Spiral CT scanning in the detection and evaluation of aneurysms of the Circle of Willis

Abstract

Purpose: To assess the utility of spiral computed tomography (CT) with three-dimensional reconstruction in defining aneurysms of the Circle of Willis.

Methods: Eighty-one patients with angiographic or surgical correlation were studied between 1993 and 1995, with surface rendered reconstructions of the arteries of the Circle of Willis.

Results: Spiral CT was useful in six clinical situations: further assessment in cases with CT suspicion of an aneurysm, follow-up of known untreated aneurysms or aneurysm remnants, subarachnoid hemorrhage (SAH) with negative angiography, a past or family history of aneurysms, and improved definition of aneurysm anatomy. Ten of fifteen patients with previous surgery had no significant artifacts on the spiral study. In 66 other patients studied in search of aneurysms, the sensitivity of detection was 95% and specificity 74%. Seventeen of nineteen aneurysms 3 mm or less in size and 38 of 39 larger were detected by spiral CT. Four of thirteen patients with SAH and previous negative angiography had aneurysms identified, which were confirmed at surgery.

Conclusions: There is great promise in the use of spiral CT in demonstrating aneurysms of the Circle of Willis, including very small ones. Careful detailing of scan protocols and meticulous examination of multiplanar images are needed for maximum accuracy.