Accuracy of 320-detector row nonsubtracted and subtracted volume CT angiography in evaluating small cerebral aneurysms.
OBJECTIVE The study aimed to assess the diagnostic accuracy of 320-detector row nonsubtracted and subtracted volume CT angiography (VCTA) in detecting small cerebral aneurysms (< 3 mm) compared with 3D digital subtraction angiography (3D DSA). METHODS Six hundred sixty-two patients underwent 320-detector row VCTA and 3D DSA for suspected cerebral aneurysms. Five neuroradiologists independently reviewed VCTA and 3D DSA images. The 3D DSA was considered the reference standard, and the sensitivity, specificity, and accuracy of nonsubtracted and subtracted VCTA in depicting small aneurysms were analyzed. A p value < 0.05 was considered a significant difference. RESULTS According to 3D DSA images, 98 small cerebral aneurysms were identified in 90 of 662 patients. Nonsubtracted VCTA depicted 90 small aneurysms. Ten small aneurysms were missed, and 2 small aneurysms were misdiagnosed. The missed small aneurysms were located almost in the internal carotid artery, near bone tissue. The sensitivity, specificity, and accuracy of nonsubtracted VCTA in depicting small aneurysms were 89.8%, 99.2%, and 96.5%, respectively, on a per-aneurysm basis. Subtracted VCTA depicted 97 small aneurysms. Three small aneurysms were missed, and 2 small aneurysms were misdiagnosed. The sensitivity, specificity, and accuracy of subtracted VCTA in depicting small aneurysms were 96.9%, 99.2%, and 98.6%, respectively, on a per-aneurysm basis. There was no difference in accuracy between subtracted VCTA and 3D DSA (p = 1.000). However, nonsubtracted VCTA had significantly less sensitivity than 3D DSA and subtracted VCTA (p = 0.039 and 0.016, respectively). CONCLUSIONS Subtracted 320-detector row VCTA is sensitive enough to replace 3D DSA in the diagnosis of small cerebral aneurysms (< 3 mm). The accuracy rate of nonsubtracted VCTA was lower than that of subtracted VCTA and 3D DSA, especially in the assessment of small internal carotid artery aneurysms adjacent to the skull base.
Departments of 1 Interventional Radiology.
Wenhua
W
Chen
Radiology, and.
Wei
W
Xing
Departments of 1 Interventional Radiology.
Zhongming
Z
He
Neurosurgery, The Third Affiliated Hospital of Soochow University, Changzhou, People's Republic of China.
Ya
Y
Peng
Departments of 1 Interventional Radiology.
Caoye
C
Wang
Departments of 1 Interventional Radiology.
Qi
Q
Wang
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015901:Angiography, Digital Subtraction; D000072226:Computed Tomography Angiography / Q000379:methods*; D054893:Cone-Beam Computed Tomography; D061827:Dimensional Measurement Accuracy; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional; D002532:Intracranial Aneurysm / Q000000981:diagnostic imaging* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D055815:Young Adult
CTA = computed tomography angiography; DSA = digital subtraction angiography; ICA = internal carotid artery; MCA = middle cerebral artery; MIP = maximum-intensity projection; SAH = subarachnoid hemorrhage; VCTA = volume CT angiography; VRT = volume-rendering technique; cerebral aneurysm; computed tomography angiography; digital subtraction angiography; multidetector computed tomography; vascular disorders