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