Intracranial Aneurysms: Detection with Three-dimensional CT Angiography with Volume Rendering-Comparison with Conventional Angiographic and Surgical Findings1
Yukunori Korogi, MD,
Mutsumasa Takahashi, MD,
Kazuhiro Katada, MD,
Yuko Ogura, MD,
Kanehiro Hasuo, MD,
Makoto Ochi, MD,
Hidetsuna Utsunomiya, MD,
Toshi Abe, MD and
Satoshi Imakita, MD
1 From the Department of Radiology, Kumamoto University School of Medicine, 1-1-1, Honjo, Kumamoto City, 860 Japan (Y.K., M.T.); the Department of Radiology, School of Medicine, Fujita Health University, Fujita, Japan (K.K., Y.O.); the Department of Radiology, Faculty of Medicine, Kyushu University, Fukuoka, Japan (K.H.); the Department of Radiology, Nagasaki University School of Medicine, Nagasaki, Japan (M.O.); the Department of Radiology, Fukuoka University School of Medicine, Fukuoka, Japan (H.U.); the Department of Radiology, Kurume University School of Medicine, Kurume, Japan (T.A.); and the Department of Radiology, National Cardiovascular Center, Osaka, Japan (S.I.). From the 1997 RSNA scientific assembly. Received January 22, 1998; revision requested March 6; final revision received August 31; accepted October 26. Address reprint requests to Y.K.
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Figure 1a. Left ICA aneurysm. (a) Anteroposterior conventional angiogram of the left ICA depicts a 2.7-mm aneurysm (arrowhead) at the origin of the anterior choroidal artery. (b, c) CT angiograms (b) from behind and (c) from the left depict the aneurysm (arrowhead), which was detected by all four observers.
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Figure 1b. Left ICA aneurysm. (a) Anteroposterior conventional angiogram of the left ICA depicts a 2.7-mm aneurysm (arrowhead) at the origin of the anterior choroidal artery. (b, c) CT angiograms (b) from behind and (c) from the left depict the aneurysm (arrowhead), which was detected by all four observers.
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Figure 1c. Left ICA aneurysm. (a) Anteroposterior conventional angiogram of the left ICA depicts a 2.7-mm aneurysm (arrowhead) at the origin of the anterior choroidal artery. (b, c) CT angiograms (b) from behind and (c) from the left depict the aneurysm (arrowhead), which was detected by all four observers.
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Figure 2a. Multiple aneurysms (of one right and one left middle cerebral artery and one ICA). (a, b) Anteroposterior conventional angiograms of the (a) right and (b) left carotid arteries depict a 2.7-mm aneurysm (arrowhead in a) at the first bifurcation of the right middle cerebral artery, a 3.4-mm aneurysm (short arrow in b) at the first bifurcation of the left middle cerebral artery, and a 5.2-mm aneurysm (long arrow in b) at the ophthalmic segment of the left carotid artery. (c) CT angiogram from behind depicts aneurysms in the right (arrowhead) and left (short arrow) middle cerebral arteries and the left ICA (long arrow). The posterior side is edited out completely in this view. All observers detected the aneurysms of the middle cerebral artery, but only one detected the ICA aneurysm.
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Figure 2b. Multiple aneurysms (of one right and one left middle cerebral artery and one ICA). (a, b) Anteroposterior conventional angiograms of the (a) right and (b) left carotid arteries depict a 2.7-mm aneurysm (arrowhead in a) at the first bifurcation of the right middle cerebral artery, a 3.4-mm aneurysm (short arrow in b) at the first bifurcation of the left middle cerebral artery, and a 5.2-mm aneurysm (long arrow in b) at the ophthalmic segment of the left carotid artery. (c) CT angiogram from behind depicts aneurysms in the right (arrowhead) and left (short arrow) middle cerebral arteries and the left ICA (long arrow). The posterior side is edited out completely in this view. All observers detected the aneurysms of the middle cerebral artery, but only one detected the ICA aneurysm.
