• World Neurosurg · Nov 2015

    Comparative Study

    The Utility of Dual-Energy Computed Tomographic Angiography for the Evaluation of Brain Aneurysms after Surgical Clipping: A Prospective Study.

    • Parviz Dolati, Daniel Eichberg, John H Wong, and Mayank Goyal.
    • Department of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA. Electronic address: pdolati@bidmc.harvard.edu.
    • World Neurosurg. 2015 Nov 1;84(5):1362-71.

    ObjectiveThe purpose of this prospective study was to compare a novel dual-energy computed tomographic angiography (DECTA) method for postoperative assessment of clipped brain aneurysms to detect aneurysm remnants and parent artery patency, with catheter-based digital subtraction angiography (DSA).MethodsPatients who underwent microsurgical cerebral aneurysm repair were prospectively evaluated after surgery by both DECTA and conventional DSA. CTA was performed using a novel dual-energy method with single source and fast kilovoltage switching (Gemstone Spectral Imaging [GSI]). DSA was performed using biplanar cerebral angiography. An experienced neuroradiologist and a neurosurgeon, both blinded to the original radiologic results, reviewed the images.ResultsOn DSA, 8 of 15 aneurysms (53%) had a remnant after clipping. All of these remnants were <2 mm except for 1. The only residual aneurysm >2 mm was clearly detected by GSI CTA. Of those 7 DSA-confirmed <2-mm remnants, 5 were detected by GSI CTA. Metal artifacts compromised the image quality in 2 patients. The sensitivity and specificity of GSI CTA for remnant aneurysm <2-mm detection in single clip-treated patients were 100%. In all patients, these were 71.4 % and 100%, respectively. GSI CTA was 100% sensitive and 77% specific to detect parent vessel compromise, with associated positive and negative predictive values of 60% and 100%, respectively.ConclusionsDECTA is a promising noninvasive alternative to conventional catheter-based angiography for identification of aneurysm remnants and assessment of adjacent arteries after surgical clipping of brain aneurysms treated by 2 or fewer clips. It allows for a more rapid image acquisition than DSA, is more cost effective, and is widely available at clinical centers.Copyright © 2015 Elsevier Inc. All rights reserved.

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