American Journal of Neuroradiology 2008;29:976.
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American Journal of Neuroradiology
DOI 10.3174/ajnr.A0964
INTERVENTIONAL
3D Rotational Angiography: The New Gold Standard in the Detection of Additional Intracranial Aneurysms
From the Department of Radiology, St. Elisabeth Ziekenhuis, Tilburg, the Netherlands.
Please address correspondence to Willem Jan van Rooij, MD, PhD, Department of Radiology, St. Elisabeth Ziekenhuis, Hilvarenbeekseweg 60, 5022 GC Tilburg, the Netherlands; e-mail: radiol{at}knmg.nl
BACKGROUND AND PURPOSE: The purpose of this study was to compare 3D rotational angiography (3DRA) and digital subtraction angiography (DSA) in the detection of small additional intracranial aneurysms.
MATERIALS AND METHODS: Three hundred fifty 3D datasets of 1 vascular tree of 350 patients with at least 1 intracranial aneurysm on the dataset were re-evaluated for the presence of additional aneurysms by 2 observers in consensus. Two other observers, blinded to the 3D images, re-evaluated DSA images of the same 350 vascular trees for these additional aneurysms. Results were compared.
RESULTS: In 350 3D datasets, 350 target aneurysms and 94 additional aneurysms were detected. The mean size of 94 additional aneurysms was 3.54 mm (median, 3; range, 0.5–17 mm). The proportion of aneurysms 
3 mm was significantly higher in additional aneurysms (61 of 94, 65%) than in the target aneurysms (61 of 350, 17%) (
2, P < .0001). Of 94 additional aneurysms, 27 (29%) were missed on DSA by both observers. The mean size of the missed aneurysms was 1.94 mm (median, 2; range, 0.5–4 mm). The proportion of aneurysms 3 mm in missed additional aneurysms (26 of 27, 96%) was significantly higher than that in all additional aneurysms (61 of 94, 65%) (2, P = .0035). The location of missed additional aneurysms was not different from the location of all additional aneurysms.
CONCLUSION: 3DRA depicts considerably more small (3 mm) additional aneurysms than DSA. In selected patients, accurate detection of these aneurysms may have consequences for the choice of treatment technique and for the frequency and duration of imaging follow-up.
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