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Research ArticleINTERVENTIONAL

Feasibility of Flat Panel Angiographic CT after Intravenous Contrast Agent Application in the Postoperative Evaluation of Patients with Clipped Aneurysms

M.-N. Psychogios, D. Wachter, A. Mohr, P. Schramm, A.-M. Frölich, K. Jung, V. Rohde and M. Knauth
American Journal of Neuroradiology August 2011, DOI: https://doi.org/10.3174/ajnr.A2611
M.-N. Psychogios
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D. Wachter
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A. Mohr
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P. Schramm
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A.-M. Frölich
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K. Jung
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V. Rohde
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M. Knauth
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Abstract

BACKGROUND AND PURPOSE: Important findings, such as aneurysm remnants or major arterial occlusion, can be detected on intra- or postoperative angiography after surgical clipping of intracranial aneurysms. The purpose of this study was to evaluate the feasibility of IV-ACT for the postoperative detection of residual aneurysms and parent vessel patency compared with IA-DSA, which was selected as the standard reference method.

MATERIALS AND METHODS: Twenty-two patients with 27 aneurysms treated by surgical clipping were examined by using both IA-DSA and IV-ACT. Both diagnostic procedures were performed on an FPD-equipped angiography system. Postprocessing of IV-ACT acquisitions was performed on a dedicated workstation producing multiplanar reformations and maximum intensity projections of the clip region and other intracranial arteries. Three interventional neuroradiologists independently evaluated both procedures.

RESULTS: A residual aneurysm was delineated in 10 cases with IA-DSA. Sufficient opacification of the intracranial vessels was assigned in 26 IV-ACT cases. Due to metal artifacts, IV-ACT images were tagged as “not diagnostic” on 8 occasions. In the other 19 aneurysms, a residual aneurysm was delineated in 6 cases—all 6 being true-positive compared with IA-DSA—and was excluded in the remaining 13 cases—all true-negative. Even small aneurysm remnants with a diameter of 1.5 mm were detected with IV-ACT.

CONCLUSIONS: Currently IV-ACT cannot be recommended as a routine tool for postoperative evaluation of clipped aneurysms due to metal artifacts in 30% of the examinations. These artifacts appear with multiple normal-sized or large clips. In patients with single or multiple small clips, IV-ACT can reliably show aneurysm remnants.

Footnotes

  • ACT
    flat-panel angiographic CT
    CI
    confidence interval
    CTA
    CT angiography
    CTDIw
    weighted CT dose index
    DSA
    digital subtraction angiography
    FPD
    flat panel detector
    IA
    intra-arterial
    IV-ACT
    flat panel CTA after intravenous contrast agent application
    MDCTA
    multidetector row CT angiography
    MRA
    MR angiography

  • © 2011 American Society of Neuroradiology
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Feasibility of Flat Panel Angiographic CT after Intravenous Contrast Agent Application in the Postoperative Evaluation of Patients with Clipped Aneurysms
M.-N. Psychogios, D. Wachter, A. Mohr, P. Schramm, A.-M. Frölich, K. Jung, V. Rohde, M. Knauth
American Journal of Neuroradiology Aug 2011, DOI: 10.3174/ajnr.A2611

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Feasibility of Flat Panel Angiographic CT after Intravenous Contrast Agent Application in the Postoperative Evaluation of Patients with Clipped Aneurysms
M.-N. Psychogios, D. Wachter, A. Mohr, P. Schramm, A.-M. Frölich, K. Jung, V. Rohde, M. Knauth
American Journal of Neuroradiology Aug 2011, DOI: 10.3174/ajnr.A2611
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