Published Online:https://doi.org/10.1148/radiol.10092373

The results of this systematic review and meta-analysis indicate that CT angiography is an accurate tool for the diagnosis of ruptured intracranial aneurysms and can be integrated as a primary examination tool into the imaging and treatment algorithm for patients with subarachnoid hemorrhage at presentation; the chance of missing a ruptured aneurysm at CT angiography is no more than 2%.

Purpose

To calculate the sensitivity and specificity of computed tomographic (CT) angiography in the diagnosis of cerebral aneurysms in patients with acute subarachnoid hemorrhage (SAH) at presentation.

Materials and Methods

A systematic search for relevant studies was performed of the PubMed/MEDLINE and EMBASE databases. Two reviewers independently assessed the methodologic quality of each study by using the Quality Assessment of Diagnostic Accuracy Studies tool. The inclusion criteria were met by 50 studies. Heterogeneity was tested, and the presence of publication bias was visually assessed (by using a funnel plot). A meta-analysis of the reported sensitivity and specificity of each study with 95% confidence intervals (CIs) was performed on a per-patient level.

Results

Concerning sensitivity, the selected studies showed moderate heterogeneity. For specificity, low heterogeneity was observed. Moderate-heterogeneity studies that investigated only sensitivity or specificity were excluded from the pooled analyses by using a bivariate random effects model. The majority of the studies (n = 30) used a four–detector row CT scanner. The studies had good methodologic quality. Pooled sensitivity was 98% (95% CI: 97%, 99%), and pooled specificity was 100% (95% CI: 97%, 100%). Potential sources of variability among the studies were variations in the methodologic features (quality score), CT examination procedure (number of rows on the multidetector CT scanner), the standard of reference used, and the prevalence of ruptured intracranial aneurysms. There was evidence for publication bias, which may have led to overestimation of the diagnostic accuracy of CT angiography.

Conclusion

Multidetector CT angiography can be used as a primary examination tool in the diagnostic work-up of patients with SAH.

