DIAGNOSTIC ACCURACY OF THREE DIMENTIONAL DIGITAL SUBSTRACTION ANGIOGRAPHY (3D DSA) IN CORRELATION WITH COMPUTED TOMOGRAPHIC ANGIOGRAPHY (CTA) AND MAGNETIC RESONANCE ANGIOGRAPHY (MRA) IN EVALUATION OF ANEURYSMAL SUBARACHNOID HAEMORRHAGE : A COMPARATIVE STUDY IN A TERTIARY CARE HOSPITAL
Abstract
ABSTRACT:-
Objectives- Subarachnoid hemorrhage from ruptured intracranial aneurysm is a serious condition, which can only be prevented by early diagnosis and treatment before rupture. In this study, we have assessed the performance of CTA and MRA in detecting, localizing and sizing intracranial aneurysms in patients of aneurysmal subarachnoid haemorrhage compared to 3D DSA and effects of above parameters on the sensitivity of these imaging modalities, taking DSA as gold standard.
Methods:- We investigated 25 consecutive patients of subarachnoid haemorrhage referred to our department between November 2017 and April 2018 after they met the inclusion criteria. Each patients underwent CTA, MRA and conventional rotational digital substraction angiography from which three dimentional reconstructed images were obtained and the findings were recorded and analysed.
Results:- We found that the sensitivity of each of CTA and MRA for identification of intracranial aneurysms is 57.1 % in small, 88.8 % in medium and 100% in large sized aneurysms. Overall, both CTA and MRA were 20% less sensitive than 3D DSA in detection of intracranial aneurysms, specially for small and medium sized ones.
Conclusion:- Hence, 3D DSA is more sensitive and accurate for evaluation of aneurysmal subarachnoid hemorrhagethan CTA and MRA.
Full Text:
PDFReferences
REFERENCES:-
Andrew Molyneux , et al.
“International Subarachnoid Aneurysm Trial (ISAT) of neurosurgical clipping versus endovascular
coiling in 2143 patients with ruptured intracranial aneurysms: a randomised trial”
The Lancet. 2002;Vol-360;No 9342;p1267-1274.
Lindsy N. Williams, Robert D. Brown Jr.
“Management of unruptured intracranial aneurysms”
Neurol Clin Pract. 2013 Apr; 3(2): 99–108.
Wiebers DO, Whisnant JP, Huston 3rd J, Meissner I, Brown Jr RD, Piepgras DG, et al.
“Unruptured intracranial aneurysms: natural history, clinical outcome, and risks of surgical and
endovascular treatment”
Lancet. 2003;362:103–10.
Dhar S, Tremmel M, Mocco J, Kim M, Yamamoto J, Siddiqui AH, et al.
“Morphology parameters for intracranial aneurysm rupture risk assessment.”
Neurosurgery. 2008;63:185–96.
Perry JJ, Stiell IG, Sivilotti ML, Bullard MJ, Emond M, Symington C, et al.
“Sensitivity of computed tomography performed within six hours of onset of headache for
diagnosis of subarachnoid haemorrhage: prospective cohort study.”
BMJ. 2011;343:d4277
Yuan MK, Lai PH, Chen JY, Hsu SS, Liang HL, Yeh LR, et al.
“Detection of subarachnoid hemorrhage at acute and subacute/chronic stages: comparison of
four magnetic resonance imaging pulse sequences and computed tomography.”
J Chin Med Assoc. 2005;68:131–7.
McCormack RF, Hutson A.
“Can computed tomography angiography of the brain replace lumbar puncture in the evaluation of acute-onset headache after a negative noncontrast cranial computed tomography scan?”
Acad Emerg Med. 2010;17:444–51.
Xing W, Chen W, Sheng J, Peng Y, Lu J, Wu X, et al.
“Sixty-four-row multislice computed tomographic angiography in the diagnosis and characterization of intracranial aneurysms: comparison with 3D rotational angiography.”
World Neurosurg. 2011;76:105–13.
Hayakawa M, Tanaka T, Sadato A, Adachi K, Ito K, Hattori N, et al.
