Skip to main content
Advertisement

Main menu

  • Home
  • Content
    • Current Issue
    • Accepted Manuscripts
    • Article Preview
    • Past Issue Archive
    • Video Articles
    • AJNR Case Collection
    • Case of the Week Archive
    • Case of the Month Archive
    • Classic Case Archive
  • Special Collections
    • AJNR Awards
    • Low-Field MRI
    • Alzheimer Disease
    • ASNR Foundation Special Collection
    • Photon-Counting CT
    • View All
  • Multimedia
    • AJNR Podcasts
    • AJNR SCANtastic
    • Trainee Corner
    • MRI Safety Corner
    • Imaging Protocols
  • For Authors
    • Submit a Manuscript
    • Submit a Video Article
    • Submit an eLetter to the Editor/Response
    • Manuscript Submission Guidelines
    • Statistical Tips
    • Fast Publishing of Accepted Manuscripts
    • Graphical Abstract Preparation
    • Imaging Protocol Submission
    • Author Policies
  • About Us
    • About AJNR
    • Editorial Board
    • Editorial Board Alumni
  • More
    • Become a Reviewer/Academy of Reviewers
    • Subscribers
    • Permissions
    • Alerts
    • Feedback
    • Advertisers
    • ASNR Home

User menu

  • Alerts
  • Log in

Search

  • Advanced search
American Journal of Neuroradiology
American Journal of Neuroradiology

American Journal of Neuroradiology

ASHNR American Society of Functional Neuroradiology ASHNR American Society of Pediatric Neuroradiology ASSR
  • Alerts
  • Log in

Advanced Search

  • Home
  • Content
    • Current Issue
    • Accepted Manuscripts
    • Article Preview
    • Past Issue Archive
    • Video Articles
    • AJNR Case Collection
    • Case of the Week Archive
    • Case of the Month Archive
    • Classic Case Archive
  • Special Collections
    • AJNR Awards
    • Low-Field MRI
    • Alzheimer Disease
    • ASNR Foundation Special Collection
    • Photon-Counting CT
    • View All
  • Multimedia
    • AJNR Podcasts
    • AJNR SCANtastic
    • Trainee Corner
    • MRI Safety Corner
    • Imaging Protocols
  • For Authors
    • Submit a Manuscript
    • Submit a Video Article
    • Submit an eLetter to the Editor/Response
    • Manuscript Submission Guidelines
    • Statistical Tips
    • Fast Publishing of Accepted Manuscripts
    • Graphical Abstract Preparation
    • Imaging Protocol Submission
    • Author Policies
  • About Us
    • About AJNR
    • Editorial Board
    • Editorial Board Alumni
  • More
    • Become a Reviewer/Academy of Reviewers
    • Subscribers
    • Permissions
    • Alerts
    • Feedback
    • Advertisers
    • ASNR Home
  • Follow AJNR on Twitter
  • Visit AJNR on Facebook
  • Follow AJNR on Instagram
  • Join AJNR on LinkedIn
  • RSS Feeds

AJNR Awards, New Junior Editors, and more. Read the latest AJNR updates

LetterLetter

Detection and Characterization of Very Small Cerebral Aneurysms by Using 2D and 3D Helical CT Angiography

Harry J. Cloft and David F. Kallmes
American Journal of Neuroradiology January 2003, 24 (1) 154;
Harry J. Cloft
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
David F. Kallmes
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • Article
  • Info & Metrics
  • Responses
  • References
  • PDF
Loading

To the Editor: The article by Villablanca et al (1) in the August 2002 issue of the AJNR presents an interesting study, but the results do not support the conclusion that the sensitivity of CT angiography is higher than that of digital subtraction angiography for the detection of cerebral aneurysms ≤5 mm. A significant problem with the study is that the CT angiograms and digital subtraction angiograms were not obtained on the same day. In the two cases of “false-negative” results of digital subtraction angiography, the CT angiograms were obtained 2 and 5 days after the digital subtraction angiograms were obtained. Both of these patients had suffered subarachnoid hemorrhage, and it is possible that these two aneurysms were filled with thrombus at the time of digital subtraction angiography but not at the time of CT angiography. It is well known that subsequent angiograms reveal a source of subarachnoid hemorrhage in 2% to 24% of patients with initially negative angiographic results (2). Repeat digital subtraction angiography performed on the day the CT angiograms were obtained probably would have also revealed the aneurysms. Also, if CT angiography had been the initial study and digital subtraction angiography had been performed later, then the aneurysms would likely have been missed by CT angiography and revealed by digital subtraction angiography.

