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Detection of Intracranial Aneurysms: Multi–Detector Row CT Angiography Compared with DSA¹

¹ From the Departments of Diagnostic Imaging (G.A.T., M.V.J., W.W.M.S., R.A.H., J.M.R., N.R.M.) and Neurosurgery (C.E.D.), Rhode Island Hospital/Brown Medical School, Providence. From the 2002 RSNA scientific assembly. Received November 8, 2002; revision requested January 16, 2003; final revision received May 30; accepted June 18. Supported in part by a grant from GE Medical Systems. Address correspondence to M.V.J., Department of Radiology, Stanford University Medical Center, 300 Pasteur Dr, Room S-047, Stanford, CA 94305-5105 (e-mail: maheshj@stanford.edu).

View larger version (35K): [in a new window]   Figure 1. Rating scale and measurement convention used to describe the presence and characteristics of aneurysms on images acquired with multi-detector row CT and with DSA. Max = maximum diameter.

View larger version (103K): [in a new window]   Figure 2a. Aneurysm in a 78-year-old woman with subarachnoid hemorrhage (Hunt and Hess grade II). (a) Coronal MIP image from multi-detector row CT angiography shows bilobed anterior communicating artery aneurysm (arrows), absent right A1 segment of the anterior cerebral artery, and enlarged left A1 segment (arrowheads). The hyperattenuating tubular structure is a ventriculostomy catheter. (b) Frontal projection from DSA performed with contrast material injection into the right common carotid artery does not depict aneurysm. (c) Frontal projection from DSA performed with contrast material injection into the left common carotid artery depicts the same aneurysm as in a (arrow). The bilobed structure of the aneurysm is not as visible in the frontal view, but note the contrast material filling in both the right and the left A2 segments (arrowheads).

View larger version (170K): [in a new window]   Figure 2b. Aneurysm in a 78-year-old woman with subarachnoid hemorrhage (Hunt and Hess grade II). (a) Coronal MIP image from multi-detector row CT angiography shows bilobed anterior communicating artery aneurysm (arrows), absent right A1 segment of the anterior cerebral artery, and enlarged left A1 segment (arrowheads). The hyperattenuating tubular structure is a ventriculostomy catheter. (b) Frontal projection from DSA performed with contrast material injection into the right common carotid artery does not depict aneurysm. (c) Frontal projection from DSA performed with contrast material injection into the left common carotid artery depicts the same aneurysm as in a (arrow). The bilobed structure of the aneurysm is not as visible in the frontal view, but note the contrast material filling in both the right and the left A2 segments (arrowheads).

View larger version (142K): [in a new window]   Figure 2c. Aneurysm in a 78-year-old woman with subarachnoid hemorrhage (Hunt and Hess grade II). (a) Coronal MIP image from multi-detector row CT angiography shows bilobed anterior communicating artery aneurysm (arrows), absent right A1 segment of the anterior cerebral artery, and enlarged left A1 segment (arrowheads). The hyperattenuating tubular structure is a ventriculostomy catheter. (b) Frontal projection from DSA performed with contrast material injection into the right common carotid artery does not depict aneurysm. (c) Frontal projection from DSA performed with contrast material injection into the left common carotid artery depicts the same aneurysm as in a (arrow). The bilobed structure of the aneurysm is not as visible in the frontal view, but note the contrast material filling in both the right and the left A2 segments (arrowheads).

View larger version (106K): [in a new window]   Figure 3a. Aneurysm in a 41-year-old woman with subarachnoid hemorrhage (Hunt and Hess grade III). (a) Lateral projection from DSA with injection into the right common carotid artery depicts a large aneurysm (arrowheads) near the posterior communicating artery but does not show the relationship of the artery to the aneurysm neck or parent vessel. (b) Coronal and (c) transverse MIP images show the same aneurysm (arrowheads), as well as the relationship of the posterior communicating artery (white arrow) to the aneurysm and parent vessel. Patency of the posterior cerebral artery segment P1 also is depicted (black arrow). The aneurysm was successfully treated with surgical clipping.

