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  • Title: Accuracy of 16-row multislice computed tomographic angiography for assessment of small cerebral aneurysms.
    Author: Chen W, Wang J, Xin W, Peng Y, Xu Q.
    Journal: Neurosurgery; 2008 Jan; 62(1):113-21; discussion 121-2. PubMed ID: 18300898.
    Abstract:
    OBJECTIVE: Many cases of subarachnoid hemorrhage are the result of rupture of small cerebral aneurysms. The aim of the study was to assess the diagnostic accuracy of 16-row multislice computed tomographic angiography (CTA) in detecting small cerebral aneurysms (<or=5 mm) compared with digital subtraction angiography (DSA), surgical findings, or both. METHODS: One hundred ninety-two consecutive patients underwent CTA for suspected cerebral aneurysms. All aneurysms prospectively detected by CTA were confirmed by DSA or surgery. This was performed with a 16-detector row machine, with a detector slice of 0.75 mm, reconstruction interval of 0.40 mm, and timing determined by bolus trigger. CTA and DSA images were reviewed by two independent, blinded neuroradiologists who performed aneurysm detection, quantitation, and characterization using maximum-intensity projections, shaded-surface display, and volume-rendering techniques reconstructions. RESULTS: Combining CTA, DSA, and intraoperative findings, 64 small cerebral aneurysms (<or=5 mm) were identified in 54 (28%) of the 192 patients. Three small cerebral aneurysms identified on CTA were not clearly depicted at DSA but were confirmed at surgery. The sensitivity, specificity, and accuracy of 16-slice CTA for small aneurysms were all 100% on a per aneurysm basis. The positive predictive value and negative predictive value of 16-slice CTA for small aneurysms were both 100%, respectively, on a per aneurysm basis. There was no statistically significant difference in sensitivity between 16-slice CTA and DSA (P > 0.05). Sixteen-slice CTA images show more clarity and accuracy in the relationship of aneurysms to bone structures and adjacent branch vessels. CONCLUSION: Noninvasive 16-slice CTA is sensitive enough to replace conventional DSA in the triage, diagnosis, and treatment planning in patients with small cerebral aneurysms.
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