Even if we accept the sensitivities reported as correct, the patient population used was too small to support the conclusion that CT angiography is more sensitive than digital subtraction angiography. For CT angiography, the sensitivity was 98% (95% confidence interval, 87% to 100%) for reader 1 and was 100% (95% confidence interval, 91% to 100%) for reader 2. For reasons that are unclear, the authors did not report a 95% confidence interval for the digital subtraction angiographic results. For digital subtraction angiography, the sensitivity was 95%, and we calculate the 95% confidence interval to be 84% to 99%. By definition, these confidence intervals tell us that there is a 95% certainty that the true sensitivity is within the interval. Note the tremendous overlap in the 95% confidence intervals, indicating that it is not possible to distinguish a difference in sensitivity. The P values for the difference in sensitivity between CT angiography and digital subtraction angiography based on the data provided are P = .56 for reader 1 and P = .15 for reader 2. Table 1 of the article by Villablanca et al (1) indicates that patient 22 also had an aneurysm missed by CT angiography, but this missed aneurysm was not included in the data analysis. If Table 1 is correct, then the sensitivity of CT angiography would be even lower.

Maximizing sensitivity for the detection of ruptured cerebral aneurysms is critical for optimal patient care. The missed diagnosis of a ruptured cerebral aneurysm can have devastating consequences. The risk of rebleeding from a ruptured aneurysm without surgery or endovascular treatment is between 20% and 30% for the first month after hemorrhage (3). Patients who rebleed from ruptured aneurysms have an 80% mortality rate (4). The risk of permanent neurologic complication associated with cerebral angiography in patients with subarachnoid hemorrhage, cerebral aneurysm, and arteriovenous malformation is known to be extremely low (0.07%), based on a meta-analysis of recent, prospective studies (5). The neurologic deficits complicating angiography tend to be much less severe than the morbidity and mortality caused by rebleeding of a ruptured aneurysm.

CT angiography is undoubtedly a promising technique for the detection of cerebral aneurysms, and the sensitivity of CT angiography is probably now beginning to approach that of digital subtraction angiography. CT angiography can already serve as a useful adjunct to digital subtraction angiography in cases of angiogram-negative subarachnoid hemorrhage (6). We think that it is premature to consider CT angiography to be a replacement for digital subtraction angiography for the evaluation of patients suspected of harboring cerebral aneurysms. The sensitivity of CT angiography must continue to improve, as the sensitivity of digital subtraction angiography has certainly improved with the development of 3D rotational angiography (7). In addition to the issue of sensitivity, the superior spatial resolution of digital subtraction angiography allows for more definitive treatment planning for patients with cerebral aneurysms. It would be interesting to know whether the authors take the results of their study seriously enough to replace digital subtraction angiography with CT angiography in their practice for patients presenting with subarachnoid hemorrhage.

References

  1. ↵
    Villablanca JP, Jahan R, Hooshi P, et al. Detection and characterization of very small cerebral aneurysms by using 2D and 3D helical CT angiography. AJNR Am J Neuroradiol 2002;23:1187–1198
    Abstract/FREE Full Text
  2. ↵
    Schwartz TH, Solomon RA. Perimesencephalic nonaneurysmal subarachnoid hemorrhage: review of the literature. Neurosurgery 1996;39:433–440
    PubMed
  3. ↵
    Mayberg MR, Batjer HH, Dacey R, et al. Guidelines for the management of aneurysmal subarachnoid hemorrhage: a statement for healthcare professionals from a special writing group of the Stroke Council, American Heart Association. Stroke 1994;25:2315–2328
    FREE Full Text
  4. ↵
    Rosenorn J, Eskesen V, Schmidt K, Ronde F. The risk of rebleeding from ruptured intracranial aneurysms. J Neurosurg 1987;67:329–332
    PubMed
  5. ↵
    Cloft HJ, Joseph GJ, Dion JE. Risk of cerebral angiography in patients with subarachnoid hemorrhage, cerebral aneurysm, and arteriovenous malformation: a meta-analysis. Stroke 1999;30:317–320
    Abstract/FREE Full Text
  6. ↵
    Hashimoto H, Iida J, Hironaka Y, Okada M, Sakaki T. Use of spiral computerized tomography angiography in patients with subarachnoid hemorrhage in whom subtraction angiography did not reveal cerebral aneurysms. J Neurosurg 2000;92:278–283
    PubMed
  7. ↵
    Hochmuth A, Spetzger U, Schumacher M. Comparison of three-dimensional rotational angiography with digital subtraction angiography in the assessment of ruptured cerebral aneurysms. AJNR Am J Neuroradiol 2002;23:1199–1205
    Abstract/FREE Full Text
  • Copyright © American Society of Neuroradiology
PreviousNext
Back to top

