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Neuroradiology |
1 From the Depts of Neurosurgery and Neuroradiology, Institute of Neurological Sciences, Southern General Hosp, Glasgow, Scotland (P.M.W.); and the Depts of Clinical Neurosciences (P.M.W., J.M.W., V.E.) and Medical Statistics (V.E.), Univ of Edinburgh, Bramwell Dott Building, Western General Hosp, Crewe Rd, Edinburgh EH4 2XU, United Kingdom. Received Dec 1, 1999; revision requested Jan 19, 2000; revision received Mar 20; accepted Mar 24. P.M.W. and V.E. supported by the British Brain and Spine Foundation from the Davie Cooper Scottish Aneurysm Study grant, administered by the Univ of Glasgow. J.M.W. supported by the Medical Research Council under the Clinical Research Initiative in Clinical Neuroscience. Address correspondence to P.M.W. (e-mail: pmw@skull.dcn.ed.ac.uk).
PURPOSE: To perform a systematic review to determine the accuracy of computed tomographic (CT) angiography, magnetic resonance (MR) angiography, and transcranial Doppler ultrasonography (US) in depicting intracranial aneurysms.
MATERIALS AND METHODS: A 1988–1998 literature search for studies with 10 or more subjects in which noninvasive imaging was compared with angiography was undertaken. Studies meeting initial criteria were evaluated by using intrinsically weighted standardized assessment to determine suitability for inclusion. Studies scoring greater than 50% were included.
RESULTS: Of 103 studies that met initial criteria, 38 scored greater than 50%. CT angiography and MR angiography had accuracies per aneurysm of 89% (95% CI: 87%, 91%) and 90% (95% CI: 87%, 92%), respectively. For US, data were scanty and accuracy was lower, although the CIs overlapped those of CT angiography and MR angiography. Sensitivity was greater for detection of aneurysms larger than 3 mm than for detection of aneurysms 3 mm or smaller—for CT angiography, 96% (95% CI: 94%, 98%) versus 61% (95% CI: 51%, 70%), and for MR angiography, 94% (95% CI: 90%, 97%) versus 38% (95% CI: 25%, 53%). Diagnostic accuracy was similar for anterior and posterior circulation aneurysms.
CONCLUSION: CT angiography and MR angiography depicted aneurysms with an accuracy of about 90%. Most studies were performed in populations with high aneurysm prevalence, which may have introduced bias toward noninvasive examinations. Supplemental material.
Index terms: Aneurysm, intracranial, 17.73 • Computed tomography (CT), angiography, 17.12116 • Digital subtraction angiography, comparative studies, 17.12483 • Magnetic resonance (MR), vascular studies, 17.12142 • Ultrasound (US), Doppler studies, 17.12983, 17.12984
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