| Objective:The purpose of this study was to evaluate and compare the diagnostic effectiveness of double-phase 3D 16-MSCT angiography and 3D-DSA in cerebral vascular diseases for patients with spontaneous subarachnoid hemorrhage(SAH) .Methods:.From February 2007 to June 2004,The total of 57 consecutive patients undergoing evaluation for spontaneous SAH with both double-phase CTA and 3D-DSA within 2 weeks. The diagnostic performance of double-phase CTA and 3D-DSA were assessed separately by two groups of radiologists, each group had two doctors . The image quantity of double-phase CTA was evaluated. The causes of SHA were analyzed. If aneurysms were observed; the location of the intracranial aneurysms the visibilities of aneurismal neck and the relationship between the aneurysm and the parent artery were also analyzed. Analyses were performed per patient; the diagnostic performance of double-phase CTA and 3D-DSA on the cause of spontaneous SHA were compared. The sensitivity, specificity, positive predictive value and negative predictive value of double-phase CTA and 3D-DSA in SHA were also calculated. Arterial phase images qualified in 40 patients'.Those patients were included in the compare study in intracranial aneurysms among conventional CTA, double -phase CTA and 3D-DSAResults:Of the 57 patients evaluated in this study, cerebral vascular lesions were detected in 52(91%) patients; aneurysms were demonstrated in 46(80.7%) patients; AVM were demonstrated in 3 patients ;other vascular lesions include:moyamoya disease,venous sinus thrombus and arteriostenosis . The overall sensitivity, specificity, positive predictive value and negative predictive value of double -phase CTA and 3D-DSA are the same; per patient was 98%,100%,100%and 85%,respectively. There was no difference in diagnosis accuracy between double -phase CTA and 3D-DSA by statistic analysis. Of the 40 patients whose arterial phase images were qualified , 42 aneurysms were detected in 36 patients. Forty (95%)aneurysms of 35 cases were detected by conventional CTA ,and forty-one(98%)aneurysms of 35 cases were detected by double -phase CTA . There was no difference in diagnosis accuracy among conventional CTA, double -phase CTA and 3D-DSA by statistic analysis. Conventional CTA failed to detect 2(17%)of the 42 aneurysms identified on 3D-DSA.Both aneurysms were≤3 mm. One of CTA-missed aneurysms was located on RICA; double -phase CTA missed this aneurysm too. The other aneurysm located on ACoA, this aneurysm was depicted clearly in double -phase CTA. At the level of visibilities of aneurismal neck and the relationship between the aneurysm and the parent artery; 3D-DSA clearly show 41 aneurysms neck and the relationship between the aneurysm and the parent artery (I-class); II-class display 0ne. Conventional CTA I-class display 36; II-class display 4; III-class shows two. Double -phase CTA I-class display 37, II-class display 4, III-class show one. In our Studies, 4 aneurysms that CTA failed to depict clear and completely come from internal carotid artery; due to the aneurysms are large and multi-faceted contact with the skull base skeleton, so that limited observation angle greatly. Another aneurysm locate in cavernous sinus,conventional CTA failed to depict clearly,due to the enhance of the sinus ;But the aneurysm was clear showed on pure artery phase CTA. At the level of visibilities of aneurismal neck and the relationship between the aneurysm and the parent artery; 3D-DSA and conventional CTA have significant difference; 3D-DSA is superior to conventional CTA; conventional CTA and double -phase CTA, double -phase CTA and 3D-DSA there are no statistical difference.Conclusions:1. There was no difference in diagnosis accuracy between double -phase CTA and 3D-DSA by statistic analysis. CTA should be used as the first choice in SHA patients.2. 3D-DSA is superior to conventional CTA; at the level of visibilities of aneurismal neck and the relationship between the aneurysm and the parent artery; especially of the aneurysms locate in skull base.3. In conventional CTA, the venous system overlying arteries sometimes obscures the presence of cerebral aneurysms. In addition of the pure artery phase CTA can improve the diagnostic accuracy.
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