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Effectiveness of MDCT Angiography for the Detection of Intracranial Aneurysms in Patients with Nontraumatic Subarachnoid Hemorrhage

Teran W. Colen1, Lilian C. Wang1, Basavaraj V. Ghodke2, Wendy A. Cohen2, William Hollingworth3 and Yoshimi Anzai1

1 Department of Radiology, University of Washington Medical Center, 1959 NE Pacific St., RR215, Box 357115, Seattle, WA 98195-7115.
2 Department of Radiology, Harborview Medical Center, Seattle, WA.
3 Harborview Injury Prevention Research Center, Seattle, WA.


Figure 1
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  		Fig. 1 —Bar graph shows sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) by aneurysm for combined MDCT data (gray bars) separated from 16-MDCT alone (black bars). There was no significant difference between data sets.

 

Figure 2
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  		Fig. 2A —69-year-old man with right middle cerebral artery (MCA) trifurcation aneurysm. Axial CT angiography (CTA) image shows thrombosed, partially calcified, 20-mm right MCA trifurcation aneurysm (arrow).

 

Figure 3
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  		Fig. 2B —69-year-old man with right middle cerebral artery (MCA) trifurcation aneurysm. Selected digital subtraction angiography image from right internal carotid artery injection shows large right MCA aneurysm (black arrow) seen on CTA (A). A second 4-mm aneurysm that was not seen on CTA is seen at origin of right MCA–anterior cerebral artery bifurcation (white arrow).

 

Figure 4
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  		Fig. 3 —Bar graph shows number of missed aneurysms on CT angiography (CTA) (gray) compared with reference standard (digital subtraction angiography) listed over total number of CTA-detected aneurysms in that location (white). Most missed aneurysms were of middle cerebral artery (MCA), which was also most common aneurysm location. Highest percentage of missed aneurysms were of posterior cerebral artery (PCA), with 45% of aneurysms in that location missed. ICA = internal carotid artery, Acom = anterior communicating artery, Pcom = posterior communicating artery. ACA = anterior cerebral artery.

 

Figure 5
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  		Fig. 4A —64-year-old man with 5-mm basilar tip aneurysm on CT angiography (CTA). Axial unenhanced head CT image shows acute hemorrhage within basal cisterns.

 

Figure 6
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  		Fig. 4B —64-year-old man with 5-mm basilar tip aneurysm on CT angiography (CTA). Axial CTA image shows prominent basilar artery tip (arrow).

 

Figure 7
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  		Fig. 4C —64-year-old man with 5-mm basilar tip aneurysm on CT angiography (CTA). Three-dimensional reconstructed image from CTA shows prominent basilar artery tip (arrow), which was described as 5-mm basilar tip aneurysm.

 

Figure 8
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  		Fig. 4D —64-year-old man with 5-mm basilar tip aneurysm on CT angiography (CTA). Selected digital subtraction angiography (DSA) image from left vertebral artery injection does not reveal aneurysm. Follow-up DSA (not shown) performed did not reveal aneurysm.

 

Figure 9
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  		Fig. 5A —67-year-old woman with 3-mm posterior communicating artery aneurysm. Axial unenhanced head CT image shows acute hemorrhage within basal cisterns.

 

Figure 10
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  		Fig. 5B —67-year-old woman with 3-mm posterior communicating artery aneurysm. Axial CT angiography image does not reveal aneurysm.

 

Figure 11
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  		Fig. 5C —67-year-old woman with 3-mm posterior communicating artery aneurysm. Selected digital subtraction angiography image from left internal carotid artery injection reveals 3-mm posterior communicating artery aneurysm (arrow).

 

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