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Comparison of multislice computed tomography angiography and digital subtraction angiography in the detection of residual or recurrent aneurysm after surgical clipping with titanium clips

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Abstract

Purpose

To determine the diagnostic accuracy of 3D-CTA using volume rendering (VR) in the detection of residual or recurrent cerebral aneurysms after clipping.

Material and methods

Between January 2006 and November 2007, 45 patients (20 female, 25 male) with 50 intracranial aneurysms treated using titanium clips were enrolled in this study. IADSA and 3D-CTA were performed within 1 month after surgery in 27 (60%) patients, after 1 year in 12 (26%) patients and after 5 years in six (13%) patients. In blinded fashion, CTA and DSA images were independently interpreted by two senior neuroradiologists with 7 years of experience in vascular diagnostic neuroradiology. The diagnostic performance of MDCTA compared with DSA for the detection of aneurysm remnants was measured by receiver operating characteristic (ROC) analysis. The area under the ROC curve, 95% confidence interval (CI), sensitivity, and specificity were calculated.

Results

For the detection of residue–recurrent aneurysm; the sensitivity and specificity of MDCTA were 87.5% (95% CI = 52.9–97.8%) and 97.4% (95% CI = 86.5–99.5%) for the first reader and 87.5% (95% CI = 52.9–97.8%) and 100% (95% CI = 90.8–100%) for the second reader respectively. Receiver operating characteristic (ROC) analysis revealed good diagnostic performance for 3D-CTA (mean area under ROC curve (Az) = 0.98 and 0.99 for the first and the second observer, respectively) The kappa values extracted from the interobserver concordance analysis for agreement observers regarding the use of MDCTA for assessment of a remnant neck was 0.62.

Conclusion

Using MDCTA, it is possible to demonstrate the status of intracranial aneurysms after surgical clipping in the immediate postoperative period as well as long-term follow-up with an high sensitivity and specificity when comparing with the findings of DSA.

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Authors and Affiliations

  1. Department of Radiology, Sisli Etfal Training and Research Hospital, Sisli, Istanbul, Turkey

    Ender Uysal, Alper Ozel, Sukru Mehmet Erturk, Önder Kırdar & Muzaffer Basak

Authors
  1. Ender Uysal
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  2. Alper Ozel
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  3. Sukru Mehmet Erturk
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  4. Önder Kırdar
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  5. Muzaffer Basak
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Corresponding author

Correspondence to Ender Uysal.

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Comments

In this interesting study, the authors deal with an important and intensely debated issue. At the non-invasive era, the need for DSA represents a serious and cumbersome drawback and it is tempting to consider CTA instead. Yet, failure of CTA to securely disclose abnormal findings has limited its implementation as DSA replacement.

In the present study, the authors should be commended for their ability to reach very high level of confidence with the use of CTA with very demonstrative illustrations to support their point. Although, the paper is rather confirmatory in substance, it has the merit to be well written and to summarize a carefully performed study.

Jean F. Soustiel

Rambam Medical Center, Haifa

This is an interesting study, analysing the diagnostic accuracy of volume rendered CT angiography in the detection of residual or recurrent cerebral aneurysms after surgical clipping as compared to the gold standard digital subtraction angiography.

Istvan Szikora

National Institute of Neurosurgery, Budapest

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Uysal, E., Ozel, A., Erturk, S.M. et al. Comparison of multislice computed tomography angiography and digital subtraction angiography in the detection of residual or recurrent aneurysm after surgical clipping with titanium clips. Acta Neurochir (Wien) 151, 131–135 (2009). https://doi.org/10.1007/s00701-009-0184-x

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  • DOI: https://doi.org/10.1007/s00701-009-0184-x

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