| Spontanous subarachnoid hemorrhage ( SAH) mostly arises from rupture and bleeding of intracranial aneurysms. Accurate diagnosis and proper evaluation of both location and spatial structure of the aneurysms have become critical for clinical treatment of the disease. Routine DSA is only able to display the two -dimensional (2D) images of cerebral vascular system. Although CTA manages to display three -dimensional (3D) structure of intracranial vessels, still it is very limited to supply intracranial hemodynamic information. 3D DSA may acquire multi - angle oblique images from reconstruction after rotational collection. Thus its application is very important for aneurysm evaluation and operative method selection. This study was supposed to evaluate and compare the diagnostic value of 2D DSA;3D DSA(MH\SSD.VR)and 3D CTA(SVR)for intracranial aneurysms.Materials and methodsFrom June 2003 to February 2004, 34 cases with SAH (16 male, 18 female, with average age of 51, ranging from 28 to 74 years old) , who underwent all examinations of routine 2D DSA; 3D DSA and CTA, were involved in our study. 28 cases out of them were diagnosed with intracranial aneurysm, and totally 33 aneurysms were found. The display ability of 2D DSA,3D DSA(MIP SSD VR)and 3D CTA(SVR)for the 33 aneurysm was retrospectively analyzed and compared.Method of CTA: Toshiba Mlti - Aquilion 4 slice spiral CT system was used, routine head CTA scanning was taken, post processing was made with software of Alatoview at SGI - 02 workstation, and method of SVR was applied for image display.Method of 2D and 3D DSA: GE Adventx LCV - Plus angiography system was taken for acquisition, and GE AW4.0 workstation with Sun Spare UNIX system was used for post processing. 2D DSA was performed with routine femoral artery method to get anterior - posterior, lateral, and oblique if necessary images. 3D DSA underwent rotational acquisition. During the second rotation, contrast media was infused into internal carotid or vertebral artery, so that in-tracranial arteries were persistently displayed. 3D reconstruction was made with 3 methods of MIP, SSD, and transparent VR.Based on all images of 2D DSA (medial, lateral, and oblique if needed) , 3D DSA (MIP, SSD, and VR) , and CTA (SVR) examinations, several applicability indexes were evaluated. They were (l)aneurysm detective rate, and (2) visibilities of both aneurismal neck and its relation to parent artery.Statistical method: With SPSS statistical software, aneurysm detective rates of 2D DSA, 3D DSA, and 3D CTA were compared with fourfold x2 test. Visibilities of both aneurismal neck and its relation to parent artery were analyzed with R x C x2 test.ResultsIn 34 cases with SAH, thirty - three aneurysms of 28 cases were detected by 2D DSA: 3D DSA and CTA. Twenty -four cases of them had single aneurysm, 3 cases had two, and the other one case had 3. Ten micro - aneurysms ( diameter <2mm) were found. Twenty - one cases took surgical treatment, and 5 cases underwent interventional embolization therapy.In terms of aneurysm detective rate, results went as follows: True - positive rate and false -nagative rate of 2D DSA were 85% and 15% respectively; The same two rates of 3D DSA were 94% and 6% respectively; They were 100% and 0% for 3D DSA (SSD, VR) , and were 88% and 12% respectively for CTA. No significant statistical difference was found between aneurysm detective rates of 2D DSA and CTA, while significant difference was found between those of 3D DSA (SSD VR) and CTA.When it came to the visibilities of both aneurismal neck and its relation toparent artery, 2D DSA clearly showed aneurismal neck in 4 cases, but failed to display neck morphological features and peripheral vascular spatial structures in another 15 cases; MIP was able to accurately display aneurismal neck and its special relation to parent artery in 10 cases, but it wrongly displayed or failed to display these features in the other 3 cases; SSD was likewise successful in 32 cases and failed in none; VR was also satisfying in 30 cases...
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