© RSNA, 2010

References

  • 1 Kirkpatrick PJ. Subarachnoid haemorrhage and intracranial aneurysms: what neurologists need to know. J Neurol Neurosurg Psychiatry 2002;73(suppl 1):i28–i33. MedlineGoogle Scholar
  • 2 van Gijn J, Rinkel GJ. Subarachnoid haemorrhage: diagnosis, causes and management. Brain 2001;124(pt 2):249–278. Crossref, MedlineGoogle Scholar
  • 3 Locksley HB. Natural history of subarachnoid hemorrhage, intracranial aneurysms and arteriovenous malformations: based on 6368 cases in the cooperative study. J Neurosurg 1966;25(2):219–239. Crossref, MedlineGoogle Scholar
  • 4 de Gans K, Nieuwkamp DJ, Rinkel GJ, Algra A. Timing of aneurysm surgery in subarachnoid hemorrhage: a systematic review of the literature. Neurosurgery 2002;50(2):336–340; discussion 340–342. MedlineGoogle Scholar
  • 5 Ohman J, Heiskanen O. Timing of operation for ruptured supratentorial aneurysms: a prospective randomized study. J Neurosurg 1989;70(1):55–60. Crossref, MedlineGoogle Scholar
  • 6 Whitfield PC, Kirkpatrick PJ. Timing of surgery for aneurysmal subarachnoid haemorrhage. Cochrane Database Syst Rev 2001;(2):CD001697. MedlineGoogle Scholar
  • 7 Kastner M, Wilczynski NL, McKibbon AK, Garg AX, Haynes RB. Diagnostic test systematic reviews: bibliographic search filters (“Clinical Queries”) for diagnostic accuracy studies perform well. J Clin Epidemiol 2009;62(9):974–981. Crossref, MedlineGoogle Scholar
  • 8 Whiting P, Rutjes AW, Reitsma JB, Bossuyt PM, Kleijnen J. The development of QUADAS: a tool for the quality assessment of studies of diagnostic accuracy included in systematic reviews. BMC Med Res Methodol 2003;3:25. Crossref, MedlineGoogle Scholar
  • 9 Agid R, Lee SK, Willinsky RA, Farb RI, terBrugge KG. Acute subarachnoid hemorrhage: using 64-slice multidetector CT angiography to “triage” patients’ treatment. Neuroradiology 2006;48(11):787–794. Crossref, MedlineGoogle Scholar
  • 10 Anderson GB, Steinke DE, Petruk KC, Ashforth R, Findlay JM. Computed tomographic angiography versus digital subtraction angiography for the diagnosis and early treatment of ruptured intracranial aneurysms. Neurosurgery 1999;45(6):1315–1320; discussion 1320–1322. Crossref, MedlineGoogle Scholar
  • 11 Caruso R, Colonnese C, Elefante A, Innocenzi G, Raguso M, Gagliardi FM. Use of spiral computerized tomography angiography in patients with cerebral aneurysm: our experience. J Neurosurg Sci 2002;46(1):4–9; discussion 9. MedlineGoogle Scholar
  • 12 Chen W, Yang Y, Qiu J, Peng Y, Xing W. Clinical application of 16-row multislice computed tomographic angiography in the preoperative and postoperative evaluation of intracranial aneurysms for surgical clipping. Surg Neurol 2009;71(5):559–565. Crossref, MedlineGoogle Scholar
  • 13 Colen TW, Wang LC, Ghodke BV, Cohen WA, Hollingworth W, Anzai Y. Effectiveness of MDCT angiography for the detection of intracranial aneurysms in patients with nontraumatic subarachnoid hemorrhage. AJR Am J Roentgenol 2007;189(4):898–903. CrossrefGoogle Scholar
  • 14 Dammert S, Krings T, Moller-Hartmann W, et al.. Detection of intracranial aneurysms with multislice CT: comparison with conventional angiography. Neuroradiology 2004;46(6):427–434. Crossref, MedlineGoogle Scholar
  • 15 Dehdashti AR, Rufenacht DA, Delavelle J, Reverdin A, de Tribolet N. Therapeutic decision and management of aneurysmal subarachnoid haemorrhage based on computed tomographic angiography. Br J Neurosurg 2003;17(1):46–53. Crossref, MedlineGoogle Scholar
  • 16 El Khaldi M, Pernter P, Ferro F, et al.. Detection of cerebral aneurysms in nontraumatic subarachnoid haemorrhage: role of multislice CT angiography in 130 consecutive patients. Radiol Med (Torino) 2007;112(1):123–137. Crossref, MedlineGoogle Scholar
