Summary
With high resolution computed tomography (CT) of the skull, performing rapid series of 1.5 mm slices during an intravenous bolus injection of contrast medium, an angiography-like image (angio-CT) of the basal cerebral arteries can be obtained. From 76 consecutive angiographically or autopsy-verified cerebral aneurysms of vaious size down to 3 mm in diameter, 74 (97.4%) were shown up by the angio-CT. One ruptured and one incidental aneurysm escaped CT visualization. Besides the correct localization of the aneurysms, angio-CT provides information concerning the size and main direction of the aneurysms and yields, in addition, a coronal view of the aneurysms and their surrounding structures. Pitfalls for mis-diagnosis can be the following: Aneurysms of below 5 mm in diameter, located at the supraclinoid part of the carotid artery, multiple or non-ruptured aneurysms, bony or movement artefacts, poorly contrasted vessels due to wrong injection technique of contrast medium or vasospasm, and incorrect interpretation.
Similar content being viewed by others
References
Bell BA, Kendall BE, Symon L (1980) Computed tomography in aneurysmal subarachnoid hemorrhage. J Neurol Neurosurg Psychiat 43:522–524
Bosley ThM, Schatz NJ (1983) Clinical diagnosis of cavernous sinus syndromes. In: Smith CH, Beck RW (eds) Neurologic Clinics, Vol 1, No 4. Neuro-Ophthalmology. WB Saunders Philadelphia London Toronto, pp 929–953
Brismar J (1979) Computed tomography as the primary radiologic procedure in acute subarachnoid hemorrhage. Acta Radiolog Diagn 20:849–864
Carmody RF, Seeger JF (1984) Intracranial applications of digital subtraction angiography. CRC Critical reviews in diagnostic imaging, Cleveland Ohio. 23 (1):1–40
Davis KR, Kistler JP, Heros RC, Davis JM (1982) A neuroradiologic approach to the patient with a diagnosis of subarachnoid hemorrhage. Radiologic Clinics of North America 20 (1): 87–94
Drake CG, Girvin JP (1976) The surgical treatment of subarachnoid hemorrhage with multiple aneurysms. In: Morley TP (ed) Current Controversies in Neurosurgery. WB Saunders, Philadelphia, pp 274–278
Esposito S, Delitala A (1984) Rupture of aneurysms during angiography. Neurochir 27:150–153
Fischer M, Mattich J, Huber P (1984) Computertomographie und Angiographie — eine vergleichende Studie an 143 Patienten. Inauguraldissertation zur Erlangung der Doktorwürde der Universität Bern (unpublished data)
Findlay GFG (1980) Computer assisted (axial) tomography in the management of subarachnoid hemorrhage. Surg Neurol 13:125–128
Fisher CM, Kistler JP, Davis JM (1980) Relation of cerebral vasospasm to subarachnoid hemorrhage visualized by computerized tomographic scanning. Neurosurg 6 (1):1–9
Fujita S (1985) Computed tomographic grading with Houns-field number related to delayed vasospasm in cases of ruptured cerebral aneurysm. Neurosurg 17:609–612
Handa J, Nakono Y, Aii H, Handa H (1978) Computed tomography with giant intracranial aneurysms. Surg Neurol 9:257–263
Heiskanen O (1981) Risk of bleeding from unruptured aneurysms in cases with multiple intracranial aneurysms. J Neurosurg 55:524–526
Huber P, Krayenbühl H, Yasargil MG (1979) Zerebrale Angiographie für Klinik und Praxis. Stuttgart, Thieme 3 Auflage
Kendall BE, Lee BCP, Claveria E (1976) Computerized tomography and angiography in subarachnoid hemorrhage. Brit J Radiol 49:483–501
Liliequist B, Lindquist M (1980) Computer tomography in the evaluation of subarachnoid hemorrhage. Acta Radiologica Diagnosis 21:327–331
Miller NR (1982) Walsh and Hoyt's Clinical Neuro-Ophthalmology, 4 Ed, Vol 2, Williams & Wilkins, Baltimore London
Mironov A, Marquardt B, Thron A (1984) Rupture of intracranial aneurysms during angiography and CT: A coincidental or causal event? Neurochirurgia (Stuttg) 27 (5):146–149
Modesti LM, Binet EF (1978) Value of computed tomography in the diagnosis and management of subarachnoid hemorrhage. Neurosurgery 3(2):151–155
Mizukami M, Takemae T, Tazawa T, Kawase T, Matsukaki T (1980) Value of computed tomography in the prediction of cerebral vasopasms after aneurysm rupture. Neurosurgery 7:583–585
Nehls DG, Flom RA, Carter LP, Spetzler RF (1985) Multiple intracranial aneurysms: Determining the site of rupture. J Neurosurg 63:342–348
Robert G, Sichez JP, Pertuiset B, Gardeur D (1981) Hémorrhagie méningée par rupture anévrismale. La tomodensitométrie permit-elle de prévoir l'apparition d'un spasme? Neurochirurgie 27:129–131
Robinson JS, Arzola DD, Moody RA (1980) Acute renal failure following cerebral angiography and infusion computerized tomography. J Neurosurg 52:111–112
Saito I, Shigeno T, Aritake K, tanishama T, Sano K (1979) Vasopasm assessed by angiography and computerized tomography. J Neurosurg 51:466–475
Salazar JL (1980) Surgical treatment of asymptomatic and incidental intracranial aneurysms. J Neurosurg 53:20–21
Samson DS, Hodosh RM, Clark WK (1977) Surgical management of unruptured asymptomatic aneurysms. J Neurosurg 46:731–734
Scotti G, Ethier R, Melancon D, Terbrugge K, Tchang S (1977) Computed tomography in the evaluation of intracranial aneurysma and subarachnoid hemorrhage. Radiology 123:65–90
Seiler RW, Grolimund P, Aaslid R, Huber P, Nornes H (1986) Relation of cerebral vasospasm evaluated by transcranial doppler ultrasound to clinical grade and CT visualized subarachnoid hemorrhage. J Neurosurg 64:594–600
Van Gijn J, Van Dongen KJ (1980) Computed tomography in the diagnosis of subarachnoid hemorrhage and ruptured aneurysm. Clin Neurol Neurosurg 82 (1):11–24
Wirth FP, Laws ER, Piepgras D, Scott RM (1983) Surgical treatment of incidental intracranial aneurysms. Neurosurgery 12:507–511
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Schmid, U.D., Steiger, H.J. & Huber, P. Accuracy of high resolution computed tomography in direct diagnosis of cerebral aneurysms. Neuroradiology 29, 152–159 (1987). https://doi.org/10.1007/BF00327540
Received:
Issue Date:
DOI: https://doi.org/10.1007/BF00327540