What is the role of CT scanning in the workup of cerebral aneurysms?

Updated: Dec 06, 2018
  • Author: David S Liebeskind, MD, FAAN, FAHA, FANA; Chief Editor: Helmi L Lutsep, MD  more...
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Answer

Aneurysmal SAH may be detected in 90-95% of cases. If CT scan result is negative and SAH is suspected, perform lumbar puncture (LP).

Noncontrast CT scan should be performed, as contrast may obscure detection of SAH.

Curvilinear calcification, aneurysmal thrombosis, or bone erosion may be characterized; however, bone structures also may produce artifacts.

Surrounding edema and an inflammatory reaction may be appreciated with contrast administration following the noncontrast study.

CTA may detect aneurysms greater than 3 mm, providing detailed evaluation of morphology such as relationship to the parent vessel and neck width.

CTA can detect more than 95% of aneurysms identified on conventional angiography. CTA may be superior to MRA because of shorter acquisition times, diminished motion artifacts, and detailed demonstration of other landmarks. However, bone and venous structures may complicate analysis.

Increasing use of CT perfusion in combination with CTA allows for reconstruction of multiphase CT angiographic images, potentially providing greater definition beyond standard CTA. [7]


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