Three-dimensional helical computerized tomography angiography in the diagnosis, characterization, and management of middle cerebral artery aneurysms: comparison with conventional angiography and intraoperative findings

2002 ◽  
Vol 97 (6) ◽  
pp. 1322-1332 ◽  
Author(s):  
J. Pablo Villablanca ◽  
Parizad Hooshi ◽  
Neil Martin ◽  
Reza Jahan ◽  
Gary Duckwiler ◽  
...  
Keyword(s):  
Middle Cerebral Artery ◽  
Treatment Planning ◽  
Ct Angiography ◽  
Computerized Tomography ◽  
Cerebral Artery ◽  
Three Dimensional ◽  
Content Type ◽  
Computerized Tomography Angiography ◽  
Fine Print

Object. Middle cerebral artery (MCA) aneurysms can be difficult to detect and characterize. The authors describe the utility and impact of helical computerized tomography (CT) angiography for the evaluation of aneurysms in this location, and compare this modality with digital subtraction (DS) angiography and intraoperative findings. Methods. Two hundred fifty-one patients with suspected cerebral aneurysms underwent CT angiography. Two-dimensional multiplanar reformatted images and three-dimensional CT angiograms were examined by two independent readers in a blinded fashion. Results were compared with findings on DS angiograms to determine the relative efficacy of these modalities in the detection and characterization of aneurysms. Questionnaires completed by neurosurgeons and endovascular therapists were used to determine the impact of CT angiograms on aneurysm management. Twenty-eight patients harboring 31 MCA aneurysms and 26 patients without aneurysms were identified using CT angiography. The sensitivity of CT angiography and DS angiography for MCA aneurysms was 97%; both techniques showed 100% specificity. In 76% of evaluations, the CT angiography studies provided information not available on DS angiography examinations. For the characterization of aneurysms, CT angiography was rated superior (72%) or equal (20%) to DS angiography in 92% of cases evaluated (p < 0.001). Computerized tomography angiography was evaluated as the only study needed for patient triage in 82% of cases (p < 0.001), and as the only study needed for treatment planning in 89% of surgically treated (p < 0.001) and in 63% of endovascularly treated cases (p < 0.001). The information acquired on CT angiograms changed the initial treatment plan in 24 (67%) of these 36 complex lesions (p < 0.01). The aneurysm appearance intraoperatively was identical or nearly identical to that seen on CT angiograms in 17 (89%) of 19 of the surgically treated cases. Conclusions. Computerized tomography angiography has unique advantages over DS angiography and is a viable alternative to the latter modality in the diagnosis, triage, and treatment planning in patients with MCA aneurysms.

Aneurysms of the posterior circulation: detection and treatment planning using volume-rendered three-dimensional helical computerized tomography angiography

2005 ◽  
Vol 103 (6) ◽  
pp. 1018-1029 ◽  
Author(s):  
J. Pablo Villablanca ◽  
Adina Achiriolaie ◽  
Parizad Hooshi ◽  
Neil Martin ◽  
Gary Duckwiler ◽  
...  
Keyword(s):  
Treatment Planning ◽  
Ct Angiography ◽  
Computerized Tomography ◽  
Treatment Options ◽  
Significant Proportion ◽  
Posterior Circulation ◽  
Content Type ◽  
Computerized Tomography Angiography ◽  
Posterior Circulation Aneurysms ◽  
Fine Print