View larger version (92K): [in a new window]   Figure 3b. Aneurysm in a 41-year-old woman with subarachnoid hemorrhage (Hunt and Hess grade III). (a) Lateral projection from DSA with injection into the right common carotid artery depicts a large aneurysm (arrowheads) near the posterior communicating artery but does not show the relationship of the artery to the aneurysm neck or parent vessel. (b) Coronal and (c) transverse MIP images show the same aneurysm (arrowheads), as well as the relationship of the posterior communicating artery (white arrow) to the aneurysm and parent vessel. Patency of the posterior cerebral artery segment P1 also is depicted (black arrow). The aneurysm was successfully treated with surgical clipping.

View larger version (97K): [in a new window]   Figure 3c. Aneurysm in a 41-year-old woman with subarachnoid hemorrhage (Hunt and Hess grade III). (a) Lateral projection from DSA with injection into the right common carotid artery depicts a large aneurysm (arrowheads) near the posterior communicating artery but does not show the relationship of the artery to the aneurysm neck or parent vessel. (b) Coronal and (c) transverse MIP images show the same aneurysm (arrowheads), as well as the relationship of the posterior communicating artery (white arrow) to the aneurysm and parent vessel. Patency of the posterior cerebral artery segment P1 also is depicted (black arrow). The aneurysm was successfully treated with surgical clipping.

View larger version (134K): [in a new window]   Figure 4a. Aneurysm in a 78-year-old woman with subarachnoid hemorrhage (Hunt and Hess grade V). (a) Transverse and (b) coronal MIP images from CT angiography show a 3-mm-diameter aneurysm (arrow) in the middle cerebral artery, at the origin of the left anterior temporal artery. (c) Frontal projection image from DSA performed with left common carotid artery injection shows the same aneurysm (arrow).

View larger version (126K): [in a new window]   Figure 4b. Aneurysm in a 78-year-old woman with subarachnoid hemorrhage (Hunt and Hess grade V). (a) Transverse and (b) coronal MIP images from CT angiography show a 3-mm-diameter aneurysm (arrow) in the middle cerebral artery, at the origin of the left anterior temporal artery. (c) Frontal projection image from DSA performed with left common carotid artery injection shows the same aneurysm (arrow).

View larger version (203K): [in a new window]   Figure 4c. Aneurysm in a 78-year-old woman with subarachnoid hemorrhage (Hunt and Hess grade V). (a) Transverse and (b) coronal MIP images from CT angiography show a 3-mm-diameter aneurysm (arrow) in the middle cerebral artery, at the origin of the left anterior temporal artery. (c) Frontal projection image from DSA performed with left common carotid artery injection shows the same aneurysm (arrow).

View larger version (187K): [in a new window]   Figure 5a. Aneurysm in a 48-year-old woman with subarachnoid hemorrhage (Hunt and Hess grade III). (a) Lateral projection image from DSA performed with right common carotid artery injection shows a 2-mm-diameter pericallosal artery aneurysm (arrow). (b) Transverse and (c) coronal MIP images from CT angiography show the same aneurysm (arrow).

View larger version (122K): [in a new window]   Figure 5b. Aneurysm in a 48-year-old woman with subarachnoid hemorrhage (Hunt and Hess grade III). (a) Lateral projection image from DSA performed with right common carotid artery injection shows a 2-mm-diameter pericallosal artery aneurysm (arrow). (b) Transverse and (c) coronal MIP images from CT angiography show the same aneurysm (arrow).

View larger version (142K): [in a new window]   Figure 5c. Aneurysm in a 48-year-old woman with subarachnoid hemorrhage (Hunt and Hess grade III). (a) Lateral projection image from DSA performed with right common carotid artery injection shows a 2-mm-diameter pericallosal artery aneurysm (arrow). (b) Transverse and (c) coronal MIP images from CT angiography show the same aneurysm (arrow).

View larger version (166K): [in a new window]   Figure 6a. Aneurysm in a 78-year-old woman with subarachnoid hemorrhage (Hunt and Hess grade V, same patient as in Fig 4). (a) Lateral projection image from DSA performed with left vertebral artery injection shows a small aneurysm (arrows) of the distal posterior cerebral artery that was missed by both readers at CT angiography. (b) Sagittal MIP image from CT angiography shows the same aneurysm (arrow) at retrospective interpretation.

