CTA versus conventional angiogram or DSA in diagnosing aneurysms

The picture at the left is a right middle cerebral saccular aneurysm demonstrated on an MRA. The above picture is a great comparison of a CTA image of a rt posterior inferior cerebral aneurysm and then the same on a DSA image. The DSA image is the conventional angiographic approach to diagnosis. CTA, computed tomography angiography, has nearly replaced traditional angiography in many cases. CTA is faster and non-invasive, whereas angiography carries more risk. There is a femoral stick and often sedation for the patient. More cost is involved as well. A physician must perform this exam. It is also a slower process with some recovery time involved. Physicians most often are turning to CTA first as a guide to finding the answers they need. This has not removed the need for MRA, however. Most neurosurgeons require both a CTA and a MRA pre-op to ensure all their bases are covered.

There was a study published in the Open Neurology Journal in January 2009 regarding the efficacy of CTA vs traditional approaches. They looked at how effective CTA was in pre-operative planning. They found that 72% of the cases CTA was the best imaging quality to define the aneurysm. There were no cases that DSA demonstrated aneurysms that CTA simply missed. They only significant reason for performing the DSA was simply for blood flow demonstration.

I think this study definitely makes the case for CTA and I think with the advent of more platforms such as Vitrea and Tera Recon and upgrades, our reformats will just get better.

Susan Brumley

Temporal bone fractures

Temporal bone fractures occur in the transverse plane and longitudinal plane. These fractures are the result of blunt force trauma. They can result in hearing loss, visual disturbances, facial paralysis, and vertigo. Sometimes these symptoms may be delayed.

Prior to CT's improved detail and spatial resolution, imaging didn't play a big role in diagnosing this. Now with the advent of multi-slice and 3 D reconstruction, CT is at the fore front of this treatment plan. Most patients will present quickly as they will also have basilar skull fractures or raccoon eyes. If a temporal bone fracture goes undiagnosed initially, the patient may present with CSF otorrhea or hearing dysfunction.

Most of these type fractures resolve on their own. Usually, these patients present with much more serious injuries ranging from whole organ injury to skull fractures. These injuries are taken care of first. However, in most cases, even the CSF leak, this resolves in times ranging from 7-14 days to 2-3 weeks for more serious cases.

Retinoblastoma

Retinoblastomas are tumors that occur in the eye. This cancer is one of four of the most common cancers that affect children. The first sign of this disease is usually noted by the white area in the child's eye or eyes. This syndrome can be bilateral. Other symptoms can include red and painful eye or eyes and misaligned eyes. Often, this is hereditary. The average age of diagnosis is 18 months old. Calcifications often occur and that is how this image shows the tumor.

Treatment for this disorder will often involve many specialists including a pediatric oncologist, pediatric opthamologist, and radiation therapist. Most often chemotherapy is given to try to shrink the tumor. Laser therapy, cryotherapy, and external beam irradiation therapy are often utilized to treat this condition. Biopsies are never performed as this can spread metastases to other parts of the body.

This condition is still rather rare with 1 case out of approximately 20,000 live births. If detected early the survival rate is 96% according to the website http://www.retinoblastoma.ca/ Blindness is still a possibility in the affected eye due to the tumor and then treatments to cure the cancer. However, many children only have unilateral retinoblastoma leaving the unaffected eye to do the work.

Susan Brumley