Object. The aim of this study was to determine whether computerized tomography (CT) angiography could be used to identify and characterize aneurysms of the posterior circulation and guide optimal treatment selection, and how data obtained using this method compared with intraoperative findings. Methods. Patients suspected of harboring brain aneurysms underwent CT angiography and digital subtraction (DS) angiography; the results were prospectively interpreted by blinded independent evaluators. All patients with posterior circulation aneurysms were consecutively enrolled in the study. After treatment, neurosurgeons and endovascular therapists evaluated the ability of CT and DS angiography to demonstrate features of the lesions important for triage between treatment options (Wilcoxon signed-rank test) and to allow for coil or clip preselection and complete treatment planning (McNemar test of proportions), while using intraoperative findings as the basis of truth. In 242 patients overall, CT angiography detected 38 aneurysms and two aneurysmal blisters in 32 patients. The sensitivity of CT angiography in revealing posterior circulation aneurysms was 100% compared with DS angiography, with no false-positive results. Furthermore, CT angiography was sufficient as the sole study at triage for 65% of the posterior circulation aneurysms (26 of 40 lesions; p < 0.001), including 62% of the complex lesions (p < 0.001), and permitted coil or clip preselection in 74% of treated cases (20 of 27 cases; p < 0.002). Results of CT angiography revealed information about mural calcification and intraluminal thrombus not available on DS angiography, which affected patient care. Conclusions. In this study population, CT angiography was comparable to DS angiography in the detection and characterization of aneurysms of the posterior circulation. Computerized tomography angiography was used successfully to triage patients between endovascular and neurosurgical treatment options in a significant proportion of cases and permitted treatment planning in more than 70% of treated cases.

Volume-rendered helical computerized tomography angiography in the detection and characterization of intracranial aneurysms

2000 ◽  
Vol 93 (2) ◽  
pp. 254-264 ◽  
Author(s):  
J. Pablo Villablanca ◽  
Neil Martin ◽  
Reza Jahan ◽  
Y. Pierre Gobin ◽  
John Frazee ◽  
...  
Keyword(s):  
Ct Angiography ◽  
Computerized Tomography ◽  
Intracranial Aneurysms ◽  
Mr Angiography ◽  
Content Type ◽  
Aneurysm Neck ◽  
Computerized Tomography Angiography ◽  
Impact On Treatment ◽  
Fine Print

Object. The goal of this study was to evaluate the utility of volume-rendered helical computerized tomography (CT) angiography in patients with intracranial aneurysms. The authors compared the abilities of CT angiography, digital subtraction (DS) angiography, and three-dimensional time-of-flight magnetic resonance (MR) angiography to characterize aneurysms.Methods. Helical CT angiography was performed in 45 patients with suspected intracranial aneurysms by using volume-rendered multiplanar reformatted (MPR) images. Digital subtraction angiography was performed using biplane angiography. These studies and those performed using MR angiography were interpreted in a blinded manner. Two neurosurgeons and two interventional neuroradiologists independently graded the utility of CT angiography with respect to aneurysm characterization.Fifty-five aneurysms were detected. Of these, 48 were evaluated for treatment. Computerized tomography angiography was judged to be superior to both DS and MR angiography in the evaluation of the arterial branching pattern at the aneurysm neck (compared with DS angiography, p = 0.001, and with MR angiography, p = 0.007), aneurysm neck geometry (compared with DS angiography, p = 0.001, and with MR angiography, p = 0.001), arterial branch incorporation (compared with DS angiography, p = 0.021, and with MR angiography, p = 0.001), mural thrombus (compared with DS angiography, p < 0.001), and mural calcification (compared with DS angiography, p < 0.001, and with MR angiography, p < 0.001). For surgical cases, CT angiography had a significant impact on treatment path (p = 0.001), operative approach (p = 0.001), and preoperative clip selection (p < 0.001). For endovascular cases, CT angiography had an impact on treatment path (p < 0.02), DS angiography study time (p = 0.01), contrast agent usage (p = 0.01), and coil selection (p = 0.02). Computerized tomography angiography provided unique information about 39 (81%) of 48 aneurysms, especially when compared with DS angiography (p = 0.003). The sensitivity and specificity of CT angiography compared with DS angiography was 1. The sensitivity and specificity of CT and DS angiography studies compared with operative findings were 0.98 and 1, respectively.Conclusions. Computerized tomography angiography is equal to DS angiography in the detection and superior to DS angiography and MR angiography in the characterization of brain aneurysms. Information contained in volume-rendered CT angiography images had a significant impact on case management.

