What is the most sensitive non-invasive imaging strategy for the diagnosisof intracranial aneurysms?

Citation
Pm. White et al., What is the most sensitive non-invasive imaging strategy for the diagnosisof intracranial aneurysms?, J NE NE PSY, 71(3), 2001, pp. 322-328
Citations number
22
Language
INGLESE
art.tipo
Article
Categorie Soggetti
Neurology,"Neurosciences & Behavoir
Journal title
JOURNAL OF NEUROLOGY NEUROSURGERY AND PSYCHIATRY
ISSN journal
0022-3050 → ACNP
Volume
71
Issue
3
Year of publication
2001
Pages
322 - 328
Database
ISI
SICI code
0022-3050(200109)71:3<322:WITMSN>2.0.ZU;2-K
Abstract
Objectives-To determine whether combining non-invasive tests for intracrani al aneurysms together would significantly improve aneurysm detection over i ndividual tests. Methods-114 patients undergoing intraarterial digital subtraction angiograp hy to confirm or exclude an intracranial aneurysm were also examined by CT angiography, AIR angiography, and transcranial power Doppler ultrasound. Th e reviewers and ultrasonographers were blinded to the angiogram. result, ot her imaging results and all clinical information. Results-The combination of noninvasive tests did improve diagnostic perform ance on a per patient basis. The combination of power Doppler and CT angiog raphy had the greatest sensitivity for aneurysm detection (0.83; 05% confid ence interval (95% CI) 0.66-0.93) and the level of agreement for this strat egy with the reference angiographic standard was excellent (kappa 0.84; 95% CI 0.72-0.95). The improvement in sensitivity of adding power Doppler to C T angiography was not significant (p = 0.55) but the improvement in the lev el of agreement with the reference standard was substantial. However, even the most sensitive combination strategy performed poorly in the detection o f small (3-5 mm.) and very small (< 3 mm.) aneurysms with a sensitivity of 0.43 (95% CI 0.23-0.66) and 0.00 (95% CI 0.00-0.31) respectively. Conclusions-The addition of transcranial power Doppler ultrasound to either CT angiography or NM angiography does improve diagnostic performance on a per patient basis but aneurysms of 5 mm or smaller can still not be reliabl y identified by current standard clinical non-invasive imaging modalities.