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AJNR - American Journal of Neuroradiology

Published ahead of print on October 10, 2007
doi: 10.3174/ajnr.A0741

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Diagnostic Accuracy of CT Angiography with Matched Mask Bone Elimination for Detection of Intracranial Aneurysms: Comparison with Digital Subtraction Angiography and 3D Rotational Angiography

M. Romijn^a, H.A.F. Gratama van Andel^b, M.A. van Walderveen^a, M.E. Sprengers^a, J.C. van Rijn^a, W.J. van Rooij^c, H.W. Venema^a,b, C.A. Grimbergen^b, G.J. den Heeten^a and C.B. Majoie^a

^a Department of Radiology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
^b Department of Medical Physics, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
^c Department of Radiology, St. Elisabeth Ziekenhuis, Tilburg, the Netherlands

View larger version (72K): [in this window] [in a new window]   Fig 1. Illustration of a MMBE procedure in a 44-year-old woman with a ruptured right middle cerebral artery (MCA) aneurysm. A–C, Axial images of nonenhanced low-dose CT, CTA, and CTA after MMBE. D, Axial MIP obtained after MMBE shows 2 right MCA aneurysms, 1 left MCA aneurysm, and a basilar tip aneurysm (arrowheads). E, Coronal MIP image of the left MCA shows a 2.8-mm MCA aneurysm (arrow) and deceptive thickening of the MCA bifurcation. F, DSA shows the same aneurysm (arrow) as in E, with an additional 1.6-mm MCA aneurysm (large arrowhead). G, 3DRA more clearly shows both MCA aneurysms (arrow and large arrowhead). H, Composite image of three 3DRAs of both ICAs and the right vertebral artery shows all 5 aneurysms (small arrowheads and large arrowhead).

View larger version (98K): [in this window] [in a new window]   Fig 2. A 77-year-old woman with SAH and a false-positive-aneurysm finding on CTA. A, Axial CTA-MMBE image shows near complete bone removal as only the auditory ossicles (arrowheads) are not masked. B and C, Axial MIP and coronal MIP with small bone remnants of auditory ossicles (arrowheads), which do not hinder evaluation. D, Coronal MIP of a volume of interest with a small bulge of the right ICA interpreted as a small aneurysm (arrow). This infundibulum was mistaken for an aneurysm because the posterior communicating artery (PcomA) is not visible. E and F, DSA and 3DRA show the infundibulum of small PcomA (arrow).