Three-dimensional computerized tomography angiography in patients with hyperacute intracerebral hemorrhage

1999 ◽  
Vol 91 (3) ◽  
pp. 424-431 ◽  
Author(s):  
Yasuo Murai ◽  
Ryo Takagi ◽  
Yukio Ikeda ◽  
Yasuhiro Yamamoto ◽  
Akira Teramoto
Keyword(s):  
Intracerebral Hemorrhage ◽  
Ct Angiography ◽  
Computerized Tomography ◽  
Three Dimensional ◽  
Ct Scanning ◽  
3D Ct ◽  
Content Type ◽  
Hematoma Enlargement ◽  
3D Ct Angiography ◽  
Fine Print

Object. The authors confirm the usefulness of extravasation detected on three-dimensional computerized tomography (3D-CT) angiography in the diagnosis of continued hemorrhage and establishment of its cause in patients with acute intracerebral hemorrhage (ICH).Methods. Thirty-one patients with acute ICH in whom noncontrast and 3D-CT angiography had been performed within 12 hours of the onset of hemorrhage and in whom conventional cerebral angiographic studies were obtained during the chronic stage were prospectively studied. Noncontrast CT scanning was repeated within 24 hours of the onset of ICH to evaluate hematoma enlargement.Findings indicating extravasation on 3D-CT angiography, including any abnormal area of high density on helical CT scanning, were observed in five patients; three of these demonstrated hematoma enlargement on follow-up CT studies. Thus, specificity was 60% (three correct predictions among five positives) and sensitivity was 100% (19 correct predictions among 19 negatives). Evidence of extravasation on 3D-CT angiography indicates that there is persistent hemorrhage and correlates with enlargement of the hematoma.Regarding the cause of hemorrhage, five cerebral aneurysms were visualized in four patients, and two diagnoses of moyamoya disease and one of unilateral moyamoya phenomenon were made with the aid of 3D-CT angiography. Emergency surgery was performed without conventional angiography in one patient who had an aneurysm, and it was clipped successfully.Conclusions. Overall, 3D-CT angiography was found to be valuable in the diagnosis of the cause of hemorrhage and in the detection of persistent hemorrhage in patients with acute ICH.

Three-dimensional computerized tomography angiography—guided surgery of acutely ruptured cerebral anuerysms

2001 ◽  
Vol 94 (5) ◽  
pp. 718-727 ◽  
Author(s):  
Masato Matsumoto ◽  
Masanori Sato ◽  
Masayuki Nakano ◽  
Yuji Endo ◽  
Youichi Watanabe ◽  
...  
Keyword(s):  
Ct Angiography ◽  
Computerized Tomography ◽  
Three Dimensional ◽  
Artery Aneurysm ◽  
3D Ct ◽  
Conventional Angiography ◽  
Content Type ◽  
Ruptured Aneurysms ◽  
3D Ct Angiography ◽  
Fine Print

Object. The aim of this study was to assess whether aneurysm surgery can be performed in patients with ruptured cerebral aneurysms by using three-dimensional computerized tomography (3D-CT) angiography alone, without conventional catheter angiography. Methods. In a previous study, 60 patients with subarachnoid hemorrhage (SAH) from ruptured aneurysms were prospectively evaluated using both 3D-CT and conventional angiography, which resulted in a 100% accuracy for 3D-CT angiography in the diagnosis of ruptured aneurysms, and a 96% accuracy in the identification of associated unruptured aneurysms. The results led the authors to consider replacing conventional angiography with 3D-CT angiography for use in diagnosing ruptured aneurysms, and to perform surgery aided by 3D-CT angiography alone without conventional angiography. Based on the results, 100 consecutive patients with SAH who had undergone surgery in the acute stage based on 3D-CT angiography findings have been studied since December 1996. One hundred ruptured aneurysms, including 41 associated unruptured lesions, were detected using 3D-CT angiography. In seven of 100 ruptured aneurysms, which included four dissecting vertebral artery aneurysms, two basilar artery (BA) tip aneurysms, and one BA—superior cerebellar artery aneurysm, 3D-CT angiography was followed by conventional angiography to acquire diagnostic confirmation or information about the vein of Labbé, which was needed to guide the surgical approach for BA tip aneurysms. All of the ruptured aneurysms were confirmed at surgery and treated successfully. Ninety-three patients who underwent operation with the aid of 3D-CT angiography only had no complications related to the lack of information gathered by conventional angiography. The 3D-CT angiography studies provided the authors with the aneurysm location as well as surgically important information on the configuration of its sac and neck, the presence of calcification in the aneurysm wall, and its relationship to the adjacent vessels and bone structures. Conclusions The authors believe that 3D-CT angiography can replace conventional angiography in the diagnosis of ruptured aneurysms and that surgery can be performed in almost all acutely ruptured aneurysms by using only 3D-CT angiography without conventional angiography.

