Diagnosis and Treatment of Intracranial Aneurysms with 320-Detector Row Volumetric Computed Tomography Angiography

ObjectivesThe objective of the study was to determine the clinical utility of 320-detector row volume-computed tomographic angiography (VCTA) in the management of intracranial aneurysms.MethodsBetween February 2011 and May 2015, 550 patients successfully underwent 320-detector row VCTA for suspected intracranial aneurysms. Three-dimensional (3D) digital subtraction angiography (DSA) was used as the ultimate reference standard, and the sensitivity, specificity, and accuracy of both nonsubtracted and subtracted VCTA in identifying aneurysms were analyzed.ResultsNonsubtracted VCTA identified 417 aneurysms (2 false-positive readings, 12 false-negative readings). The diagnostic sensitivity, specificity, and accuracy of non-subtracted VCTA, on a per-aneurysm basis, were 97.2%, 99.0%, and 97.6%, respectively. Subtracted VCTA identified 426 aneurysms (2 false-positive readings, 3 false-negative readings). The sensitivity, specificity, and accuracy of subtracted VCTA, on a per-aneurysm basis, were 99.3%, 99.0%, and 99.2%, respectively. No differences in diagnostic accuracy were found between subtracted VCTA and 3D DSA. Nonsubtracted VCTA, however, was observed to be significantly less sensitive than 3D DSA and subtracted VCTA. Twenty-six aneurysm cases were referred for surgical treatment based on VCTA imaging. All aneurysms were deemed completely occluded during surgical clipping. On the basis of VCTA imaging, 299 aneurysms were found suitable for endovascular coiling, of which 293 aneurysms (98%) were treated successfully.ConclusionsThe 320-detector row subtracted VCTA technique is an effective, first-line diagnostic imaging modality for surgical and endovascular treatment of aneurysms. The nonsubtracted VCTA was less accurate than the subtracted VCTA, especially for intracranial aneurysms adjoining bone tissue.