American Journal of Neuroradiology 2008;29:134.
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American Journal of Neuroradiology
DOI 10.3174/ajnr.A0741
BRAIN
Diagnostic Accuracy of CT Angiography with Matched Mask Bone Elimination for Detection of Intracranial Aneurysms: Comparison with Digital Subtraction Angiography and 3D Rotational Angiography
From the Departments of Radiology (M.R., M.A.v.W., M.E.S., J.C.v.R., H.W.V., G.J.d.H., C.B.M.) and Medical Physics (H.A.F.G.v.A., H.W.V., C.A.G.), Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands; and the Department of Radiology (W.J.v.R.), St. Elisabeth Ziekenhuis, Tilburg, the Netherlands.
Please address correspondence to C.B. Majoie, MD, PhD, Department of Radiology, Room G1-223.2, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands; e-mail: c.b.majoie{at}amc.uva.nl
BACKGROUND AND PURPOSE: Our aim was to determine the diagnostic accuracy of multisection CT angiography combined with matched mask bone elimination (CTA-MMBE) for detection of intracranial aneurysms compared with digital subtraction angiography (DSA) and 3D rotational angiography (3DRA).
MATERIALS AND METHODS: Between January 2004 and February 2006, 108 patients who presented with clinically suspected subarachnoid hemorrhage underwent both CTA-MMBE and DSA for diagnosis of an intracranial aneurysm. Two neuroradiologists, independently, evaluated 27 predefined vessel locations in the CTA-MMBE images for the presence of an aneurysm. After consensus, diagnostic accuracy of CTA was calculated per predefined location and per patient. Interobserver agreement was calculated with 
statistics.
RESULTS: In 88 patients (81%), 117 aneurysms (82 ruptured, 35 unruptured) were present on DSA. CTA-MMBE detected all ruptured aneurysms except 1. Overall specificity, sensitivity, positive predictive value, and negative predictive value of CTA-MMBE were 0.99, 0.90, 0.98, and 0.95 per patient and 0.91, 1.00, 0.97, and 0.99 per location, respectively. Sensitivity was 0.99 for aneurysms 
3 mm and 0.38 for aneurysms <3 mm. Interobserver agreement for aneurysm detection was excellent ( value of 0.92 per location and 0.80 per patient).
CONCLUSION: CTA-MMBE is accurate in detecting intracranial aneurysms in any projection without overprojecting bone. CTA-MMBE has limited sensitivity in detecting very small aneurysms. Our data suggest that DSA and 3DRA can be limited to the vessel harboring the ruptured aneurysm before endovascular treatment, after detection of a ruptured aneurysm with CTA.
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