Artikel
Dual source CT angiography for non-invasive and accurate imaging of aneurysm occlusion and parent vessel integrity following intracranial aneurysm repair
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Autoren
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Amr Abdulazim
- Klinik für Neurochirurgie und
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Bernd Turowski
- Institut für Diagnostische und Interventionelle Radiologie, Heinrich-Heine-Universität, Düsseldorf
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Hans-Jakob Steiger
- Klinik für Neurochirurgie und
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Daniel Hänggi
- Klinik für Neurochirurgie und
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Nima Etminan
- Klinik für Neurochirurgie und
| Veröffentlicht: | 2. Juni 2015 |
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Gliederung
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Objective: The golden standard for assessment of aneurysm occlusion and of parent vessel patency following endovascular or surgical repair remains catheter angiography (DSA). In view of the invasiveness and, moreover, the risk of thromboembolic complications, single-source CT angiography (CTA) can be used as a non-invasive and rapid alternative. However, the accurate visualization of the aneurysm neck or parent and branching arteries is often limited due to superimposed clip or coil artifacts. We aimed to prospectively investigate the potential of dual-source CTA for the more accurate assessment of degree of aneurysm occlusion and parent vessel integrity following aneurysm repair, as compared to single-source CTA.
Method: Patients with rupture or unruptured intracranial aneurysms underwent dual-source CTA imaging following endovascular or surgical repair. These datasets were matched for ten similar patients who underwent single-source CTA imaging following endovascular or surgical aneurysm repair at similar sites and similar numbers of clips or coils. Image quality was objectively rated by expressing the beam hardening artifact as the volume of a prolate ellipsoid. Subjective image quality was rated as such: 4: excellent (no artifacts, unrestricted evaluation); 3: good (minor artifacts, good diagnostic quality); 2: adequate (moderate artifacts, still acceptable and diagnostic); 1: not acceptable (severe artifacts impairing accurate evaluation). A score of 2 or higher was considered diagnostic.
Results: To date, 7 patients surgically and 3 patients endovascularly treated for their ruptured (n=6) or unruptured (n=4) aneurysm received dual-source CTA imaging. Volume of the beam hardening artifact was significantly lower for dual-source, compared to single-source CTA (median: 1.98 vs.118.3 ml; p<0.0286). Subjective image quality was good or excellent in 8 out of 10 patients in dual-source CTA cohort, compared to 2 out of 10 patients in the single-source CTA cohort.
Conclusions: The imaging quality of dual-source CTA imaging is distinctly superior, compared to single-source CTA with respect to assessment of the degree of intracranial aneurysm or parent vessel integrity. While dual-source CTA imaging may not be an unrestricted alternative to catheter angiography, it may well be considered as an alternative imaging modality for patients with an increased cardiovascular risk profile.