  • 17 González-Darder JM, Pesudo-Martínez JV, Feliu-Tatay RA. Microsurgical management of cerebral aneurysms based in CT angiography with three-dimensional reconstruction (3D-CTA) and without preoperative cerebral angiography. Acta Neurochir (Wien) 2001;143(7):673–679. Crossref, MedlineGoogle Scholar
  • 18 Guo YW, Ke YQ, Zhang SZ, et al.. Combined application of virtual imaging techniques and three-dimensional computed tomographic angiography in diagnosing intracranial aneurysms. Chin Med J (Engl) 2008;121(24):2521–2524. Crossref, MedlineGoogle Scholar
  • 19 Halaji A, Budiselic B, Kovacic-Dujmovic S, Eskinja N, Miletic D. Computed tomography angiography in the diagnosis of intracranial aneurysms. [in Croatian]. Medicina (Croatia) 2006;42(2):103–107. Google Scholar
  • 20 Hoh BL, Cheung AC, Rabinov JD, Pryor JC, Carter BS, Ogilvy CS. Results of a prospective protocol of computed tomographic angiography in place of catheter angiography as the only diagnostic and pretreatment planning study for cerebral aneurysms by a combined neurovascular team. Neurosurgery 2004;54(6):1329–1340; discussion 1340–1342. Crossref, MedlineGoogle Scholar
  • 21 Jayaraman MV, Mayo-Smith WW, Tung GA, et al.. Detection of intracranial aneurysms: multi-detector row CT angiography compared with DSA. Radiology 2004;230(2):510–518. LinkGoogle Scholar
  • 22 Kadri S, Brunel H, Bourbotte G, Delort P, Lust S, Bonafe A. Can multislice helical computed tomography replace conventional angiography in the diagnosis of non traumatic subarachnoid hemorrhage? [in French]. J Neuroradiol 2006;33(1):45–50. Crossref, MedlineGoogle Scholar
  • 23 Karamessini MT, Kagadis GC, Petsas T, et al.. CT angiography with three-dimensional techniques for the early diagnosis of intracranial aneurysms: comparison with intra-arterial DSA and the surgical findings. Eur J Radiol 2004;49(3):212–223. Crossref, MedlineGoogle Scholar
  • 24 Kershenovich A, Rappaport ZH, Maimon S. Brain computed tomography angiographic scans as the sole diagnostic examination for excluding aneurysms in patients with perimesencephalic subarachnoid hemorrhage. Neurosurgery 2006;59(4):798–801; discussion 801–802. Crossref, MedlineGoogle Scholar
  • 25 Kouskouras C, Charitanti A, Giavroglou C, et al.. Intracranial aneurysms: evaluation using CTA and MRA—correlation with DSA and intraoperative findings. Neuroradiology 2004;46(10):842–850. Crossref, MedlineGoogle Scholar
  • 26 Lai PH, Yang CF, Pan HB, Chen C, Ho JT, Hsu SS. Detection and assessment of circle of Willis aneurysms in acute subarachnoid hemorrhage with three-dimensional computed tomographic angiography: correlation with digital subtraction angiography findings. J Formos Med Assoc 1999;98(10):672–677. MedlineGoogle Scholar
  • 27 Lenhart M, Bretschneider T, Gmeinwieser J, Ullrich OW, Schlaier J, Feuerbach S. Cerebral CT angiography in the diagnosis of acute subarachnoid hemorrhage. Acta Radiol 1997;38(5):791–796. Crossref, MedlineGoogle Scholar
  • 28 Lubicz B, Levivier M, François O, et al.. Sixty-four-row multisection CT angiography for detection and evaluation of ruptured intracranial aneurysms: interobserver and intertechnique reproducibility. AJNR Am J Neuroradiol 2007;28(10):1949–1955. Crossref, MedlineGoogle Scholar
  • 29 Lukosevicius S, Vaitkevicius G. Brain computed tomography angiography in case of subarachnoid hemorrhage. [in Lithuanian]. Medicina (Kaunas) 2002;38(2):140–146. MedlineGoogle Scholar
  • 30 Matsumoto M, Endo Y, Sato M, et al.. Acute aneurysm surgery using three-dimensional CT angiogrphy without conventional catheter angiography. Fukushima J Med Sci 2002;48(2):63–73. Crossref, MedlineGoogle Scholar
  • 31 Matsumoto M, Kasuya H, Sato T, et al.. Can 3D-CT angiography (3D-CTA) replace conventional catheter angiography in ruptured aneurysm surgery? our experience with 162 cases. Fukushima J Med Sci 2007;53(2):85–94. Crossref, MedlineGoogle Scholar
