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AJNR - American Journal of Neuroradiology

Published ahead of print on February 7, 2008
doi: 10.3174/ajnr.A0964

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3D Rotational Angiography: The New Gold Standard in the Detection of Additional Intracranial Aneurysms

W.J. van Rooij^a, M.E. Sprengers^a, A.N. de Gast^a, J.P.P. Peluso^a and M. Sluzewski^a

^a From the Department of Radiology, St. Elisabeth Ziekenhuis, Tilburg, the Netherlands

View larger version (85K): [in this window] [in a new window]   Fig 1. A 2-mm middle cerebral artery aneurysm missed on DSA in 45-year-old man. A–D, DSA in 4 projections fails to depict an aneurysm. E, Demonstration of an aneurysm on 3DRA (arrow).

View larger version (51K): [in this window] [in a new window]   Fig 2. Two angiographically occult additional microaneurysms adjacent to a ruptured posterior inferior cerebellar artery aneurysm in a 53-year-old woman. A and B, DSA in 2 projections demonstrates a posterior inferior cerebellar artery aneurysm. C, 3DRA detects 2 additional microaneurysms (arrows).

View larger version (62K): [in this window] [in a new window]   Fig 3. A 44-year-old woman with subarachnoid hemorrhage. A and B, DSA in 2 projections reveals a posterior communicating artery aneurysm and an asymptomatic left parietal arteriovenous malformation. C, 3DRA shows, besides the posterior communicating artery aneurysm, 3 additional small aneurysms on the supraclinoidal carotid and proximal A1 arteries (short arrows) and on a fenestrated anterior communicating artery (long arrow).

View larger version (92K): [in this window] [in a new window]   Fig 4. Four examples of small additional aneurysms missed on DSA. A, A very small (0.5 mm) A1 aneurysm (arrow) in a patient with a ruptured middle cerebral artery aneurysm. B, Two supraclinoidal aneurysms (arrows) in a patient with a ruptured posterior communicating artery aneurysm. C, Two middle cerebral artery aneurysms (arrows) in a patient with a ruptured pericallosal artery aneurysm (not shown). D, An intracavernous carotid artery aneurysm (arrow) in a patient with a large ophthalmic artery aneurysm, symptomatic by mass effect.

View larger version (79K): [in this window] [in a new window]   Fig 5. Four more examples of missed additional aneurysms on DSA. A, A small middle cerebral artery aneurysm (arrow) in a patient with a ruptured anterior communicating artery aneurysm. B, Two small additional aneurysms on the anterior communicating and middle cerebral arteries (arrows) in a patient with a ruptured anterior communicating artery aneurysm. C, A very small (0.5 mm) A1 aneurysm (arrow) in a patient with a ruptured posterior communicating artery aneurysm. D, A small additional anterior communicating artery aneurysm (arrow) in a patient with a ruptured middle cerebral artery aneurysm.