (P.A., K.E., K.H., R.v.K.), University Hospital Carl Gustav Carus, Technische Universität, Dresden, Germany.
authors.forename: K
authors.initials: K
authors.lastname: Engellandt
authors.affiliation: From the Department of Neuroradiology (P.A., K.E., K.H., R.v.K.), University Hospital Carl Gustav Carus, Technische Universität, Dresden, Germany.
authors.forename: K
authors.initials: K
authors.lastname: Hädrich
authors.affiliation: Institute for Medical Informatics and Biometry at the Medical Faculty (M.K.), Technische Universität, Dresden, Germany.
authors.forename: M
authors.identifier: http://orcid.org/0000-0003-2868-5155
authors.initials: M
authors.lastname: Kuhn
authors.affiliation: From the Department of Neuroradiology (P.A., K.E., K.H., R.v.K.), University Hospital Carl Gustav Carus, Technische Universität, Dresden, Germany ruediger.vonkummer@uniklinikum-dresden.de.
authors.forename: R
authors.initials: R
authors.lastname: von Kummer
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015901:Angiography, Digital Subtraction / Q000379:methods; D002533:Cerebral Angiography / Q000379:methods*; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000150:complications / Q000175:diagnosis / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D012680:Sensitivity and Specificity; D013345:Subarachnoid Hemorrhage / Q000000981:diagnostic imaging* / Q000209:etiology*