Intracranial Aneurysms: Clinical Value of 3D Digital Subtraction Angiography in the Therapeutic Decision and Endovascular Treatment

PURPOSE: To evaluate three-dimensional (3D) digital subtraction angiography (DSA) as a supplement to two-dimensional (2D) DSA in the endovascular treatment (EVT) of intracranial aneurysms.

MATERIALS AND METHODS: In 22 ruptured aneurysms, neck visualization, aneurysm shape, and EVT feasibility were analyzed at 2D DSA (anteroposterior, lateral, and rotational views) and at maximum intensity projection (MIP) and surface shaded display (SSD) 3D DSA. The possibility of obtaining a working view for EVT at 3D DSA and the relevance of measurements in choosing the first coil also were assessed.

RESULTS: Two-dimensional DSA images clearly depicted the aneurysm neck in four of 22 aneurysms; MIP images, in 10; and SSD images, in 21, but SSD led to overestimation of the neck size in one aneurysm. Aneurysm shape was precisely demonstrated in five of 22 aneurysms at 2D DSA, in eight at MIP, and in all cases at SSD. In two of 22 aneurysms, EVT seemed to be nonfeasible at 2D DSA; however, SSD demonstrated feasibility and EVT was successfully performed. In one aneurysm, only SSD demonstrated the extension of the neck to a parent vessel, which was proved at surgery. Working views for EVT were deduced from 3D DSA findings in 20 of 21 aneurysms. The choice of the first coil was correct in 19 of 21 aneurysms.

CONCLUSION: Three-dimensional DSA is valuable for evaluating the potential for EVT, finding a working view, and performing accurate measurements.