Surgical anatomy of the cerebral arteries in patients with subarachnoid hemorrhage: comparison of computerized tomography angiography and digital subtraction angiography

2001 ◽  
Vol 95 (2) ◽  
pp. 206-212 ◽  
Author(s):  
Birgitta K. Velthuis ◽  
Maarten S. van Leeuwen ◽  
Theodoor D. Witkamp ◽  
Lino M. P. Ramos ◽  
Jan Willem Berkelbach van der Sprenkel ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Ct Angiography ◽  
Computerized Tomography ◽  
Cerebral Arteries ◽  
Digital Subtraction ◽  
Aneurysm Surgery ◽  
Content Type ◽  
Computerized Tomography Angiography ◽  
Vertebrobasilar Artery ◽  
Fine Print

Object. The purpose of this study was to compare computerized tomography (CT) angiography and digital subtraction (DS) angiography studies in patients with subarachnoid hemorrhage (SAH) to assess their vascular anatomy relevant to cerebral aneurysm surgery. Methods. From a prospective series of 100 patients with SAH, the authors selected 73 patients whose CT angiography studies were of adequate quality and in whom DS angiography of both carotid arteries had been performed. Eleven patients with no DS angiographic studies of the vertebrobasilar artery were only evaluated for the anterior half of the circle of Willis. Anterior communicating arteries (ACoAs), both precommunicating anterior cerebral arteries (A1 segments), both posterior communicating arteries (PCoAs), and both precommunicating posterior cerebral arteries (P1 segments) were assessed on CT angiography and DS angiography by two independent observers. Conclusions. Computerized tomography angiography compares well with DS angiography for visualizing normal-sized arteries, and is superior for visualizing ACoAs and hypoplastic A1 and P1 segments. Important preoperative aspects such as dominant A1 segments and PCoAs are equally well seen using either modality. Neither method enabled the authors to visualize more than 50% of PCoAs. Use of CT angiography can provide the required preoperative anatomical information for aneurysm surgery in most patients with SAH.

Incidence and risk factors for the growth of unruptured cerebral aneurysms: observation using serial computerized tomography angiography

2004 ◽  
Vol 101 (6) ◽  
pp. 908-914 ◽  
Author(s):  
Shunji Matsubara ◽  
Hiromu Hadeishi ◽  
Akifumi Suzuki ◽  
Nobuyuki Yasui ◽  
Hiromi Nishimura
Keyword(s):  
Risk Factors ◽  
Computerized Tomography ◽  
Cerebral Artery ◽  
Maximum Diameter ◽  
Content Type ◽  
Computerized Tomography Angiography ◽  
Unruptured Intracranial Aneurysms ◽  
Aneurysm Growth ◽  
Fine Print

