The Accuracy and Usefulness of 3D-DSA and 3D-CT Angiography for Cerebral Aneurysms

Abstract

For evaluation of intracranial cerebral aneurysms, three-dimensional (3D) digital subtraction angiography (DSA) and 3D-computed tomographic angiography (CTA) were demonstrated in fifteen patients. The diagnostic accuracy of preoperative 3D-CTA is equal to that of 3D-DSA except for the case with a dissecting aneurysm. The virtual images of 3D-CTA were well correlated with surgical findings. In endovascular treatment of intracranial aneurysms, 3D-DSA had an obvious advantage in obtaining the best working angle of the C-arm. The major branches originating from the dome were depicted on 3D-DSA in two cases that could not be judged on 3D-CTA. The aim of the present study was to verify the difference between 3D-DSA and 3D-CTA for evaluation of intracranial aneurysms.

Figure 1

A 59-year-old man with angiogram negative-SAH was referred to our hospital. One week later 3D-CTA revealed a basilar trunk aneurysm. Three-dimensional DSA showed a similar 3D iamge and this aneurysm was confirmed during surgical exposure.

Figure 2

The patient was a 52-year-old woman who experienced sudden onset left oculomotor nerve palsy. Three-dimensional CTA revealed a left IC-PC aneurysm with two blebs near the neck (Left). These blebs were depicted with 3D-DSA (Center) and this image was well correlated with surgical findings (Right).

Figure 3

Three-dimensional DSA revealed a left vertebral dissecting aneurysm. The false lumen was diagnosed clearly observed and it extended from just proximal to the left posterior-inferior cerebellar artery to the union of the vertebral artery. Auto-positioning function provided the best working angle for embolization of the left VA with GDCs (Right).

Figure 4

Left IC-PC aneurysm could not be diagnosed with DSA (Left); however the posterior communicating artery from the dome was imaged using 3D-DSA (Center) and an endoscopic image on 3D-CTA (Right).

Figure 5

The neck remnant of a right IC-PC aneurysm treated with a titanium clip was evaluated using 3D-DSA (A) and 3D-CTA (B). Both 3D-images depicted a small proximal neck remnant.