  • 32 Milosevic Z.. Acute subarachnoid haemorrhage: detection of aneurysms of intracranial arteries by computed tomographic angiography. Radiol Oncol 1999;33(4):275–282. Google Scholar
  • 33 Muto M, Bonsignore R, Ambrosanio G, et al.. CTA and DSA evaluation of patients with subarachnoid haemorrhage. [in Italian]. Riv Neuroradiol 1999;12(3):399–408. CrossrefGoogle Scholar
  • 34 Nakajima Y, Yoshimine T, Yoshida H, et al.. Computerized tomography angiography of ruptured cerebral aneurysms: factors affecting time to maximum contrast concentration. J Neurosurg 1998;88(4):663–669. Crossref, MedlineGoogle Scholar
  • 35 Nijjar S, Patel B, McGinn G, West M. Computed tomographic angiography as the primary diagnostic study in spontaneous subarachnoid hemorrhage. J Neuroimaging 2007;17(4):295–299. Crossref, MedlineGoogle Scholar
  • 36 Papke K, Kuhl CK, Fruth M, et al.. Intracranial aneurysms: role of multidetector CT angiography in diagnosis and endovascular therapy planning. Radiology 2007;244(2):532–540. LinkGoogle Scholar
  • 37 Pechlivanis I, Schmieder K, Scholz M, König M, Heuser L, Harders A. 3-Dimensional computed tomographic angiography for use of surgery planning in patients with intracranial aneurysms. Acta Neurochir (Wien) 2005;147(10):1045–1053; discussion 1053. Crossref, MedlineGoogle Scholar
  • 38 Pedersen HK, Bakke SJ, Hald JK, et al.. CTA in patients with acute subarachnoid haemorrhage: a comparative study with selective, digital angiography and blinded, independent review. Acta Radiol 2001;42(1):43–49. Crossref, MedlineGoogle Scholar
  • 39 Pozzi-Mucelli F, Bruni S, Doddi M, Calgaro A, Braini M, Cova M. Detection of intracranial aneurysms with 64 channel multidetector row computed tomography: comparison with digital subtraction angiography. Eur J Radiol 2007;64(1):15–26. Crossref, MedlineGoogle Scholar
  • 40 Rajagopal KV, Lakhkar BN, Acharya DK. Three-dimensional CT angiography in the evaluation of cerebral arteries in acute hemorrhage. Neurol India 2003;51(2):206–207. MedlineGoogle Scholar
  • 41 Röhnert W, Hänig V, Hietschold V, Abolmaali N. Detection of aneurysm in subarachnoid hemorrhage: CT angiography vs. digital subtraction angiography. [in German]. Aktuelle Radiol 1998;8(2):63–70. MedlineGoogle Scholar
  • 42 Romijn M, Gratama van Andel HA, van Walderveen MA, et al.. Diagnostic accuracy of CT angiography with matched mask bone elimination for detection of intracranial aneurysms: comparison with digital subtraction angiography and 3D rotational angiography. AJNR Am J Neuroradiol 2008;29(1):134–139. Crossref, MedlineGoogle Scholar
  • 43 Rotim K, Marinovic T, Vilendecic M, Pavic L, Grahovac G. Computed tomography angiography vs. digital subtraction angiography for detection and characterization of intracranial aneurysms at Dubrava University Hospital, Zagreb. [in Croatian]. Neurol Croat 2007;56(3-4):43–48. Google Scholar
  • 44 Santos N, Machado E, Carvalho S, Barbosa M, Martins F. Subarachnoid hemorrhage and computerized tomography cerebral angiography. [in Portuguese]. Acta Med Port 2001;14(1):43–47. MedlineGoogle Scholar
  • 45 Sasiadek M, Kowalewski K, Turek T, Hendrich B, Podkowa J, Maksymowicz H. Efficiency of CT-angiography in the diagnosis of intracranial aneurysms. Med Sci Monit 2002;8(6):MT99–MT104. MedlineGoogle Scholar
  • 46 Seruga T, Bunc G, Klein GE. Helical high-resolution volume-rendered 3-dimensional computer tomography angiography in the detection of intracranial aneurysms. J Neuroimaging 2001;11(3):280–286. Crossref, MedlineGoogle Scholar
  • 47 Taschner CA, Thines L, Lernout M, Lejeune JP, Leclerc X. Treatment decision in ruptured intracranial aneurysms: comparison between multi-detector row CT angiography and digital subtraction angiography. J Neuroradiol 2007;34(4):243–249. Crossref, MedlineGoogle Scholar
  • 48 Teksam M, McKinney A, Casey S, Asis M, Kieffer S, Truwit CL. Multi-section CT angiography for detection of cerebral aneurysms. AJNR Am J Neuroradiol 2004;25(9):1485–1492. MedlineGoogle Scholar