Object. The goal of this study was to examine the growth of unruptured intracranial aneurysms with the focus on the risk factors and incidence of these lesions. Methods. One hundred sixty-six untreated cerebral saccular aneurysms were analyzed in 140 patients. The age of the patients ranged from 29 to 82 years (mean 62.8 years), the female/male ratio was 94:46, and the mean follow-up period was 17.7 months. Aneurysms were located at the internal carotid artery (ICA) in 68 patients, the middle cerebral artery (MCA) in 43, the anterior cerebral artery in 38, the basilar artery (BA) in 13, and the vertebral artery in four patients. The maximum diameter of the lesions ranged from 2 to 20 mm (mean 4.1 mm). All patients were examined using serial computerized tomography angiography to evaluate signs of aneurysm growth. Although growth was identified in 10 aneurysms (nine patients [6.4%]), no bleeding occurred. Growth-related changes were significantly associated with the size of the aneurysm and occurred in three (2.4%) of 125 aneurysms measuring 2 to 4 mm, three (9.1%) of 33 lesions measuring 5 to 9 mm, and four (50%) of eight lesions measuring 10 to 20 mm. These changes were more frequently found in aneurysms located at the BA bifurcation (two [40%] of five lesions) and the ICA (six [8.8%] of 68 lesions) than in those located at the MCA (zero of 43 lesions, p < 0.05). The 1-, 2-, and 3-year cumulative growth rates calculated using the Kaplan—Meier method were 2.5, 8, and 17.6%, respectively. Conclusions. A diameter of at least 10 mm and a location at the BA bifurcation or the ICA were significant risk factors for aneurysm growth. The incidence of growth was 2.5% in the 1st year and this risk increased yearly. Computerized tomography angiography is useful for follow up of patients with aneurysms because it allows the detection of even subtle morphological changes.

Identification of the carotid artery dural ring by using three-dimensional computerized tomography angiography

2001 ◽  
Vol 95 (3) ◽  
pp. 533-536 ◽  
Author(s):  
Yoshihisa Murayama ◽  
Kazuhide Sakurama ◽  
Koichi Satoh ◽  
Shinji Nagahiro
Keyword(s):  
Carotid Artery ◽  
Ct Angiography ◽  
Computerized Tomography ◽  
Three Dimensional ◽  
3D Ct ◽  
Aneurysm Surgery ◽  
Anatomical Studies ◽  
Content Type ◽  
3D Ct Angiography ◽  
Fine Print

✓ The carotid artery (CA) dural ring is an important structure in aneurysm surgery of the paraclinoid region. The authors used three-dimensional computerized tomography (3D-CT) angiography to study the CA dural ring. Three-dimensional computerized tomography angiography was performed in patients with cerebral aneurysms and other cerebrovascular diseases. The paraclinoid segment of the internal carotid artery (ICA) was examined by the shaded surface reconstruction method on targeted 3D-CT angiography. The concavity was recognized in the paraclinoid segment of the ICA. The relationship between the concavity and the dural ring was investigated with anatomical studies and surgical findings. In anatomical studies, the concavity in the paraclinoid segment of the ICA on 3D-CT angiography coincided with the level of attachment of the dural ring. Using 3D-CT angiography, it is possible to identify the location of the dural ring in patients being considered for aneurysm surgery.

MRI demonstration of clot in a small unruptured aneurysm causing stroke

1986 ◽  
Vol 65 (3) ◽  
pp. 411-412 ◽  
Author(s):  
Theodore W. Eller
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Middle Cerebral Artery ◽  
Computerized Tomography ◽  
Cerebral Artery ◽  
Unruptured Aneurysm ◽  
Resonance Imaging ◽  
Content Type ◽  
The Right ◽  
Fine Print

✓ The case is reported of a 69-year-old woman with an 18-mm unruptured aneurysm of the right middle cerebral artery which caused a moderate stroke. Magnetic resonance imaging revealed a clot inside the aneurysm that was not visible on computerized tomography scans. The danger of embolism from the clot prompted clipping of the aneurysm.