References

  • 1 Velthuis BK, Rinkel GJE, Ramos LMP, et al. Subarachnoid hemorrhage: aneurysm detection and preoperative evaluation with CT angiography. Radiology 1998; 208:423-430. LinkGoogle Scholar
  • 2 Alberico RA, Patel M, Casey S, Jacobs B, Maguire W, Decker R. Evaluation of the circle of Willis with three-dimensional CT angiography in patients with suspected intracranial aneurysms. AJNR Am J Neuroradiol 1995; 16:1571-1578. MedlineGoogle Scholar
  • 3 Schwartz RB, Tice HM, Hooten SM, Hsu LH, Stieg PE. Evaluation of intracranial aneurysms with helical CT: correlation with conventional angiography and MR angiography. Radiology 1994; 192:717-722. LinkGoogle Scholar
  • 4 Vieco PT, Shuman WP, Alsofrom GF, Gross CE. Detection of circle of Willis aneurysms in patients with acute subarachnoid hemorrhage: a comparison of CT angiography and digital subtraction angiography. AJR Am J Roentgenol 1995; 165:425-430. Crossref, MedlineGoogle Scholar
  • 5 Heinz ER. Commentary: prospective evaluation of the circle of Willis with three-dimensional CT angiography in patients with suspected intracranial aneurysms. AJNR Am J Neuroradiol 1995; 16:1579-1580. Google Scholar
  • 6 Korogi Y, Takahashi M, Katada K, et al. Intracranial aneurysms: detection with three-dimensional CT angiography with volume rendering—comparison with conventional angiographic and surgical findings. Radiology 1999; 211:497-506. LinkGoogle Scholar
  • 7 Ida M, Kurisu Y, Yamashita M. MR angiography of ruptured aneurysms in acute subarachnoid hemorrhage. AJNR Am J Neuroradiol 1997; 18:1025-1032. MedlineGoogle Scholar
  • 8 Chung TS, Joo JY, Lee SK, Chien D, Laub G. Evaluation of intracranial aneurysms with high-resolution MR angiography using a section-interpolation technique: correlation with digital subtraction angiography. AJNR Am J Neuroradiol 1999; 20:229-235. MedlineGoogle Scholar
  • 9 Anzalone N, Triulzi F, Scotti G. Acute subarachnoid hemorrhage: 3D time-of flight MR angiography versus intra-arterial digital angiography. Neuroradiology 1995; 37:257-261. Crossref, MedlineGoogle Scholar
  • 10 Korogi Y, Takahashi M, Imakita S, et al. Diagnostic accuracy of three-dimensional computed tomographic angiography in the screening evaluation of intracranial aneurysms. Int J Neuroradiol 1998; 5:373-379. Google Scholar
  • 11 Korogi Y, Takahashi M, Mabuchi N, et al. Intracranial aneurysms: diagnostic accuracy of MR angiography with evaluation of maximum intensity projection and source images. Radiology 1996; 199:199-207. LinkGoogle Scholar
  • 12 Young N, Dorsch NWC, Kingston RJ. Pitfalls in the use of spiral CT for identification of intracranial aneurysms. Neuroradiology 1999; 41:93-99. Crossref, MedlineGoogle Scholar
  • 13 Schumacher M, Kutluk K, Ott D. Digital rotational angiography in neuroradiology. AJNR Am J Neuroradiol 1989; 10:644-649. MedlineGoogle Scholar
  • 14 Hoff DJ, Wallace MC, terBrugge KG, Gentili F. Rotational angiography assessment of intracranial aneurysms. AJNR Am J Neuroradiol 1994; 15:1945-1948. MedlineGoogle Scholar
  • 15 Tu RK, Cohen WA, Maravilla KR, et al. Digital subtraction rotational angiography for aneurysms of the intracranial anterior circulation: injection method and optimization. AJNR Am J Neuroradiol 1996; 17:1127-1136. MedlineGoogle Scholar
  • 16 Cognard C, Weill A, Castaings L, Rey A, Moret J. Intracranial berry aneurysms: angiographic results after endovascular treatment. Radiology 1998; 206:499-510. LinkGoogle Scholar
  • 17 Fahrig R, Fox AJ, Lownie S, Holdsworth DW. Use of a C-arm system to generate true three-dimensional computed rotational angiograms: preliminary in vitro and in vivo results. AJNR Am J Neuroradiol 1997; 18:1507-1514. MedlineGoogle Scholar
  • 18 Carsin M, Chabert E, Croci S, Romeas R, Scarabin JM. Place des reconstructions tri-dimensionnelles dans le bilan angiographique des malformations vasculaires cérébrales: le Morphomètre 3D. J Neuroradiol 1997; 24:137-140. MedlineGoogle Scholar
  • 19 Heautot JF, Chabert E, Gandon Y, et al. Analysis of cerebrovascular diseases by a new 3-dimensional computerised x-ray angiography system. Neuroradiology 1998; 40:203-209. Crossref, MedlineGoogle Scholar
  • 20 Turjman F, Bendib K, Girerd C, Froment JC, Amiel M. Pretherapeutic evaluation of intracranial aneurysms using three-dimensional angiography (3D morphometer): preliminary results. In: Taki W, Picard L, Kikuchi H, eds. Advances in interventional neuroradiology and intravascular neurosurgery. Amsterdam, the Netherlands: Elsevier Science, 1996; 75-79. Google Scholar
  • 21 Saint-Felix D, Trousset Y, Picard C, Ponchut C, Romeas R, Rougee A. In vivo evaluation of a new system for 3-D computerized angiography. Phys Med Biol 1994; 39:583-595. Crossref, MedlineGoogle Scholar
  • 22 Rougee A, Picard C, Trousset Y, Ponchut C. Geometrical calibration for 3D x-ray imaging. Proc SPIE Med Imaging 1993; 1897:161-169. CrossrefGoogle Scholar
  • 23 Trousset Y, Desecures H, Grimaud M. Support in 3D vascular reconstruction. Proc SPIE Med Imaging 1994; 2164:107-117. CrossrefGoogle Scholar
  • 24 Linskey ME, Sekhar LN, Hirsch WL, Jr, Yonas H, Horton JA. Aneurysms of the intracavernous carotid artery: natural history and indications for treatment. Neurosurgery 1990; 26:933-938. Crossref, MedlineGoogle Scholar
  • 25 Moret J, Cognard C, Weill A, Castaings L, Rey A. The “remodeling technique” in the treatment of wide neck intracranial aneurysms: angiographic results and clinical follow-up in 56 cases. Intervent Neuroradiol 1997; 3:21-35. Crossref, MedlineGoogle Scholar
  • 26 Guglielmi G, Vinuela F, Dion J, Duckwiler G. Electrothrombosis of saccular aneurysms via endovascular approach. II. Preliminary clinical experience. J Neurosurg 1991; 75:8-14. Crossref, MedlineGoogle Scholar
  • 27 Anxionnat R, Bracard S, Macho J, et al. 3D angiography: clinical interest—first applications in interventional neuroradiology. J Neuroradiol 1998; 25:251-262. MedlineGoogle Scholar
  • 28 Anxionnat R, Bracard S, Picard L, et al. 3D DSA: first results in intracranial aneurysms. Riv Neuroradiol 1999; 12(suppl 2):85-87. CrossrefGoogle Scholar

Article History

Published in print: Mar 2001