computed tomography

INTRODUCTION: This study aims to determine whether contrast enhanced magnetic resonance angiography (CEMRA) is preferable to computed tomographic angiography (CTA) as primary diagnostic tool in patients presenting with subarachnoid haemmorhage (SAH). When an intracranial aneurysm is the source of SAH it is of primordial importance to exclude it from circulation as soon as possible, preferably using endovascular coiling. The preferred diagnostic tool, therefore, must be able to quickly and accurately predict coilability of the aneurysm. In this study we evaluated both CEMRA and CTA in this aspect. METHODS: Two experienced neuroradiologists evaluated CEMRA and CTA images of 75 consecutive patients with SAH. Accuracy in predicting coilability of aneurysms of both modalities was evaluated using digital subtraction angiography (DSA) as standard of reference. RESULTS: 65 aneurysms were detected in 57 patients. No significant difference was found between the 2 modalities with respect to accuracy in assessing the feasibility of endovascular treatment: sensitivity and specificity for both were rather low (52.8-72.2 and 80.9-89.4 respectively), and Kappa was only 0.49 for both. CONCLUSION: The diagnostic performance of CEMRA does not significantly differ to that of CTA in the work-up of patients presenting with SAH; additionally, both modalities are found to have a rather low accuracy in predicting coilability of intracranial aneurysms.

INTRODUCTION: Most centres use computed tomographic angiography (CTA) as the primary diagnostic tool in patients presenting with a subarachnoid haemorrhage (SAH). Contrast enhanced magnetic resonance angiography (CEMRA) might be an alternative. In this study the ability to detect cerebral aneurysms with CEMRA in patients presenting with a SAH is investigated and compared with CTA. METHODS: In 75 consecutive patients, two experienced neuroradiologists evaluated CEMRA and CTA images. Digital subtraction angiography (DSA) served as standard of reference. The diagnostic performance in detection of aneurysms was calculated for both modalities and a comparison was made between the two. RESULTS: No significant difference was found between the two modalities for the detection of aneurysms: sensitivities for the two observers were 96.6 and 93.8 respectively for CEMRA and 90.8 and 92.3 respectively for CTA; specificities were 77.8 and 88.9 for CEMRA and 94.4 for both observers for CTA. Kappa values for interobserver variability were 0.82 for CEMRA and 0.85 for CTA. CONCLUSION: The diagnostic accuracy of CEMRA and CTA in the work-up of patients presenting with a SAH does not differ significantly. The choice to use either CEMRA or CTA depends on preference or availability.