“Detection of pulsation in unruptured cerebral aneurysms by ECG-gated 3D-CT angiography (4D
CTA) with 320-row area detector CT (ADCT) and follow-up evaluation results: assessment based on
heart rate at the time of scanning.”
Clin Neuroradiol. 2014;24:145–50.
Berg P, Roloff C, Beuing O, Voss S, Sugiyama S, Aristokleous N, et al.
“The Computational Fluid Dynamics Rupture Challenge 2013-Phase II: Variability of
hemodynamic simulations in two intracranial aneurysms.”
J Biomech Eng. 2015;137:121008.
Da Rocha AJ, da Silva CJ, Gama HP, Baccin CE, Braga FT, de Araújo Cesare F, et al.
“Comparison of magnetic resonance imaging sequences with computed tomography to detect
low-grade subarachnoid hemorrhage: Role of fluid attenuated inversion recovery sequence.”
J Comput Assist Tomogr. 2006;30:295–303.
Sailer AM, Wagemans BA, Nelemans PJ, de Graaf R, van Zwam WH.
“Diagnosing intracranial aneurysms with MR angiography: systematic review and meta
analysis.
Stroke. 2014;45:119–26.
Ruifang Yan, et al.
“A comparison of contrast-free MRA at 3.0 T in cases of intracranial aneurysms with or without
subarachnoid hemorrhage.”
Clinical Imaging. Vol-49;May-June 2018;131-135.
Nael K, Villablanca JP, Saleh R, Pope W, Nael A, Laub G, et al.
“Contrast-enhanced MR angiography at 3 T in the evaluation of intracranial aneurysms: a
comparison with time-of-flight MR angiography.”
AJNR Am J Neuroradiol. 2006;27:2118–21.
Nael K, Villablanca JP, Mossaz L, Pope W, Juncosa A, Laub G, et al.
“3-T contrast-enhanced MR angiography in evaluation of suspected intracranial aneurysm:
comparison with MDCT angiography.”
AJR Am J Roentgenol. 2008;190:389–95.
Matouk CC, Mandell DM, Gunel M, Bulsara KR, Malhotra A, Hebert R, et al.
“Vessel wall magnetic resonance imaging identifies the site of rupture in patients with multiple
intracranial aneurysms: proof of principle.
Neurosurgery. 2013;72:492–6. discussion 496.
Vakil P, Ansari SA, Cantrell CG, Eddleman CS, Dehkordi FH, Vranic J, et al.
“Quantifying intracranial aneurysm wall permeability for risk assessment using dynamic
contrast-enhanced MRI: A pilot study.
AJNR Am J Neuroradiol. 2015;36:953–9.
Kleinloog R, Korkmaz E, Zwanenburg JJ, Kuijf HJ, Visser F, Blankena R, et al.
“Visualization of the aneurysm wall: a 7.0-tesla magnetic resonance imaging study.”
Neurosurgery. 2014;75:614–22.
Cebral JR, Vazquez M, Sforza DM, Houzeaux G, Tateshima S, Scrivano E, et al.
“Analysis of hemodynamics and wall mechanics at sites of cerebral aneurysm rupture.”
J Neurointerv Surg. 2015;7:530–6.
Futami K, Sano H, Misaki K, Nakada M, Ueda F, Hamada J.
“Identification of the inflow zone of unruptured cerebral aneurysms: comparison of 4D flow
MRI and 3D TOF MRA data.”
AJNR Am J Neuroradiol. 2014;35:1363–70.
Fifi JT, Meyers PM, Lavine SD, Cox V, Silverberg L, Mangla S, et al.
“Complications of modern diagnostic cerebral angiography in an academic medical center.”
J Vasc Interv Radiol. 2009;20:442–7.
Bakker NA, Groen RJ, Foumani M, Uyttenboogaart M, Eshghi OS, Metzemaekers JD, et al.
“Repeat digital subtraction angiography after a negative baseline assessment in
nonperimesencephalic subarachnoid hemorrhage: a pooled data meta-analysis.”
J Neurosurg. 2014;120:99–103.
Refbacks
© Copyright PJR 2008- |