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Journal of Neurosurgical Sciences 2016 May 18

lingua: Inglese

Wall motion at 4D-CT angiography and surgical correlation in unruptured intracranial aneurysms: a pilot study

Fabio FERRARI 1, Luigi CIRILLO 1, 2, Fabio CALBUCCI 3, Fiorina BARTIROMO 2, Paolo AMBROSETTO 4, Antonio FIORAVANTI 5, Marco LEONARDI 6

1 Department of Neuroradiology, IRCCS Istituto delle Scienze Neurologiche, Bologna, Italy; 2 Department of Experimental, Diagnostic and Specialty Medicine (DIMES), University of Bologna, Bologna, Italy; 3 Department of Neurosurgery, Villalba Hospital, GVM, Care and Research, Bologna, Italy; 4 Department of Diagnostic Imaging, Villalba Hospital, GVM, Care and Research, Bologna, Italy; 5 Department of Neurosurgery, IRCCS Istituto delle Scienze Neurologiche, Bologna, Italy; 6 Neuroradiology, University of Bologna, Bologna, Italy


BACKGROUND: Unruptured intracranial aneurysms (UIAs) are reported more frequently nowadays but their management is not well established; it depends on different structural features of the aneurysms and on multiple patient’s risk factors. With this prospective observational study we report our preliminary experience by using four-dimensional (4D) computed tomographic (CT) angiography with ECG-gated reconstructions in the evaluation of dynamic modifications of the aneurysm wall, as a potential predicting factor of growth or rupture. The novelty of this study consists in correlation between Angio 4D-CT angiography images and surgical findings; only few scientific papers, in fact, have studied this issue.
METHODS: Thirty-one patients (1 male, 30 females; 59.0±12.7 years old) with 43 unruptured aneurysms (medium size: 5.2±3.0 mm) were studied. ECG-triggered 4D-CT angiography was performed with a 320-detector CT system (Aquilion ONE; Toshiba Medical Systems Corporation, Japan); ECG-gated reconstruction was performed for visualizing local displacement of the aneurysmal wall over a heart cycle. In the aneurysms surgically treated in our institution we were able to compare the macroscopic features of the aneurysm wall with 4D-CTA findings. We performed long-term follow-up on untreated patients.
RESULTS: Pulsation was detected in 13 of 43 unruptured aneurysms. Eighteen aneurysms were treated: thirteen were surgically treated and five underwent embolization with detachable coil placement. In nine aneurysms surgically treated in our institution (5 with pulsation and 4 without) we observed a significant correlation between 4D-CTA findings and macroscopic features of the aneurysms wall, in particular the pulsations detected at 4D-CTA study have shown to correspond to dark-reddish thinner wall at surgery.
CONCLUSIONS: Our data confirm the previous reports concerning the reliability of 4D-CT angiography with ECG-gated reconstructions in defining the dynamic and structural features of the aneurysm wall. Moreover, optimal correlation rate between the findings provided by the 4D-CTA and the macroscopic surgical evaluation support a possible role of this technique to identify aneurysms with a higher risk of rupture.

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