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AJNR - American Journal of Neuroradiology

Published ahead of print on March 27, 2008
doi: 10.3174/ajnr.A1040

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Subtraction 3D CT Angiography with the Orbital Synchronized Helical Scan Technique for the Evaluation of Postoperative Cerebral Aneurysms Treated with Cobalt-Alloy Clips

Y. Watanabe^a, N. Kashiwagi^c, N. Yamada^a, M. Higashi^a, T. Fukuda^a, S. Morikawa^a, Y. Onishi^a, K. Iihara^b, S. Miyamoto^b and H. Naito^a

^a Department of Radiology, National Cardiovascular Center, Osaka, Japan
^b Department of Neurosurgery, National Cardiovascular Center, Osaka, Japan
^c Department of Radiology, Osaka Medical Center for Cancer and Cardiovascular Disease, Osaka, Japan

View larger version (116K): [in this window] [in a new window]   Fig 1. A cobalt-alloy clip scanned with and without OSHST. A, Control image. B, Second image with OSHST. C, Second image without OSHST. D, Subtraction image (B – A). E, Subtraction image (C – A). The streak artifact generated by the clip is in the same direction as that with OSHST (A and B), and the subtraction image (D) eliminates the artifacts. Subtraction image without OSHST (E) removes the clip itself, but the artifact around the clip remains.

View larger version (58K): [in this window] [in a new window]   Fig 2. One-year follow-up of a 46-year-old man who underwent clipping of an aneurysm of the right middle cerebral artery with 2 cobalt-alloy clips. A, Subtraction CTA. B, Conventional CTA. C, 3D DSA with clips. D, 3D DSA without clips. Subtraction CTA (A) and 3D DSA (C and D) represent re-expansion of the aneurysm (arrows). Visualizing the aneurysm on conventional CTA (B) is complicated by a large artifact arising from the clips.

View larger version (51K): [in this window] [in a new window]   Fig 3. Two-month follow-up of a 38-year-old man who underwent clipping of a left middle cerebral artery aneurysm with a cobalt-alloy clip. A, Subtraction CTA. B, Conventional CTA. C, DSA of the left internal carotid artery. Conventional CTA (B) represents the pseudostenosis (arrow) at proximal M2 near the clipping site.