  • 49 Uysal E, Yanbuloğlu B, Ertürk M, Kilinç BM, Başak M. Spiral CT angiography in diagnosis of cerebral aneurysms of cases with acute subarachnoid hemorrhage. Diagn Interv Radiol 2005;11(2):77–82. MedlineGoogle Scholar
  • 50 Uysal E, Oztora F, Ozel A, Erturk SM, Yildirim H, Basak M. Detection and evaluation of intracranial aneurysms with 16-row multislice CT angiography: comparison with conventional angiography. Emerg Radiol 2008;15(5):311–316. Crossref, MedlineGoogle Scholar
  • 51 Velthuis BK, Rinkel GJ, Ramos LM, et al.. Subarachnoid hemorrhage: aneurysm detection and preoperative evaluation with CT angiography. Radiology 1998;208(2):423–430. LinkGoogle Scholar
  • 52 Velthuis BK, Van Leeuwen MS, Witkamp TD, Ramos LM, Berkelbach van Der Sprenkel JW, Rinkel GJ. Computerized tomography angiography in patients with subarachnoid hemorrhage: from aneurysm detection to treatment without conventional angiography. J Neurosurg 1999;91(5):761–767. Crossref, MedlineGoogle Scholar
  • 53 Velthuis BK, Rinkel GJ, Ramos LM, Witkamp TD, van Leeuwen MS. Perimesencephalic hemorrhage: exclusion of vertebrobasilar aneurysms with CT angiography. Stroke 1999;30(5):1103–1109. Crossref, MedlineGoogle Scholar
  • 54 Westerlaan HE, Gravendeel J, Fiore D, et al.. Multislice CT angiography in the selection of patients with ruptured intracranial aneurysms suitable for clipping or coiling. Neuroradiology 2007;49(12):997–1007. Crossref, MedlineGoogle Scholar
  • 55 White PM, Teasdale EM, Wardlaw JM, Easton V. Intracranial aneurysms: CT angiography and MR angiography for detection prospective blinded comparison in a large patient cohort. Radiology 2001;219(3):739–749. LinkGoogle Scholar
  • 56 Wintermark M, Uske A, Chalaron M, et al.. Multislice computerized tomography angiography in the evaluation of intracranial aneurysms: a comparison with intraarterial digital subtraction angiography. J Neurosurg 2003;98(4):828–836. Crossref, MedlineGoogle Scholar
  • 57 Yan SX, Yang TH, Fan YM, Tiao C, Jin S, Yin L. 3-dimension computed tomography angiography and digital subtraction angiography in diagnosis of intracranial aneurysm: a comparative study. [in Chinese]. Zhonghua Yi Xue Za Zhi 2007;87(8):559–561. MedlineGoogle Scholar
  • 58 Zouaoui A, Sahel M, Marro B, et al.. Three-dimensional computed tomographic angiography in detection of cerebral aneurysms in acute subarachnoid hemorrhage. Neurosurgery 1997;41(1):125–130. Crossref, MedlineGoogle Scholar
  • 59 Higgins JP, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analyses. BMJ 2003;327(7414):557–560. Crossref, MedlineGoogle Scholar
  • 60 Zamora J, Abraira V, Muriel A, Khan K, Coomarasamy A. Meta-DiSc: a software for meta-analysis of test accuracy data. BMC Med Res Methodol 2006;6:31. Crossref, MedlineGoogle Scholar
  • 61 Reitsma JB, Glas AS, Rutjes AW, Scholten RJ, Bossuyt PM, Zwinderman AH. Bivariate analysis of sensitivity and specificity produces informative summary measures in diagnostic reviews. J Clin Epidemiol 2005;58(10):982–990. Crossref, MedlineGoogle Scholar
  • 62 Harbord RM, Whiting P, Sterne JA, et al.. An empirical comparison of methods for meta-analysis of diagnostic accuracy showed hierarchical models are necessary. J Clin Epidemiol 2008;61(11):1095–1103. Crossref, MedlineGoogle Scholar
  • 63 White PM, Wardlaw JM, Easton V. Can noninvasive imaging accurately depict intracranial aneurysms? a systematic review. Radiology 2000;217(2):361–370. LinkGoogle Scholar
  • 64 van Gelder JM. Computed tomographic angiography for detecting cerebral aneurysms: implications of aneurysm size distribution for the sensitivity, specificity, and likelihood ratios. Neurosurgery 2003;53(3):597–605; discussion 605–606. Crossref, MedlineGoogle Scholar