In this issue

American Journal of Neuroradiology: 24 (1)
American Journal of Neuroradiology
Vol. 24, Issue 1
1 Jan 2003
  • Table of Contents
  • Index by author
Advertisement
Print
Download PDF
Email Article

Thank you for your interest in spreading the word on American Journal of Neuroradiology.

NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

Enter multiple addresses on separate lines or separate them with commas.
Detection and Characterization of Very Small Cerebral Aneurysms by Using 2D and 3D Helical CT Angiography
(Your Name) has sent you a message from American Journal of Neuroradiology
(Your Name) thought you would like to see the American Journal of Neuroradiology web site.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
Cite this article
Harry J. Cloft, David F. Kallmes
Detection and Characterization of Very Small Cerebral Aneurysms by Using 2D and 3D Helical CT Angiography
American Journal of Neuroradiology Jan 2003, 24 (1) 154;

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
0 Responses
Respond to this article
Share
Bookmark this article
Detection and Characterization of Very Small Cerebral Aneurysms by Using 2D and 3D Helical CT Angiography
Harry J. Cloft, David F. Kallmes
American Journal of Neuroradiology Jan 2003, 24 (1) 154;
del.icio.us logo Twitter logo Facebook logo Mendeley logo
  • Tweet Widget
  • Facebook Like
  • Google Plus One

Jump to section

  • Article
    • References
  • Info & Metrics
  • Responses
  • References
  • PDF

Related Articles

  • No related articles found.
  • PubMed
  • Google Scholar

Cited By...

  • No citing articles found.
  • Crossref
  • Google Scholar

This article has not yet been cited by articles in journals that are participating in Crossref Cited-by Linking.

More in this TOC Section

  • Reply:
  • Brain AVM’s Nidus: What if We Hadn’t Understood Anything?
  • Letter to the Editor regarding “Automated Volumetric Software in Dementia: Help or Hindrance to the Neuroradiologist?”
Show more LETTERS

Similar Articles

Advertisement

Indexed Content

  • Current Issue
  • Accepted Manuscripts
  • Article Preview
  • Past Issues
  • Editorials
  • Editor's Choice
  • Fellows' Journal Club
  • Letters to the Editor
  • Video Articles

Cases

  • Case Collection
  • Archive - Case of the Week
  • Archive - Case of the Month
  • Archive - Classic Case

More from AJNR

  • Trainee Corner
  • Imaging Protocols
  • MRI Safety Corner
  • Book Reviews

Multimedia

  • AJNR Podcasts
  • AJNR Scantastics

Resources

  • Turnaround Time
  • Submit a Manuscript
  • Submit a Video Article
  • Submit an eLetter to the Editor/Response
  • Manuscript Submission Guidelines
  • Statistical Tips
  • Fast Publishing of Accepted Manuscripts
  • Graphical Abstract Preparation
  • Imaging Protocol Submission
  • Evidence-Based Medicine Level Guide
  • Publishing Checklists
  • Author Policies
  • Become a Reviewer/Academy of Reviewers
  • News and Updates

About Us

  • About AJNR
  • Editorial Board
  • Editorial Board Alumni
  • Alerts
  • Permissions
  • Not an AJNR Subscriber? Join Now
  • Advertise with Us
  • Librarian Resources
  • Feedback
  • Terms and Conditions
  • AJNR Editorial Board Alumni

American Society of Neuroradiology

  • Not an ASNR Member? Join Now

© 2025 by the American Society of Neuroradiology All rights, including for text and data mining, AI training, and similar technologies, are reserved.
Print ISSN: 0195-6108 Online ISSN: 1936-959X

Powered by HighWire