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Automatic Bone Removal Dual-Energy CT Angiography for the Evaluation of Intracranial Aneurysms

Zhang, Long-Jiang MD*; Wu, Sheng-Yong MD; Poon, Colin S. MD; Zhao, Yan-E MS*; Chai, Xue MS; Zhou, Chang-Sheng BS*; Lu, Guang-Ming MD*

Journal of Computer Assisted Tomography: November-December 2010 - Volume 34 - Issue 6 - p 816-824
doi: 10.1097/RCT.0b013e3181eff93c

Purpose: To evaluate the diagnostic accuracy of dual-energy computed tomographic angiography (DE-CTA) in the detection of intracranial aneurysms and to determine whether DE-CTA provides adequate information to guide treatment choice.

Materials and Methods: Eighty patients (31 men and 49 women; mean [SD] ages of 52 [9] years) with spontaneous subarachnoid hemorrhage underwent DE-CTA. The performance of DE-CTA was compared with conventional CTA created from average weighted images and digital subtraction angiography (DSA). Sensitivity and specificity for aneurysm detection were determined on a per-patient and per-aneurysm basis. The treatment choice was assessed on the basis of aneurysm neck size and/or the dome/neck ratio.

Results: With DSA as reference standard (n = 61; 47 aneurysms in 41 patients), DE-CTA correctly detected 45 aneurysms in 41 patients corresponding to sensitivity and specificity of 100% and 95.0% on a per-patient basis versus 95.7% and 95.0% on a per-aneurysm basis, whereas conventional CTA correctly detected 43 aneurysms in 39 patients corresponding to sensitivity and specificity of 95.1% and 95.0% on a per-patient basis versus 91.5% and 95.0% on a per-aneurysm basis. No statistical difference between DE-CTA and conventional CTA was found for the diagnostic evaluation of intracranial aneurysms. Surgery was performed to treat 38 aneurysms, coiling in 26 aneurysms, stent in one patient, and follow-up in the remaining 5 aneurysms. Dual-energy CTA correctly predicted treatment choice in 44 aneurysms, with 15 aneurysms coiled and 29 aneurysms clipped.

Conclusions: Compared with DSA, DE-CTA had a comparable diagnostic accuracy for the detection of intracranial aneurysms, visualization of the morphology of aneurysms at the skull base, and prediction of aneurysm treatment choice in most patients with spontaneous subarachnoid hemorrhage based on this study.

From the *Department of Medical Imaging, Jinling Hospital, Clinical School of Medical College, Nanjing University, Nanjing, Jiangsu, China; †Medical Imaging Institute of Tianjin, Tianjin, China; ‡Department of Radiology, University of Chicago, Chicago, IL; and §Department of Radiology, Nanjing Brain Hospital Affiliated to Nanjing Medical University, Nanjing, Jiangsu, China.

Received for publication April 7, 2010; accepted June 27, 2010.

Reprints: Guang-Ming Lu, Department of Medical Imaging, Jinling Hospital, Clinical School of Medical College, Nanjing University, 305 Zhongshan East Rd, Xuanwu District, Nanjing, Jiangsu Province, China, 200012 (e-mail:

The authors declare that they have no conflict of interest.

© 2010 Lippincott Williams & Wilkins, Inc.