Assessthe accuracy of CTA detection of intracranial ruptured aneurysms

Ref: Philipp LR,et alCurry. 2017 Feb 14doi: 10.1093/neuros/nyw113At, CT angiography (CTA) is widely used in the diagnosis of intracranial ruptureanoma, which is reported to be sensitive to 97%-100%However, there is not much research to verify the accuracy of CTALucas RPhilipp of Emory University School of Medicine in Atlanta, USA, conducted a retrospective clinical study, the results of which were published online in February 2017703 cases of acute non-traumatic cobweb subcavity hemorrhage were admitted to the author's unit between December 2009 and December 2013Of these, 431 cases were diagnosed by DSA as aneurystic cobweb subcranial hemorrhage (aSAH), 409 cases were diagnosed by CTA and DSA, and 8 cases were excluded due to more than 5 aneurysms, thus analyzing 401 casesFor ctA missed and DSA-confirmed aneurysms, they were compared according to their size and locationstudy found that the 330 aneurysms detected by CTA were falsely positive by DSA, 274 (89.5%) were precirculatory aneurysms (including post-traffic aneurysms), and 32 The ethliance (10.5%) was a post-circulatory aneurysm, while 387 (89.6%) of the 431 aneurysms detected by DSA during the same period were pre-circulating aneurysms and 44 (10.2%) were post-circulating aneurysmsCTA missed 125 aneurysms, all of which were diagnosed by DSAOf the 24 aneurysms where CTA was mistaken for false positive, the intra-cervical aneurysm had the highest false positive (21.6%), especially the intra-neck artery spongiform sinus section aneurysm (16%), followed by the post-traffic aneurysm (16%)In terms of the size of the aneurysm, ctA failed to detect 72.7% of 0-3mm diameter aneurysms, 16.2% 3.01-5mm diameter aneurysms, and 9.4% 5.01-10mm diameter aneurysms83.2% diameter 5mm aneurysms were diagnosed by CTA and diagnosed by DSA Statistical analysis showed that the overall accuracy of CTA diagnosis of aneurysms was only 70.7% For aneurysms with a diameter of 5mm, the accuracy of CTA is 57.6%, and for intra-cervical aneurysms, the CTA accuracy is 45% (Table 1) Table 1 CTA diagnosis and missed aneurysm diameter and site , THE CTA diagnosis of ruptured aneurysms may not be as accurate as previously reported Furthermore, CTA diagnosis is less accurate for aneurysms with a diameter of 5mm, near bone structure, and originating from smaller blood vessels So the authors argue that peers need to be vigilant if ctA is diagnosed alone Although the above conclusions are single-center retrospective studies, to some extent reflect the difference between CTA and the gold standard DSA diagnosis in terms of diagnosis of ruptured aneurysms, and further research and verification is recommended (Feng Menglong, of Neurosurgery, Xiangnan College Hospital, compiled , Liu Chonghong, of the First People's Hospital in Changshu City, Jiangsu Province, review, editor-in-chief of "Outside The God Information" and professor of 's final review of The Outside Information, Professor Chen Rongcheng , affiliated with Fudan University