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CT angiography (CTA) should be used as the primary imaging modality for intracranial aneurysms, Turkish researchers have suggested.

While digital subtraction angiography (DSA) is currently the first-line option, it is invasive and has a one per cent complication rate, as well as being relatively expensive, they said.

The group recruited 55 patients with suspected intracranial aneurysms to undergo both multi-detector row CTA and DSA.

Fifty-three patients had been diagnosed with subarachnoid haemorrhage on nonenhanced CT, while the remaining two had xanthochromia on lumbar puncture.

Two reviewers viewed all images independently. DSA, which was used as the standard of reference, revealed 64 aneurysms in 50 patients. Two aneurysms were missed by one reader on CTA, and one missed by both.

The researchers calculated the sensitivity of CTA for each reader to be 96.9 and 98.4 per cent; for aneurysms less than three mm in diameter, 84.6 and 92.3 per cent. Specificity was 100 per cent for both readers, and interobserver agreement was excellent.

The researchers concluded that "multidetector CTA clearly has a role in the rapid evaluation of patients with acute subarachnoid haemorrhage."

They noted that "CTA is equally as sensitive as DSA in the detection of intracranial aneurysms greater than 3mm," and also has high sensitivity for smaller aneurysms owing to technical advances.

They added: "A strategy of using CTA as the primary method, with DSA reserved for any cases of uncertainty, appears safe and reliable."


'Detection and evaluation of intracranial aneurysms with 16-row multislice CT angiography: comparison with conventional angiography'
Emerg Radiol Online First