RT Journal Article
SR Electronic
T1 Feasibility of Flat Panel Angiographic CT after Intravenous Contrast Agent Application in the Postoperative Evaluation of Patients with Clipped Aneurysms
JF American Journal of Neuroradiology
JO Am. J. Neuroradiol.
FD American Society of Neuroradiology
SP 1956
OP 1962
DO 10.3174/ajnr.A2611
VO 32
IS 10
A1 Psychogios, M.-N.
A1 Wachter, D.
A1 Mohr, A.
A1 Schramm, P.
A1 Frölich, A.-M.
A1 Jung, K.
A1 Rohde, V.
A1 Knauth, M.
YR 2011
UL http://www.ajnr.org/content/32/10/1956.abstract
AB 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. ACTflat-panel angiographic CTCIconfidence intervalCTACT angiographyCTDIwweighted CT dose indexDSAdigital subtraction angiographyFPDflat panel detectorIAintra-arterialIV-ACTflat panel CTA after intravenous contrast agent applicationMDCTAmultidetector row CT angiographyMRAMR angiography