Spiral ct angiography: a modern approach to diagnosis of aneurysms and arteriovenous malformations of the brain

Savello A.V., Anosov N.A., Svistov D.V., Kandyba D.V.

(Chair of Rentgenology and Radiology, Chair of Neurosurgery Medicomilitary Academy, Saint Petersburg, Russia)

Potentialities of spiral CT angiography (SCTA) in diagnosis of intracranial aneurysms and arteriovenous malformations (AVM) and its role among other diagnostic methods were studied. It was done with the help of a complex clinical and radiation examination of 54 patients (30 cases with intracranial aneurysms, 24 cases with intracranial AVM). Radiation examination included use of ultrasound Doppler, CT, SCTA, digital subtraction angiography (DSA), MRI.

The results show, that SCTA is a highly informative method of diagnosis of intracranial aneurysms. Its resolution capacity allows to identify both small aneurysms (about 2 mm) and big, partially thrombosed aneurysms. SCTA data play a very important part in choosing treatment tactics and planning a direct endovascular surgical intervention. Besides, they permit to carry out virtual modeling of a surgical method, which can be used for aneurysm treatment. SCTA is a valuable means of determining efficacy of destructive endovascular interventions in big and giant aneurysms. According to the results of investigation, SCTA sensitivity and specificity in intracranial aneurysms are equal to 97.1% and 98.5% respectively.

Use of SCTA allows to visualize an AVM glome, to estimate its size and volume, to determine main sources of blood supply, ways of draining and a type of AVM according to Spetzier-Martin. SCTA makes it possible to assess indications for an endovascular operation before DSA use, to plan it and then to control results of endovascular or direct surgical interventions and to diagnose their complications. SCTA sensitivity and specificity in intracranial AVM are 100% and 98.4% respectively.

The experience of SCTA use has shown, that it is a reliable method of diagnosis of intracranial aneurysms and AVM in an acute period of hemorrhage. It allows to recommend it as a method of choice for identifying a cause of non-traumatic subarachnoid hemorrhage.

Thus, SCTA is a quick method of visualization, which is not very invasive. It ensures effective diagnosis of intracranial aneurysms and AVM, permits to determine tactics of treatment and to control adequacy of correction. SCTA in combination with other methods shortens a diagnostic process and makes it less invasive without causing any negative effect on an informative aspect of examination.