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Neuroradiology |
1 From the University Department of Neurosurgery and Department of Neuroradiology, Institute of Neurological Sciences, Southern General Hospital, Glasgow, Scotland (P.M.W., E.M.T.); and the University of Edinburgh Departments of Clinical Neurosciences, Bramwell Dott Bldg, Western General Hospital, Crewe Rd, Edinburgh EH4 2XU, Scotland (P.M.W., J.M.W., V.E.), and Medical Statistics, Edinburgh, Scotland (V.E.). Received May 23, 2000; revision requested July 15; revision received August 21; accepted October 2. 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 University of Glasgow. J.M.W. supported by the Medical Research Council under the Clinical Research Initiative in Clinical Neuroscience, Medical Research Council, London, United Kingdom. Address correspondence to P.M.W. (e-mail: pmw@skull.dcn.ed.ac.uk).
PURPOSE: To compare computed tomographic (CT) angiography and magnetic resonance (MR) angiography with intraarterial digital subtraction angiography (DSA) in the detection of intracranial aneurysms.
MATERIALS AND METHODS: One hundred forty-two patients underwent intraarterial DSA to detect aneurysms. CT angiography, three-dimensional time-of-flight MR angiography, and intraarterial DSA were performed contemporaneously. Film hard-copy images and maximum intensity projection reconstructions of the CT angiograms and MR angiograms were reviewed at different times.
RESULTS: The accuracy per patient for the best observer was 0.87 at CT angiography and 0.85 at MR angiography. The accuracy per aneurysm for the best observer was 0.73 at CT angiography and 0.67 at MR angiography. Differences between readers and modalities were not significant. Interobserver agreement was good: 
value of 0.73 for CT angiography and of 0.74 for MR angiography. The sensitivity for detection of aneurysms smaller than 5 mm was 0.57 for CT angiography and 0.35 for MR angiography compared with 0.94 and 0.86, respectively, for detection of aneurysms 5 mm or larger. The accuracy of both CT angiography and MR angiography was lower for detection of internal carotid artery aneurysms compared with that at other sites. With low observer confidence, the likelihood of correct interpretation was significantly poorer.
CONCLUSION: CT angiography and MR angiography have limited sensitivity in the detection of small aneurysms but good interobserver agreement. There is no significant difference in diagnostic performance between the noninvasive modalities. Supplemental material: radiology.rsnajnls.org/cgi/content/full/219/3/739/DC1.
Index terms: Aneurysm, intracranial, 17.73 • Computed tomography (CT), angiography, 17.12112, 17.12115, 17.12116 • Digital subtraction angiography, comparative studies, 17.12483 • Magnetic resonance (MR), vascular studies, 17.121411, 17.121416, 17.12142
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