Limitations of three-dimensional reconstructed computerized tomography angiography after clip placement for intracranial aneurysms

2005 ◽  
Vol 103 (4) ◽  
pp. 656-661 ◽  
Author(s):  
Yoshiko Sagara ◽  
Hiro Kiyosue ◽  
Yuzo Hori ◽  
Michifumi Sainoo ◽  
Hirofumi Nagatomi ◽  
...  
Keyword(s):  
Ct Angiography ◽  
Computerized Tomography ◽  
Intracranial Aneurysms ◽  
Three Dimensional ◽  
Parent Artery ◽  
3D Ct ◽  
Metal Artifacts ◽  
Content Type ◽  
Aneurysm Neck ◽  
Fine Print

Object. The authors compared the usefulness of three-dimensional (3D) reconstructed computerized tomography (CT) angiography with 3D digital subtraction (DS) angiography in assessing intracranial aneurysms after clip placement. A retrospective review of clinical cases was performed. Methods. Between May 2001 and May 2003, 17 patients with a total of 20 intracranial aneurysms underwent 3D CT and 3D DS angiography following clip placement. The authors assessed the presence or absence of residual aneurysm necks and stenoocclusive changes in the parent artery and the neighboring artery. The efficacy of CT angiographic visualization was also evaluated. In 12 of the 20 aneurysms, both 3D modalities similarly demonstrated the residual aneurysm neck and stenoocclusive changes in the parent artery and neighboring artery. Three-dimensional CT angiography failed to demonstrate three of the aneurysms, and the studies were not considered suitable for evaluation because of the presence of metallic artifacts. In the remaining five studies, the 3D CT angiograms did not effectively demonstrate the neighboring and parent arteries. The detectability of residual aneurysm necks was correlated with the clip material and with the number of clips applied. Conclusions. Three-dimensional DS angiography is still necessary in cases involving multiple clips or with cobalt alloy clips because the clips appear as metal artifacts on 3D CT angiography.

Computerized tomography angiography in patients with subarachnoid hemorrhage: from aneurysm detection to treatment without conventional angiography

1999 ◽  
Vol 91 (5) ◽  
pp. 761-767 ◽  
Author(s):  
Birgitta K. Velthuis ◽  
Maarten S. van Leeuwen ◽  
Theodoor D. Witkamp ◽  
Lino M. P. Ramos ◽  
Jan Willem Berkelbach van der Sprenkel ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Ct Angiography ◽  
Computerized Tomography ◽  
Intracranial Aneurysms ◽  
Parent Artery ◽  
Imaging Method ◽  
Content Type ◽  
Computerized Tomography Angiography ◽  
Ruptured Intracranial Aneurysms ◽  
Fine Print

Object. The purpose of this study was to determine prospectively whether and to what extent computerized tomography (CT) angiography can serve as the sole imaging method for a preoperative workup in patients with ruptured intracranial aneurysms.Methods. During a 1-year period, all patients who presented to the authors' hospital with subarachnoid hemorrhage demonstrated by unenhanced CT scanning or lumbar puncture underwent CT angiography. Two radiologists evaluated the CT angiography source images and maximum intensity projection slabs and arrived at a consensus. They categorized the quality of the CT angiography as adequate or inadequate and classified aneurysms that were detected as definitely or possibly present. The parent artery of anterior communicating artery aneurysms was identified by asymmetrical anterior cerebral artery size and asymmetrical aneurysm location. The parent artery was indicated by the larger A1 segment in cases of asymmetrical A1 size. Only CT angiograms of adequate quality that revealed aneurysms classified as definitely present and with an unequivocal parent artery were presented to the neurosurgeons, who decided whether preoperative digital subtraction (DS) angiography should still be performed.Forty-nine of the 100 studied patients did not undergo surgery because of poor clinical condition, nonaneurysmal cause of the hemorrhage, or endovascular treatment of the ruptured aneurysm. Of the 51 patients who underwent surgery, radiologists required DS angiography in 17 patients; the imaging technique provided greater certainty in 13 instances. The neurosurgeons required DS angiography 11 times; this provided additional information in two instances. Twenty-three (45%) of the 51 patients were surgically treated successfully on the basis of CT angiography findings alone.Conclusions. Computerized tomography angiography can replace DS angiography as the preoperative neuroimaging technique in a substantial proportion of patients with ruptured intracranial aneurysms.

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