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. 2023 May 30;27(1):2636.
doi: 10.4102/sajr.v27i1.2636. eCollection 2023.

Accuracy of CT angiography for detecting ruptured intracranial aneurysms

Nomasonto N Mkhize  1 , Victor Mngomezulu  1   2 , Thandi E Buthelezi  1   2
Affiliations

Accuracy of CT angiography for detecting ruptured intracranial aneurysms

Nomasonto N Mkhize et al. SA J Radiol. .

Abstract

Background: Digital subtraction angiography (DSA) is invasive, costly and unavailable in many South African hospitals; however, it remains the gold standard for imaging intracranial aneurysms. CT angiography (CTA) is a non-invasive and readily available screening tool prior to DSA.

Objectives: This study aimed to evaluate the diagnostic performance of CTA in detecting ruptured intracranial aneurysms using DSA as the reference standard and to determine the effect of aneurysm size and location on CTA sensitivity.

Method: A retrospective analysis of CTA and DSA data from reports of patients suspected to have aneurysmal subarachnoid haemorrhage (SAH) at Chris Hani Baragwanath Academic Hospital between January 2017 and June 2020.

Results: Conventional DSA detected aneurysms in 94 out of 115 patients; while of these, CTA detected 75 and missed 19. The CTA sensitivity, specificity and accuracy was 80%, 43% and 73%, respectively. The CTA sensitivity for aneurysms < 3 mm and 3 mm - 5 mm in size was 30% and 81.5%, respectively (p = 0.024). Sensitivity of CTA for posterior communicating artery (PComm) aneurysms was 56% and lower than other major anterior circulation locations (83% - 91%) (p = 0.045).

Conclusion: The CTA diagnostic efficiency was lower than previously reported, with even lower sensitivity for aneurysms < 3 mm and for those arising from the PComm. Thus, CTA should remain a screening tool prior to DSA in all local patients suspected to have aneurysmal SAH.

Contribution: Larger, prospective studies are required to accurately define the role of CTA in diagnosing intracranial aneurysms in a developing country with limited resources.

Keywords: CTA; DSA; accuracy; comparison; computed tomography angiography; diagnosis; digital subtraction angiography; intracranial aneurysms; ruptured aneurysms.

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Conflict of interest statement

The authors declare that they have no financial or personal relationships that may have inappropriately influenced them in writing this article.

Figures

FIGURE 1
FIGURE 1
Left internal carotid artery angiogram (non-subtracted images) frontal views of different patients. (a) Very small (2.8 mm) saccular aneurysm arising from the anterior communicating artery (arrow), which was missed on computed tomography angiography, in a 62-year-old male. (b) Small (4.4 mm) saccular aneurysm also arising from the anterior communicating artery (arrow), which was correctly identified on computed tomography angiography, in a 54-year-old female.
FIGURE 2
FIGURE 2
(a) CT angiography axial and (b) left internal carotid artery angiogram (non-subtracted image) frontal view showing a medium-sized (13 mm) fusiform aneurysm arising from the supraclinoid segment of left internal carotid artery (arrows) in a 65-year-old female. (c) CT angiography coronal maximum intensity projection (MIP) and (d) right internal carotid artery angiogram (non-subtracted image) lateral view showing a small (4.6 mm) saccular aneurysm arising from the medial aspect of supraclinoid segment of right internal carotid artery.
See this image and copyright information in PMC

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