View larger version (132K): [in a new window]   Figure 6b. Aneurysm in a 78-year-old woman with subarachnoid hemorrhage (Hunt and Hess grade V, same patient as in Fig 4). (a) Lateral projection image from DSA performed with left vertebral artery injection shows a small aneurysm (arrows) of the distal posterior cerebral artery that was missed by both readers at CT angiography. (b) Sagittal MIP image from CT angiography shows the same aneurysm (arrow) at retrospective interpretation.

View larger version (112K): [in a new window]   Figure 7a. Aneurysm and arteriovenous malformation in a 60-year-old woman with subarachnoid hemorrhage (Hunt and Hess grade III). (a) Coronal and (b) sagittal MIP images from CT angiography show bilobed aneurysm (white arrows) in the anterior communicating artery, aneurysm (white arrowheads) in the left posterior communicating artery, large left frontal arteriovenous malformation (black arrows), and prominently enlarged anterior cerebral arteries (black arrowheads). Attenuation in the vertex is decreased because of an inadvertent delay before scanning of this section. The tubular high-attenuating structure is a ventriculostomy catheter. (c) Lateral projection image from DSA with left common carotid artery injection and (d) oblique projection image from DSA with right common carotid artery injection also show the aneurysms in the anterior communicating artery (white arrow) and the posterior communicating artery (white arrowhead), enlarged feeding vessels (black arrowheads), and arteriovenous malformation (black arrows).

View larger version (118K): [in a new window]   Figure 7b. Aneurysm and arteriovenous malformation in a 60-year-old woman with subarachnoid hemorrhage (Hunt and Hess grade III). (a) Coronal and (b) sagittal MIP images from CT angiography show bilobed aneurysm (white arrows) in the anterior communicating artery, aneurysm (white arrowheads) in the left posterior communicating artery, large left frontal arteriovenous malformation (black arrows), and prominently enlarged anterior cerebral arteries (black arrowheads). Attenuation in the vertex is decreased because of an inadvertent delay before scanning of this section. The tubular high-attenuating structure is a ventriculostomy catheter. (c) Lateral projection image from DSA with left common carotid artery injection and (d) oblique projection image from DSA with right common carotid artery injection also show the aneurysms in the anterior communicating artery (white arrow) and the posterior communicating artery (white arrowhead), enlarged feeding vessels (black arrowheads), and arteriovenous malformation (black arrows).

View larger version (130K): [in a new window]   Figure 7c. Aneurysm and arteriovenous malformation in a 60-year-old woman with subarachnoid hemorrhage (Hunt and Hess grade III). (a) Coronal and (b) sagittal MIP images from CT angiography show bilobed aneurysm (white arrows) in the anterior communicating artery, aneurysm (white arrowheads) in the left posterior communicating artery, large left frontal arteriovenous malformation (black arrows), and prominently enlarged anterior cerebral arteries (black arrowheads). Attenuation in the vertex is decreased because of an inadvertent delay before scanning of this section. The tubular high-attenuating structure is a ventriculostomy catheter. (c) Lateral projection image from DSA with left common carotid artery injection and (d) oblique projection image from DSA with right common carotid artery injection also show the aneurysms in the anterior communicating artery (white arrow) and the posterior communicating artery (white arrowhead), enlarged feeding vessels (black arrowheads), and arteriovenous malformation (black arrows).

View larger version (106K): [in a new window]   Figure 7d. Aneurysm and arteriovenous malformation in a 60-year-old woman with subarachnoid hemorrhage (Hunt and Hess grade III). (a) Coronal and (b) sagittal MIP images from CT angiography show bilobed aneurysm (white arrows) in the anterior communicating artery, aneurysm (white arrowheads) in the left posterior communicating artery, large left frontal arteriovenous malformation (black arrows), and prominently enlarged anterior cerebral arteries (black arrowheads). Attenuation in the vertex is decreased because of an inadvertent delay before scanning of this section. The tubular high-attenuating structure is a ventriculostomy catheter. (c) Lateral projection image from DSA with left common carotid artery injection and (d) oblique projection image from DSA with right common carotid artery injection also show the aneurysms in the anterior communicating artery (white arrow) and the posterior communicating artery (white arrowhead), enlarged feeding vessels (black arrowheads), and arteriovenous malformation (black arrows).