Chin J Radiol 2002; 27: 201-213 201 74 26 [1] 4.8% 2.6% 42.2% Sahs [2] 48 20% 40% 67% 2% 5% [3] 20% [4] 10% 15% 41% 48% [5] [6] 95 710 901 Computed Tomogram Angiography,
202 Subtraction Angiography (DSA) [7] Digital 8mm CT Picker PQ2000 CT Elsint Twin FLASH CT 21 3 80 100 nonionic iodinized contrast medium 18 CT 1:2.5 pitch 2mm CT l0mm 2mm 60-80mm Sylvian fissure Sylvian 85 5 Picker PQ2000 spiral CT 87 3 Elsint Twin FLASH spiral CT 88 6 103 30-40 source images Picker PQ2000 CT Voxel Q Elsint Silicon Graphy 2 surface shaded display (SSD) 4 maximal intensity projection (MIP) 5 1 CT 2000 17 for Windows SPSS 8.0 Microsoft ACCESS PC SPSS 8.0
203 Maximal Intensity Projection (MIP) Surface Shaded Display (SSD) 103 CT- 89 54 95 DSA 95 8 85 5 1 88 6 11 103 CT- 95 Sensitivity Specificity Positive predictive value Negative predictive value CT-
204 [17] 103 86 23 56.8 23-86 14.8 6 43 60 7 Bifurcation of MCA(13), ACoA(12),ICA of PCoA orifice(33), Distal A1(3), M1 of MCA(2), Proximal A2(1), ICA(4), Tip of basilar artery(2), PCA(3), Vertebral artery(1) 9 95 65 8 6 3 66 74 58 29 8
205 3 2 2 3 10 26 3 4 74 CT 95 CT 62 Positive predictive value Sensitivity Specificity Negative predictive value Positive predictive value Sensitivity Negative predictive value Specificity 11a DSA 11b
206 6 68 24 4 1 Dilatation of the tip of basilar artery 1 DSA 11 SSD 12 2 DSA 74 91.8%(68/74) 85.7% (24/24+4) [7] 4 high-attenuation blood clot motion artifacts vascular loops infundibulum of the posterior communicating artery [8] 4 2 13 [8] 2 14 12a 12b SSD 13a 13b
207 14a 14b 15a 15b DSA M2 SSD SDH DSA M2 SSD SDH 15 1 M1 M2 12 mm 16a CT sylvian fissure 16b DSA 6 mm DSA 17a reconstruction MPR outside the imaging volume 17b closing to the skull base
208 16a 16b M 1 M 2 12 mm CT Sylvian fissure 17a 17b DSA 6 mm MPR difficult to identify against the bony background cavernous portion of the internal carotid artery in the positive predictive value negative predictive value 95 62 26 3 4 [9]
209 18a 18b MIP MIP SSD 19a 19b CT DSA [10] IV line injector 90% (1) Shaded surface display, SSD (2)
210 20a 20b CT DSA scan CT number Maximal intensity projection, MIP CT DSA (3) Multiple Planer reconstruction, MPR Curved planer reconstruction, CPR (4) Multiple threshold display inner view SSD MIP SSD 3D MIP [11] MIP SSD MIP a,b 3D [7,9,11~21] CT spiral 3ml 350mg% Omnipaque 370mg% Ultravist 80ml 18 CT CT 2mm 95 65 [8] 8 6 3 3 2 2 3 8 4 19 4
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213 Three dimensional CT angiography in the detection of intracranial aneurysms KUEI-LI LIN 1,2,3 WU-CHUNG SHEN 1,2 Department of Radiology 1, China Medical College Hospital; School of Medicine 2, China Medical College Department of Radiation Oncology 3, Chimei Medical Center The purposes of this study are, first, to evaluate the diagnosis sensitivity and specificity of in intracranial arterial aneurysm and, second, to assess the advantages and pitfalls of its role as the first-line diagnostic tool for spontaneous SAH and for the patients suspected of having intracranial aneurysm due to other symptoms. During the period form May 1996 to June 1999, we performed with MIP and SSD for 103 patients with suspicion of intracranial aneurysm. We analyzed the presence and morphology of any aneurysms. DSA or surgery acted as the control. 95 patients were eligible for analysis. (Mean age, 56.8 years; range, 23 to 86 years). 74 aneurysms were found in 66 patients. Negative findings at angiography were noted in 7 patients. Sensitivity and specificity of 3-D for all patients and all aneurysm were 93.9% and 89.6%, 91.8% and 85.7%, respectively. with its high sensitivity and specificity for aneurysms can compliment conventional catheter angiography for its better demonstration of the 3-D anatomy. It can provide surgical information about the shape, neck, direction of aneurysms, and adjacent vascular and bone structures. can be the first-line screening tool for SAH routinely. with its high sensitivity and specificity for all patients may be useful in the follow-up of untreated aneurysms and at-risk groups due to its less invasive and less expensive. But if radiation is essential, MRA is the alternative. Recognition of the limitations of CT angiography is important in minimizing interpretation errors. Key words: computed tomography; angiography; brain, aneurysm