  • 65 Chappell ET, Moure FC, Good MC. Comparison of computed tomographic angiography with digital subtraction angiography in the diagnosis of cerebral aneurysms: a meta-analysis. Neurosurgery 2003;52(3):624–631; discussion 630–631. Crossref, MedlineGoogle Scholar
  • 66 White PM, Wardlaw JM, Lindsay KW, Sloss S, Patel DK, Teasdale EM. The non-invasive detection of intracranial aneurysms: are neuroradiologists any better than other observers? Eur Radiol 2003;13(2):389–396. Crossref, MedlineGoogle Scholar
  • 67 Milosevic Z. Acute subarachnoid haemorrhage: detection of aneurysms of intracranial arteries by computed tomographic angiography. Radiol Oncol 1999;33(4):275–282. Google Scholar
  • 68 Unruptured intracranial aneurysms: risk of rupture and risks of surgical intervention. International Study of Unruptured Intracranial Aneurysms Investigators. N Engl J Med 1998;339(24):1725–1733. Crossref, MedlineGoogle Scholar
  • 69 Ishibashi T, Murayama Y, Urashima M, et al.. Unruptured intracranial aneurysms: incidence of rupture and risk factors. Stroke 2009;40(1):313–316. Crossref, MedlineGoogle Scholar
  • 70 Juvela S, Porras M, Poussa K. Natural history of unruptured intracranial aneurysms: probability of and risk factors for aneurysm rupture. J Neurosurg 2008;108(5):1052–1060. Crossref, MedlineGoogle Scholar
  • 71 Hochmuth A, Spetzger U, Schumacher M. Comparison of three-dimensional rotational angiography with digital subtraction angiography in the assessment of ruptured cerebral aneurysms. AJNR Am J Neuroradiol 2002;23(7):1199–1205. MedlineGoogle Scholar
  • 72 Ishihara H, Kato S, Akimura T, Suehiro E, Oku T, Suzuki M. Angiogram-negative subarachnoid hemorrhage in the era of three dimensional rotational angiography. J Clin Neurosci 2007;14(3):252–255. Crossref, MedlineGoogle Scholar
  • 73 van Rooij WJ, Peluso JP, Sluzewski M, Beute GN. Additional value of 3D rotational angiography in angiographically negative aneurysmal subarachnoid hemorrhage: how negative is negative? AJNR Am J Neuroradiol 2008;29(5):962–966. Crossref, MedlineGoogle Scholar
  • 74 Houben MP, van Rooij WJ, Sluzewski M, Tijssen CC. Subarachnoid hemorrhage without aneurysm on the angiogram: the value of repeat angiography. [in Dutch]. Ned Tijdschr Geneeskd 2002;146(17):804–808. MedlineGoogle Scholar
  • 75 Inamasu J, Nakamura Y, Saito R, et al.. “Occult” ruptured cerebral aneurysms revealed by repeat angiography: result from a large retrospective study. Clin Neurol Neurosurg 2003;106(1):33–37. Crossref, MedlineGoogle Scholar
  • 76 Jafar JJ, Weiner HL. Surgery for angiographically occult cerebral aneurysms. J Neurosurg 1993;79(5):674–679. Crossref, MedlineGoogle Scholar
  • 77 Jung JY, Kim YB, Lee JW, Huh SK, Lee KC. Spontaneous subarachnoid haemorrhage with negative initial angiography: a review of 143 cases. J Clin Neurosci 2006;13(10):1011–1017. Crossref, MedlineGoogle Scholar
  • 78 Little AS, Garrett M, Germain R, et al.. Evaluation of patients with spontaneous subarachnoid hemorrhage and negative angiography. Neurosurgery 2007;61(6):1139–1150. Crossref, MedlineGoogle Scholar
  • 79 Pathirana N, Refsum SE, McKinstry CS, Bell KE. The value of repeat cerebral angiography in subarachnoid haemorrhage. Br J Neurosurg 1994;8(2):141–146. Crossref, MedlineGoogle Scholar
  • 80 Tatter SB, Crowell RM, Ogilvy CS. Aneurysmal and microaneurysmal “angiogram-negative” subarachnoid hemorrhage. Neurosurgery 1995;37(1):48–55. Crossref, MedlineGoogle Scholar
  • 81 Topcuoglu MA, Ogilvy CS, Carter BS, Buonanno FS, Koroshetz WJ, Singhal AB. Subarachnoid hemorrhage without evident cause on initial angiography studies: diagnostic yield of subsequent angiography and other neuroimaging tests. J Neurosurg 2003;98(6):1235–1240. Crossref, MedlineGoogle Scholar
