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Benefit of a Sharp Computed Tomography Angiography Reconstruction Kernel for Improved Characterization of Intracranial Aneurysms

O'Meara, Brian; Rahal, Jason P. MD; Lauric, Alexandra PhD; Malek, Adel M. MD, PhD

doi: 10.1227/NEU.0000000000000167
Technique Assessment

BACKGROUND: Computed tomography angiography (CTA) is the first-line imaging modality used for cerebral aneurysms because of its speed and sensitivity for detection, although digital subtraction angiography is often required for more detailed aneurysm shape delineation.

OBJECTIVE: To determine whether a sharper CTA reconstruction kernel can better characterize an aneurysm and improve decision-making before intervention.

METHODS: Fifteen patients presenting with aneurysmal subarachnoid hemorrhage underwent 64-row CTA. CTA data were reconstructed using the default H20f smooth kernel and a H60f sharp kernel and compared with contemporaneous catheter 3-dimensional rotational angiography (3DRA). Aneurysm neck, width, and aspect ratio measurements were made using intensity line plots of identical projections on all imaging datasets and compared by matched-pair statistics.

RESULTS: Aneurysm neck measurements from the H20f smooth kernel revealed overestimation compared with both the sharp kernel (greater by 0.64 ± 0.21 mm, P < .01) and 3DRA (greater by 0.68 ± 0.19 mm, P < .01). There was no statistically significant difference between 3DRA and the sharp kernel CTA measurements. Neck measurements correlated well between the H60f kernel and 3DRA but not between the H20f Kernel and 3DRA (R 0.97 vs 0.86).

CONCLUSION: H60f sharp CTA kernel reconstruction provides more accurate anatomic characterization of cerebral aneurysms than the H20f smooth kernel at the expense of less visually pleasing reconstructions. Because it does not require additional contrast, radiation, or imaging hardware and is more similar to 3DRA, it may aid in selecting the appropriate treatment strategy before to evaluation by catheter-based angiography.

ABBREVIATIONS: 3DRA, 3-dimensional rotational angiography

CTA, computed tomography angiography

DSA, digital subtraction angiography

SAH, subarachnoid hemorrhage

Cerebrovascular and Endovascular Division, Department of Neurosurgery, Tufts Medical Center and Tufts University School of Medicine, Boston, Massachusetts

Correspondence: Adel M. Malek, MD, PhD, Department of Neurosurgery, Tufts Medical Center, 800 Washington Street, #178, Proger 7, Boston, MA 02111. E-mail:

Received May 15, 2013

Accepted September 05, 2013

Copyright © by the Congress of Neurological Surgeons