The Role Of 3D-CTA In The Diagnosis, Treatment And Postoperative Review Of Intracranial Aneurysms

Objective:To study the role and value of 3D-CTA in the diagnosis, treatment and postoperative review of intracranial aneurysms.Methods:55 patients,who had undergone both 3D-CTA and DSA before surgery,were included in this study.The data including the location,size,their sac,neck,parent artery of aneurysms and anatomical structures of operative region was retrospectively analyzed by preoperative 3D-CTA and DSA of these cases and compared with the surgical findings furtherly.The data including the degree of clipped aneurysm,presence of residual aneurysm and obstruction or spasm of parent artery and major intracranial blood vessels were also analyzed by postoperative 3D-CTA.Results:65 aneurysms were finally found in 55 cases by 3D-CTA, DSA and microneurosurgical detection.Based on combining with intraoperative findings,DSA and 3D-CTA,all of those aneurysms were divided into 3 groups such as small group(maximum diameter＜5mm) was 14 aneurysms,middle group(5mm～15mm) was 43 aneurysms,and large group(≥15mm) was 8 aneurysms.Compared with final findings, 63 aneurysms were correctly diagnosed by 3D-CTA,2 small aneurysms were failed to be detected,and 2 small aneurysms were misdiagnosed. And by DSA 64 aneurysms were correctly diagnosed,1 aneurysm which was also small one was failed to be detected,and 4 small aneurysms were misdiagnosed.The final findings were regarded as the golden standard. The overall sensitivity,accuracy and positive predictive value of 3D-CTA for aneurysms were 96.9%,94.0%and 96.9%,those of DSA were 98.5%, 92.8%and 94.1%respectively.There was no significantly statistical difference between 3D- CTA and DSA in the diagnosis for overall aneurysms(p＞0.05).The sensitivities of 3D- CTA for small,middle, large aneurysms were 85.7%,100%and 100%.And those of DSA were respectively 92.9%,100%and 100%.In small group of aneurysms there was no statistically significant difference in the diagnosis between 3D-CTA and DSA(p＞0.05).3D-CTA was superior to DSA in the presence of aneurysmal sac and neck,and displayed parent artery and anatomical structures of operative region well.3D-CTA was used for postoperative review in 44 cases.In these cases the location and the number of aneurysm clips can be clearly displayed by 3D-CTA.The aneurysms clipped were completely disappeared,and there was no residual neck of aneurysm.3 cases with postoperative cerebral vasospasm were detected by 3D-CTA.The parent arteries and major intracranial blood vessels were unobstructed in all cases except in 1 case the vascular occlusion in the distal of clip placement was found.Conclusion:3D-CTA has the same capacity with DSA to diagnose intracranial aneurysms.It is feasible that 3D-CTA could be used as unique preoperative imaging data for urgent neurosurgical clipping operation.DSA is also required when CTA is negative in the patient with suspicious intracranial aneurysm.3D-CTA and DSA can complement each other.3D-CTA is a reliable method for postoperative review after neurosurgical clipping operation.