  • 82 Cloft HJ, Joseph GJ, Dion JE. Risk of cerebral angiography in patients with subarachnoid hemorrhage, cerebral aneurysm, and arteriovenous malformation: a meta-analysis. Stroke 1999;30(2):317–320. Crossref, MedlineGoogle Scholar
  • 83 Dawkins AA, Evans AL, Wattam J, et al.. Complications of cerebral angiography: a prospective analysis of 2,924 consecutive procedures. Neuroradiology 2007;49(9):753–759. Crossref, MedlineGoogle Scholar
  • 84 Fifi JT, Meyers PM, Lavine SD, et al.. Complications of modern diagnostic cerebral angiography in an academic medical center. J Vasc Interv Radiol 2009;20(4):442–447. Crossref, MedlineGoogle Scholar
  • 85 Grzyska U, Freitag J, Zeumer H. Selective cerebral intraarterial DSA: complication rate and control of risk factors. Neuroradiology 1990;32(4):296–299. Crossref, MedlineGoogle Scholar
  • 86 Leffers AM, Wagner A. Neurologic complications of cerebral angiography: a retrospective study of complication rate and patient risk factors. Acta Radiol 2000;41(3):204–210. Crossref, MedlineGoogle Scholar
  • 87 Willinsky RA, Taylor SM, TerBrugge K, Farb RI, Tomlinson G, Montanera W. Neurologic complications of cerebral angiography: prospective analysis of 2,899 procedures and review of the literature. Radiology 2003;227(2):522–528. LinkGoogle Scholar
  • 88 Görzer H, Heimberger K, Schindler E. Spiral CT angiography with digital subtraction of extra- and intracranial vessels. J Comput Assist Tomogr 1994;18(5):839–841. Crossref, MedlineGoogle Scholar
  • 89 Jayakrishnan VK, White PM, Aitken D, Crane P, McMahon AD, Teasdale EM. Subtraction helical CT angiography of intra- and extracranial vessels: technical considerations and preliminary experience. AJNR Am J Neuroradiol 2003;24(3):451–455. MedlineGoogle Scholar
  • 90 Lell M, Anders K, Klotz E, Ditt H, Bautz W, Tomandl BF. Clinical evaluation of bone-subtraction CT angiography (BSCTA) in head and neck imaging. Eur Radiol 2006;16(4):889–897. Crossref, MedlineGoogle Scholar
  • 91 Li Q, Lv F, Li Y, Li K, Luo T, Xie P. Subtraction CT angiography for evaluation of intracranial aneurysms: comparison with conventional CT angiography. Eur Radiol 2009;19(9):2261–2267. Crossref, MedlineGoogle Scholar
  • 92 Morhard D, Fink C, Becker C, Reiser MF, Nikolaou K. Value of automatic bone subtraction in cranial CT angiography: comparison of bone-subtracted vs. standard CT angiography in 100 patients. Eur Radiol 2008;18(5):974–982. Crossref, MedlineGoogle Scholar
  • 93 Sakamoto S, Kiura Y, Shibukawa M, Ohba S, Arita K, Kurisu K. Subtracted 3D CT angiography for evaluation of internal carotid artery aneurysms: comparison with conventional digital subtraction angiography. AJNR Am J Neuroradiol 2006;27(6):1332–1337. MedlineGoogle Scholar
  • 94 Tomandl BF, Hammen T, Klotz E, Ditt H, Stemper B, Lell M. Bone-subtraction CT angiography for the evaluation of intracranial aneurysms. AJNR Am J Neuroradiol 2006;27(1):55–59. MedlineGoogle Scholar
  • 95 Venema HW, Hulsmans FJ, den Heeten GJ. CT angiography of the circle of Willis and intracranial internal carotid arteries: maximum intensity projection with matched mask bone elimination-feasibility study. Radiology 2001;218(3):893–898. LinkGoogle Scholar
  • 96 Tomura N, Otani T, Sakuma I, Takahashi S, Nishii T, Watarai J. Three-dimensional bone-free computed tomographic angiography of aneurysms near the skull base using a new bone-removal application. Jpn J Radiol 2009;27(1):31–36. Crossref, MedlineGoogle Scholar
  • 97 Watanabe Y, Uotani K, Nakazawa T, et al.. Dual-energy direct bone removal CT angiography for evaluation of intracranial aneurysm or stenosis: comparison with conventional digital subtraction angiography. Eur Radiol 2009;19(4):1019–1024. Crossref, MedlineGoogle Scholar

Article History

Received December 23, 2009; revision requested February 6, 2010; revision received May 27; accepted June 2; final version accepted August 2.
Published online: Jan 2011
Published in print: Jan 2011