• AJNR Am J Neuroradiol · Jan 2008

    Comparative Study

    Diagnostic accuracy of CT angiography with matched mask bone elimination for detection of intracranial aneurysms: comparison with digital subtraction angiography and 3D rotational angiography.

    • M Romijn, H A F Gratama van Andel, M A van Walderveen, M E Sprengers, J C van Rijn, W J van Rooij, H W Venema, C A Grimbergen, G J den Heeten, and C B Majoie.
    • Department of Radiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands. c.b.majoie@amc.uva.nl
    • AJNR Am J Neuroradiol. 2008 Jan 1;29(1):134-9.

    Background And PurposeOur aim was to determine the diagnostic accuracy of multisection CT angiography combined with matched mask bone elimination (CTA-MMBE) for detection of intracranial aneurysms compared with digital subtraction angiography (DSA) and 3D rotational angiography (3DRA).Materials And MethodsBetween January 2004 and February 2006, 108 patients who presented with clinically suspected subarachnoid hemorrhage underwent both CTA-MMBE and DSA for diagnosis of an intracranial aneurysm. Two neuroradiologists, independently, evaluated 27 predefined vessel locations in the CTA-MMBE images for the presence of an aneurysm. After consensus, diagnostic accuracy of CTA was calculated per predefined location and per patient. Interobserver agreement was calculated with kappa statistics.ResultsIn 88 patients (81%), 117 aneurysms (82 ruptured, 35 unruptured) were present on DSA. CTA-MMBE detected all ruptured aneurysms except 1. Overall specificity, sensitivity, positive predictive value, and negative predictive value of CTA-MMBE were 0.99, 0.90, 0.98, and 0.95 per patient and 0.91, 1.00, 0.97, and 0.99 per location, respectively. Sensitivity was 0.99 for aneurysms >/=3 mm and 0.38 for aneurysms <3 mm. Interobserver agreement for aneurysm detection was excellent (kappa value of 0.92 per location and 0.80 per patient).ConclusionCTA-MMBE is accurate in detecting intracranial aneurysms in any projection without overprojecting bone. CTA-MMBE has limited sensitivity in detecting very small aneurysms. Our data suggest that DSA and 3DRA can be limited to the vessel harboring the ruptured aneurysm before endovascular treatment, after detection of a ruptured aneurysm with CTA.

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