What is the most sensitive non-invasive imaging strategy for the diagnosis of intracranial aneurysms?
P M Whitea b, E Teadsalea, J M Wardlawb, V Eastonc
a University
Department of Neurosurgery and Department of Neuroradiology, Institute
of Neurological Sciences, Southern General Hospital, Glasgow G52
4TF, UK, b University of Edinburgh Department of Clinical
Neurosciences2, Bramwell Dott Building, Western General Hospital, Crewe
Road, Edinburgh EH4 2XU, UK, c University of Edinburgh Department of Medical
Statistics, Medical School, Teviot Place, Edinburgh, UK
Correspondence to: Dr PM White pmw{at}skull.dcn.ed.ac.uk
Received 10 October
2000 and in revised form 26 February 2001;
Accepted 7
March 2001
OBJECTIVES
To
determine whether combining non-invasive tests for intracranial
aneurysms together would significantly improve aneurysm detection over
individual tests.
METHODS114 patients
undergoing intra-arterial digital subtraction angiography to confirm or
exclude an intracranial aneurysm were also examined by CT angiography,
MR angiography, and transcranial power Doppler ultrasound. The
reviewers and ultrasonographers were blinded to the angiogram result,
other imaging results and all clinical information.
RESULTSThe
combination of non-invasive tests did improve diagnostic performance on
a per patient basis. The combination of power Doppler and CT
angiography had the greatest sensitivity for aneurysm detection (0.83;
05% confidence interval (95% CI) 0.66-0.93) and the level of
agreement for this strategy with the reference angiographic standard
was excellent (
0.84; 95% CI 0.72-0.95). The improvement in
sensitivity of adding power Doppler to CT angiography was not significant (p=0.55) but the improvement in the level of agreement with
the reference standard was substantial. However, even the most
sensitive combination strategy performed poorly in the detection of
small (3-5 mm) and very small (<3 mm) aneurysms with a sensitivity of
0.43 (95% CI 0.23-0.66) and 0.00 (95% CI 0.00-0.31) respectively.
CONCLUSIONSThe
addition of transcranial power Doppler ultrasound to either CT
angiography or MR angiography does improve diagnostic performance on a
per patient basis but aneurysms of 5 mm or smaller can still not be
reliably identified by current standard clinical non-invasive imaging modalities.
Keywords: intracranial aneurysms; CT angiography; MR angiography; transcranial power Doppler
© 2001 by Journal of Neurology, Neurosurgery, and Psychiatry
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- What is the most sensitive non-invasive strategy for the diagnosis of intracranial aneurysms?
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J. Neurol. Neurosurg. Psychiatry 2001 71: 289.[Extract] [Full Text] [PDF]
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[Abstract] [Full Text] -
HUTCHINSON, P., KIRKPATRICK, P.
(2001). What is the most sensitive non-invasive strategy for the diagnosis of intracranial aneurysms?. J. Neurol. Neurosurg. Psychiatry
71: 289-289
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