The Open Neurology Journal




ISSN: 1874-205X ― Volume 13, 2019

Computed Tomographic Angiography as an Adjunct to Digital Subtraction Angiography for the Pre-Operative Assessment of Cerebral Aneurysms



Khashayar Farsad1, 3, Alexander C Mamourian2, 4, Clifford J Eskey2, Jonathan A Friedman*, 1, 5
1 Section of Neurosurgery, Dartmouth-Hithchcock Medical Center, Lebanon, NH, USA
2 Section of Neuroradiology, Dartmouth-Hithchcock Medical Center, Lebanon, NH, USA
3 Present address: Department of Radiology, Massachusetts General Hospital, Boston, MA 02114, USA
4 Present address: Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA 19104, USA
5 Present address: Texas A&M Health Science Center College of Medicine, Bryan, TX, USA

Abstract

Objectives:

Computerized tomographic angiography (CTA) has emerged as a valuable diagnostic tool for the management of patients with cerebrovascular disease. The use of CTA in lieu of, or as an adjunct to, conventional cerebral angiography in the management of cerebral aneurysms awaits further experience. In this study, we evaluated the role of CTA specifically for the pre-operative assessment and planning of cerebral aneurysm surgery.

Patients and Methods:

We reviewed the relevant neuroimaging of all patients treated at Dartmouth Hitchcock Medical Center between January, 2001 and December, 2004 with a diagnosis of cerebral aneurysm and diagnostic evaluation with both CTA and conventional digital subtraction angiography (DSA) using standard imaging protocols. 32 patients underwent both CTA and DSA during the study period for a total of 36 aneurysms. Images were independently re-assesed by two neurosurgeons for information valuable for pre-operative surgical planning.

Results:

In 26 of 36 aneurysms (72%), the CTA was felt to provide the best image quality in defining the morphology of the aneurysm. In 14 aneurysms (39%), CTA provided clinically valuable anatomic detail not demonstrated on DSA, largely due to better visualization of parent and perforating vessel relationships at the aneurysm neck. There were no instances where a lesion was seen on DSA but missed on CTA. The DSA was of most clinical value in determining flow dynamics, such as the arterial supply of an anterior communicating artery aneurysm and distal anterior cerebral branches via the two A1 segments.

Conclusion:

CTA with three-dimensional reconstructions is a valuable adjunct to the preoperative evaluation of cerebral aneurysms. We advocate routine use of CTA in all patients in whom surgical aneurysm repair is planned, even when DSA has already been performed.

Keywords: Computed tomographic angiography, cerebral aneurysm, magnetic resonance angiography, digital subtraction angiography, pre-operative assessment.


Article Information


Identifiers and Pagination:

Year: 2009
Volume: 3
First Page: 1
Last Page: 7
Publisher Id: TONEUJ-3-1
DOI: 10.2174/1874205X00903010001

Article History:

Received Date: 14/7/2008
Revision Received Date: 08/10/2008
Acceptance Date: 22/10/2008
Electronic publication date: 28/1/2009
Collection year: 2009

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© Farsad et al.; Licensee Bentham Open.

open-access license: This is an open access article licensed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted, non-commercial use, distribution and reproduction in any medium, provided the work is properly cited.


* Address correspondence to this author at the Texas A&M Health Science Center College of Medicine, Bryan, TX, USA; Tel: (979) 776-8896; Fax: (979) 774-0716; E-mail: jfriedman@mail.st-joseph.org


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