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Figure 2c. Multiple aneurysms (of one right and one left middle cerebral artery and one ICA). (a, b) Anteroposterior conventional angiograms of the (a) right and (b) left carotid arteries depict a 2.7-mm aneurysm (arrowhead in a) at the first bifurcation of the right middle cerebral artery, a 3.4-mm aneurysm (short arrow in b) at the first bifurcation of the left middle cerebral artery, and a 5.2-mm aneurysm (long arrow in b) at the ophthalmic segment of the left carotid artery. (c) CT angiogram from behind depicts aneurysms in the right (arrowhead) and left (short arrow) middle cerebral arteries and the left ICA (long arrow). The posterior side is edited out completely in this view. All observers detected the aneurysms of the middle cerebral artery, but only one detected the ICA aneurysm.
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Figure 3a. Multiple aneurysms (of the left middle cerebral, anterior communicating, and posterior inferior cerebellar arteries and the ICA). (a, b) Conventional angiograms of the (a) right (anteroposterior oblique) and (b) left (lateral) carotid arteries depict a 3.4-mm aneurysm (arrow in b) of the cavernous sinus, a 6.7-mm aneurysm (arrow in a) of the anterior communicating artery, and a 2.0-mm aneurysm (arrowhead in b) of the middle cerebral artery. (c) Anteroposterior conventional angiogram of the right vertebral artery depicts a 2.7-mm aneurysm (arrow) at the origin of the posterior inferior cerebellar artery. (d) CT angiogram from above demonstrates an aneurysm of the left middle cerebral artery (arrowhead), the anterior communicating artery (black arrow), and the vertebral artery (white arrow). All observers detected the aneurysm of the anterior communicating artery, and three observers detected that of the middle cerebral artery, but only one observer detected that of the vertebral artery. No definite aneurysm of the ICA was detected.
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Figure 3b. Multiple aneurysms (of the left middle cerebral, anterior communicating, and posterior inferior cerebellar arteries and the ICA). (a, b) Conventional angiograms of the (a) right (anteroposterior oblique) and (b) left (lateral) carotid arteries depict a 3.4-mm aneurysm (arrow in b) of the cavernous sinus, a 6.7-mm aneurysm (arrow in a) of the anterior communicating artery, and a 2.0-mm aneurysm (arrowhead in b) of the middle cerebral artery. (c) Anteroposterior conventional angiogram of the right vertebral artery depicts a 2.7-mm aneurysm (arrow) at the origin of the posterior inferior cerebellar artery. (d) CT angiogram from above demonstrates an aneurysm of the left middle cerebral artery (arrowhead), the anterior communicating artery (black arrow), and the vertebral artery (white arrow). All observers detected the aneurysm of the anterior communicating artery, and three observers detected that of the middle cerebral artery, but only one observer detected that of the vertebral artery. No definite aneurysm of the ICA was detected.
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Figure 3c. Multiple aneurysms (of the left middle cerebral, anterior communicating, and posterior inferior cerebellar arteries and the ICA). (a, b) Conventional angiograms of the (a) right (anteroposterior oblique) and (b) left (lateral) carotid arteries depict a 3.4-mm aneurysm (arrow in b) of the cavernous sinus, a 6.7-mm aneurysm (arrow in a) of the anterior communicating artery, and a 2.0-mm aneurysm (arrowhead in b) of the middle cerebral artery. (c) Anteroposterior conventional angiogram of the right vertebral artery depicts a 2.7-mm aneurysm (arrow) at the origin of the posterior inferior cerebellar artery. (d) CT angiogram from above demonstrates an aneurysm of the left middle cerebral artery (arrowhead), the anterior communicating artery (black arrow), and the vertebral artery (white arrow). All observers detected the aneurysm of the anterior communicating artery, and three observers detected that of the middle cerebral artery, but only one observer detected that of the vertebral artery. No definite aneurysm of the ICA was detected.
