Philipp Lucas R, McCracken D Jay, McCracken Courtney E, Halani Sameer H, Lovasik Brendan P, Salehani Arsalaan A, Boulter Jason H, Cawley C Michael, Grossberg Jonathan A, Barrow Daniel L, Pradilla Gustavo
Emory University School of Medicine, Atlanta, Georgia.
Department of Neu-rosurgery, Emory University School of Medicine, Atlanta, Georgia.
Neurosurgery. 2017 May 1;80(5):769-777. doi: 10.1093/neuros/nyw113.
Computerized tomography angiography (CTA) is commonly used to diagnose ruptured cerebral aneurysms with sensitivities reported as high as 97% to 100%. Studies validating CTA accuracy in the setting of subarachnoid hemorrhage (SAH) are scarce and limited by small sample sizes.
To evaluate the diagnostic accuracy of CTA in detecting intracranial aneurysms in the setting of SAH.
A single-center, retrospective cohort of 643 patients was reviewed. A total of 401 patients were identified whose diagnostic workup included both CTA and confirmatory digital subtraction angiography (DSA). Aneurysms missed by CTA but diagnosed by DSA were further stratified by size and location.
Three hundred and thirty aneurysms were detected by CTA while DSA detected a total of 431 aneurysms. False positive CTA results were seen for 24 aneurysms. DSA identified 125 aneurysms that were missed by CTA and 83.2% of those were <5 mm in diameter. The sensitivity of CTA was 57.6% for aneurysms smaller than 5 mm in size, and 45% for aneurysms originating from the internal carotid artery. The overall sensitivity of CTA in the setting of SAH was 70.7%.
The accuracy of CTA in the diagnosis of ruptured intracranial aneurysm may be lower than previously reported. CTA has a low sensitivity for aneurysms less than 5 mm in size, in locations adjacent to bony structures, and for those arising from small caliber parent vessels. It is our recommendation that CTA should be used with caution when used alone in the diagnosis of ruptured intracranial aneurysms.
计算机断层血管造影（CTA）常用于诊断破裂性脑动脉瘤，其敏感性报告高达97%至100%。在蛛网膜下腔出血（SAH）情况下验证CTA准确性的研究很少，且受样本量小的限制。
评估CTA在SAH情况下检测颅内动脉瘤的诊断准确性。
回顾了一个单中心的643例患者的回顾性队列。共确定了401例患者，其诊断检查包括CTA和确定性数字减影血管造影（DSA）。CTA漏诊但DSA诊断出的动脉瘤按大小和位置进一步分层。
CTA检测到330个动脉瘤，而DSA共检测到431个动脉瘤。CTA出现24例假阳性结果。DSA识别出125个CTA漏诊的动脉瘤，其中83.2%直径小于5mm。对于直径小于5mm的动脉瘤，CTA的敏感性为57.6%，对于起源于颈内动脉的动脉瘤，敏感性为45%。CTA在SAH情况下的总体敏感性为70.7%。
CTA在诊断破裂性颅内动脉瘤方面的准确性可能低于先前报道。CTA对直径小于5mm、位于骨结构附近以及起源于小口径供血血管的动脉瘤敏感性较低。我们建议，单独使用CTA诊断破裂性颅内动脉瘤时应谨慎。
