Abstract TP87: Comparative Analysis of 3-Dimensional Rotation Angiography versus 3-Dimensional Computed Tomography Angiography for Intracranial Aneurysm Treatment Detection and Planning
Introduction: 3D Rotational Angiography (3DRA) is the gold standard for intracranial aneurysm (IA) detection, but is invasive and time consuming. While 3DCTA has shown to be sensitive for IA detection, no published studies have compared 3DRA to 3DCTA in guiding clinical management. Our aim was to compare suggested treatment for IA based on 3DRA and 3DCTA vs actual final treatment and outcome.
Hypothesis: Management recommendations based on blinded review of 3DRA and 3DCTA for IA do not differ significantly.
Methods: Prospective blinded review of contemporaneous 3DRA and 3DCTA was performed for patients with suspected IA. Two interventionalists and two neuroradiologists performed blinded, prospective review of 3DRA or 3DCTA, respectively. IA size, location, and morphology were assessed. After IA characterization, each observer independently recommended optimal therapy (conservative, coil, surgery, combined/other) while blinded to other reviewers’ decisions. Findings were analyzed with Spearman, and agreement coefficient 1 (AC1) inter-rater reliability statistics.
Results: 41/52 enrolled patients had IA confirmed by 3DRA (52 IA total). 50/52 (96%) IA were initially identified by 3DCTA (both false negatives seen retrospectively). Average IA sac and neck size measured by 3DRA and 3DCTA correlated closely (p<0.01) and were 9.8 and 5.0 mm vs 9.5 and 4.5 mm, respectively. Treatment recommendations by reviewers for 3DRA vs 3DCTA correlated very strongly (AC1= 0.77), as did reader recommendations within a modality (3DRA, AC1=0.66; 3DCTA, AC1=0.79). For 39/52 (75%) of IA, majority consensus for all readers was reached (3/4 or 4/4 reviewers), which correlated well with final executed treatments (95%).
Conclusions: Recommendations for IA treatment based on 3DCTA correlate closely with those based on 3DRA, as well as with actual treatment in a majority of patients. 3DCTA holds promise as a primary imaging tool for IA detection and clinical decision making.
- © 2012 by American Heart Association, Inc.