Application of three dimensional computed tomographic angiography to acutely ruptured intracranial aneurysms associated with clinical diagnosis and treatment

Objective To evaluate the value of clinical application of three-dimensional computed tomographic angiography (3D-CTA) in acutely ruptured intracranial aneurysms. Methods 148 consecutive patients with acute subarachnoid hemorrhage and clinical highly suspected ruptured intracranial aneurysms underwent 3D-CTA by GE Lightspeed pro scanner in 2h to 4d after attack. 6 patients were performed digital subtraction angiography (DSA) before 3D-CTA scan, and 142 patients were had DSA after scan. All of the source images were processing into volume rendering ( VR) and some of them have maximal intensity projection ( MIP). Results were blindly reviewed by two independent radiologist and neurosurgon. Intracranial aneurysms were treated by surgery clipping or coil embolization. Results 130 intracranial aneurysms were found in 112 cases by examination and clinic treatment, dimensions from 1. 1 ~ 28mm. 97 cases were a single aneurysm, 15 cases were found total 33 multiple intracranial aneurysms ( MIA) , including 12 patients had two aneurysms and 3 had three aneurysms. 128 aneurysms were detected by 3D-CTA in all 112 patients. DSA demonstrated 127 aneurysms in 109 patients. The sensitivity of CTA for the detection of all aneurysms was 98. 5% , the specificity 94. 7% , the accuracy 97. 6% , the positive predictive value (PPV) 98.5% , the negative predictive value (NPV) 94.7%. The sensitivity of DSA was 97.6% , the specificity 100% , the PPV 100% , the NPV 92. 3% and the accuracy 92. 3%. Besides 2 ophthalimic aneurysms, Image of 128 aneurysms found by 3D-CTA showed more clear detail of the neck and the feeding artery of aneurysm (98. 4% ) than DSA (40. 9% ) , X2 test were significance different (X2 -5.545, P0.05). Conclusions 3D-CTA is a quick, economical and relative noninvasive method for the diagnosis of intracranial aneurysms and has highly sensitivity and specificity, which can be used to diagnose acutely ruptured intracranial aneurysms as good as DSA.