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Figure 3d. Multiple aneurysms (of the left middle cerebral, anterior communicating, and posterior inferior cerebellar arteries and the ICA). (a, b) Conventional angiograms of the (a) right (anteroposterior oblique) and (b) left (lateral) carotid arteries depict a 3.4-mm aneurysm (arrow in b) of the cavernous sinus, a 6.7-mm aneurysm (arrow in a) of the anterior communicating artery, and a 2.0-mm aneurysm (arrowhead in b) of the middle cerebral artery. (c) Anteroposterior conventional angiogram of the right vertebral artery depicts a 2.7-mm aneurysm (arrow) at the origin of the posterior inferior cerebellar artery. (d) CT angiogram from above demonstrates an aneurysm of the left middle cerebral artery (arrowhead), the anterior communicating artery (black arrow), and the vertebral artery (white arrow). All observers detected the aneurysm of the anterior communicating artery, and three observers detected that of the middle cerebral artery, but only one observer detected that of the vertebral artery. No definite aneurysm of the ICA was detected.
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Figure 4a. Ruptured very small aneurysm of the basilar artery. (a) Anteroposterior conventional angiogram of the vertebral artery depicts a 2-mm aneurysm (arrowhead) at the origin of the left superior cerebellar artery. (b) CT angiogram from behind demonstrates the basilar artery aneurysm (arrowhead), which was not detected by any observer.
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Figure 4b. Ruptured very small aneurysm of the basilar artery. (a) Anteroposterior conventional angiogram of the vertebral artery depicts a 2-mm aneurysm (arrowhead) at the origin of the left superior cerebellar artery. (b) CT angiogram from behind demonstrates the basilar artery aneurysm (arrowhead), which was not detected by any observer.
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Figure 5a. Aneurysm of the anterior communicating artery and false-positive aneurysm of the middle cerebral artery. (a) Oblique conventional angiogram of the left carotid artery depicts an aneurysm (arrow) of the anterior communicating artery. (b) CT angiogram from below depicts an aneurysm (arrow) of the anterior communicating artery and an aneurysmlike protrusion (arrowhead) at the bifurcation of the right middle cerebral artery. This protrusion was interpreted by all observers as an aneurysm, but no aneurysm was depicted at conventional angiography.
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Figure 5b. Aneurysm of the anterior communicating artery and false-positive aneurysm of the middle cerebral artery. (a) Oblique conventional angiogram of the left carotid artery depicts an aneurysm (arrow) of the anterior communicating artery. (b) CT angiogram from below depicts an aneurysm (arrow) of the anterior communicating artery and an aneurysmlike protrusion (arrowhead) at the bifurcation of the right middle cerebral artery. This protrusion was interpreted by all observers as an aneurysm, but no aneurysm was depicted at conventional angiography.
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Figure 6. The ROC curves for CT angiography.
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Figure 7a. Ruptured very small aneurysm of the anterior cerebral artery that was not depicted at conventional angiography. (a) CT angiogram (median view from the right) depicts an aneurysm (arrowhead) smaller than 2 mm of the left anterior cerebral artery (A2 portion) that was proved at surgery. None of the observers detected this aneurysm. (b) Oblique conventional angiogram of the left carotid artery does not depict an aneurysm.
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Figure 7b. Ruptured very small aneurysm of the anterior cerebral artery that was not depicted at conventional angiography. (a) CT angiogram (median view from the right) depicts an aneurysm (arrowhead) smaller than 2 mm of the left anterior cerebral artery (A2 portion) that was proved at surgery. None of the observers detected this aneurysm. (b) Oblique conventional angiogram of the left carotid artery does not depict an aneurysm.
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Figure 8. Very small aneurysm of the middle cerebral artery that was not depicted at conventional angiography. CT angiogram from the front depicts an aneurysm at the bifurcations of the right (arrowhead) and left (arrow) middle cerebral arteries. All observers detected the aneurysm on the left, which was positive at conventional angiography, but the aneurysm on the right, which was not depicted at conventional angiography, was detected by only two observers.
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Copyright © 1999 by the Radiological Society of North America.
