Diagnostic Accuracy of Computed Tomographic Angiography (CTA) in the Management of Aneurysmal Subarachnoid Haemorrhage (SAH)

Aim: To assess the diagnostic accuracy of three dimensional computed tomographic angiography (3D-CTA) for the detection of cerebral aneurysm in the patients of spontaneous subarachnoid hemorrhage (SAH). Methods: This prospective study extended from 1st November 2007 to 1st February 2010. All the patients of spontaneous SAH were included in the study. Plain computed tomography (CT) head followed by computed tomographic angiography (CTA) was done in all patients using multi-slice spiral CT scan. Results were analyzed by both Radiologist and the Neurosurgeons. The points considered were i. The site of aneurysm. ii. In multiple aneurysms, which is the aneurysm that has bled? iii. The relationship of vessels to the aneurysm. iv. If any need for repeat study or digital subtraction angiography (DSA). Results: We have found 60 ruptured aneurysms in total of 75 patients on which 3D-CTA was done. 58 aneurysms found on 3D-CTA were confirmed on intra-operative findings during surgery and were surgically managed. In our study, CTA have a sensitivity of 96.7% and specificity of 75.0% for detecting aneurysms. Conclusion: Majority of patients with intracranial aneurysms could be operated solely based on pre- operative 3D-CTA data sets. DSA should be used as an additional diagnostic tool in 3D-CTA negative patients.