ROLE OF 128 DUAL SOURCE CT ANGIOGRAPHY IMAGING FOR DETECTION OF CEREBRAL ANEURYSM: A RETROSPECTIVE STUDY
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Keywords
128-slice dual source CT, Cerebral aneurysm, CT angiography, Digital subtraction angiography, Subarachnoid hemorrhage
Abstract
Subarachnoid hemorrhage (SAH) is a devastating neurological condition with high mortality and morbidity rates. Approximately 80% of non-traumatic SAH cases are caused by ruptured intracranial aneurysms. While digital subtraction angiography (DSA) remains the gold standard for aneurysm detection, it is invasive and time-consuming. With advances in multidetector computed tomography technology, CT angiography (CTA) has emerged as a non-invasive alternative for preoperative assessment of intracranial aneurysms.
Objectives: To evaluate the diagnostic accuracy and clinical utility of 128-slice dual source CT angiography for detection and characterization of cerebral aneurysms in patients presenting with spontaneous subarachnoid hemorrhage.
Methods: This retrospective study included 48 patients with spontaneous subarachnoid hemorrhage who underwent 128-slice dual source CT angiography using DSA CT brain angiography protocol over an 18-month period. Analysis was performed using 2D multiplanar reconstructions, 3D maximum intensity projection, and volume-rendered techniques. Patients negative for aneurysm on CTA were further evaluated by digital subtraction angiography. Comprehensive evaluation of aneurysm size, location, morphology, and other imaging characteristics was performed.
Results: Of 48 patients (26 males, 22 females; age range 21-85 years; mean age 52.4 years), aneurysms were detected in 34 patients (70.8%). The most common locations were anterior communicating artery (ACOM) (26.5%), middle cerebral artery (MCA) (20.6%), and internal carotid artery (ICA) (20.6%). Single aneurysms were present in 95% of cases, with 5% having multiple aneurysms. The majority of aneurysms were small (<10mm). All 7 patients negative for aneurysm on CTA were also negative on subsequent DSA. Two cases of arteriovenous malformation and one calcified meningioma were identified. Three cases were attributed to hematoma without underlying vascular pathology.
Conclusion: The 128-slice dual source CT angiography provides rapid, non-invasive, and accurate identification of cerebral aneurysms with excellent determination of size, morphology, and location. Its high sensitivity and specificity approaching that of DSA makes it a valuable first-line investigation for patients presenting with subarachnoid hemorrhage.
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Dr. Deepak Choudhary
Junior Resident, Department of Radiodiagnosis, Rajshree Medical Research Institute, Bareilly, Choudharyd13.dc1994@gmail.com
Dr. R. Madhok
Professor and Head of Department, Department of Radiodiagnosis, Rajshree Medical Research Institute, Bareilly, drmadhok@gmail.com
