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Feasibility of Flat Panel Angiographic CT after Intravenous Contrast Agent Application in the Postoperative Evaluation of Patients with Clipped Aneurysms

Feasibility of Flat Panel Angiographic CT after Intravenous Contrast Agent Application in the... BACKGROUND AND PURPOSE: Important findings, such as aneurysm remnants or major arterial occlusion, can be detected on intra- or postoperative angiography after surgical clipping of intracranial aneurysms. The purpose of this study was to evaluate the feasibility of IV-ACT for the postoperative detection of residual aneurysms and parent vessel patency compared with IA-DSA, which was selected as the standard reference method. MATERIALS AND METHODS: Twenty-two patients with 27 aneurysms treated by surgical clipping were examined by using both IA-DSA and IV-ACT. Both diagnostic procedures were performed on an FPD-equipped angiography system. Postprocessing of IV-ACT acquisitions was performed on a dedicated workstation producing multiplanar reformations and maximum intensity projections of the clip region and other intracranial arteries. Three interventional neuroradiologists independently evaluated both procedures. RESULTS: A residual aneurysm was delineated in 10 cases with IA-DSA. Sufficient opacification of the intracranial vessels was assigned in 26 IV-ACT cases. Due to metal artifacts, IV-ACT images were tagged as “not diagnostic” on 8 occasions. In the other 19 aneurysms, a residual aneurysm was delineated in 6 cases—all 6 being true-positive compared with IA-DSA—and was excluded in the remaining 13 cases—all true-negative. Even small aneurysm remnants with a diameter of 1.5 mm were detected with IV-ACT. CONCLUSIONS: Currently IV-ACT cannot be recommended as a routine tool for postoperative evaluation of clipped aneurysms due to metal artifacts in 30% of the examinations. These artifacts appear with multiple normal-sized or large clips. In patients with single or multiple small clips, IV-ACT can reliably show aneurysm remnants. Abbreviations ACT flat-panel angiographic CT CI confidence interval CTA CT angiography CTDI w weighted CT dose index DSA digital subtraction angiography FPD flat panel detector IA intra-arterial IV-ACT flat panel CTA after intravenous contrast agent application MDCTA multidetector row CT angiography MRA MR angiography http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png American Journal of Neuroradiology American Journal of Neuroradiology

Feasibility of Flat Panel Angiographic CT after Intravenous Contrast Agent Application in the Postoperative Evaluation of Patients with Clipped Aneurysms

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Publisher
American Journal of Neuroradiology
Copyright
Copyright © 2011 by the American Society of Neuroradiology.
ISSN
0195-6108
eISSN
1936-959X
DOI
10.3174/ajnr.A2611
pmid
21852377
Publisher site
See Article on Publisher Site

Abstract

BACKGROUND AND PURPOSE: Important findings, such as aneurysm remnants or major arterial occlusion, can be detected on intra- or postoperative angiography after surgical clipping of intracranial aneurysms. The purpose of this study was to evaluate the feasibility of IV-ACT for the postoperative detection of residual aneurysms and parent vessel patency compared with IA-DSA, which was selected as the standard reference method. MATERIALS AND METHODS: Twenty-two patients with 27 aneurysms treated by surgical clipping were examined by using both IA-DSA and IV-ACT. Both diagnostic procedures were performed on an FPD-equipped angiography system. Postprocessing of IV-ACT acquisitions was performed on a dedicated workstation producing multiplanar reformations and maximum intensity projections of the clip region and other intracranial arteries. Three interventional neuroradiologists independently evaluated both procedures. RESULTS: A residual aneurysm was delineated in 10 cases with IA-DSA. Sufficient opacification of the intracranial vessels was assigned in 26 IV-ACT cases. Due to metal artifacts, IV-ACT images were tagged as “not diagnostic” on 8 occasions. In the other 19 aneurysms, a residual aneurysm was delineated in 6 cases—all 6 being true-positive compared with IA-DSA—and was excluded in the remaining 13 cases—all true-negative. Even small aneurysm remnants with a diameter of 1.5 mm were detected with IV-ACT. CONCLUSIONS: Currently IV-ACT cannot be recommended as a routine tool for postoperative evaluation of clipped aneurysms due to metal artifacts in 30% of the examinations. These artifacts appear with multiple normal-sized or large clips. In patients with single or multiple small clips, IV-ACT can reliably show aneurysm remnants. Abbreviations ACT flat-panel angiographic CT CI confidence interval CTA CT angiography CTDI w weighted CT dose index DSA digital subtraction angiography FPD flat panel detector IA intra-arterial IV-ACT flat panel CTA after intravenous contrast agent application MDCTA multidetector row CT angiography MRA MR angiography

Journal

American Journal of NeuroradiologyAmerican Journal of Neuroradiology

Published: Nov 1, 2011

References

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