Diagnostic Value of 64-slice CTA in Detection of Intracranial Aneurysm in Patients with SAH and Comparison of the CTA Results with 2D-DSA and Intraoperative Findings

Rupture of an aneurysm is the major cause of subarachnoid hemorrhage (SAH). This condition has a mortality rate of 40-60%, and 10-20% of the survivors remain functionally dependent (1-3). Rapid diagnosis and an immediate treatment decision are of crucial importance because a delay in diagnosis increases the morbidity and mortality rate. Aneurysms may be treated by surgical clipping or endovascular intervention (4). In order to make the appropriate treatment choice, a neurosurgeon needs to be aware of the characteristics of the aneurysm, such as its localization, size and neck size. Digital subtraction angiography (DSA) has been the standard method for detecting and characterizing the intracranial aneurysms for decades. However, DSA is invasive, time consuming and expensive. It carries a 4% risk of neurological and non-neurological complications and 0.07%-0.5% risk of persistent neurological deficit (5-7). Thus, there is need for an alternate non-invasive modality to detect cerebral aneurysms. Nevertheless, in order to replace DSA, an imaging modality should have at least the same diagnostic accuracy as DSA in detecting and characterizing cerebral aneurysms. CT angiography (CTA) has been increasingly used for the diagnosis of intracranial aneurysms since 1990s (8). CT technology has rapidly evolved in the last decade and, especially with the introduction of multi-detector CT, the accuracy of CTA in detecting and characterizing intracranial aneurysms has increased significantly. The purpose of the present study is to prospectively compare the effectiveness of 64-slice CTA with DSA for the detection of intracranial aneurysms in a patient population with SAH.