T. Katakura

Evaluation of cervical arteries with 3D-CTA using multi-detector row CT—one-session scanning of the head and neck using single or double injection of contrast medium

Abstract To detect cervical vascular lesions in 90 patients with intracranial cerebrovascular diseases, we performed three-dimensional CT angiography (3D-CTA) of the head and neck using multi-detector row CT (MD-CT) with a single- or double-bolus injection of contrast material. In the single-injection group (n=70), the head and neck were scanned in one session after continuous injection at a rate of 3 ml/s of contrast medium (total 100 ml). In the double-bolus injection group (n=20), the head was scanned first after the delivery of contrast material (3 ml/s, total 70 ml) and the neck was scanned after a boost injection (2 ml/s, total 30 ml). The single-bolus injection method was simple and suitable for screening for vascular lesions at the carotid bifurcations. The double bolus injection method yielded excellent 3D-CTA of the vertebral- and carotid arteries without interference by cervical veins and was suitable for screening the whole length of the carotid arteries, including the origin of the vertebral arteries. The head and neck 3D-CTA using MD-CT provides valuable diagnostic information regarding vascular lesions of the intracranial and cervical arteries.

The surgery of ruptured and unruptured cerebral aneurysms using three-dimensional CT angiography without conventional catheter angiography

Abstract The object of this study is to assess whether aneurysm surgery can be performed in patients with ruptured and unruptured cerebral aneurysms by using three-dimensional computerized tomography angiography (3D-CTA) alone, without conventional catheter angiography (CCA). We have operated on 153 consecutive patients with ruptured aneurysms and 89 patients with unruptured aneurysms based on 3D-CTA findings since December 1996 and February 1997, respectively. In the cases of ruptured aneurysm, 153 ruptured aneurysms including 62 associated unruptured aneurysms were detected by 3D-CTA. CCA was performed in 7 of 153 patients after they underwent 3D-CTA, which included four dissecting vertebral artery (VA) aneurysms, two basilar artery (BA) tip aneurysms, and one BA–superior cerebellar artery (SCA) aneurysm. In 89 patients with unruptured aneurysms, 101 unruptured aneurysms were detected by 3D-CTA. In 5 of 101 unruptured aneurysms, which included giant or large aneurysms and a case of an aneurysm associated with infarction, CCA was needed. All of the ruptured and unruptured aneurysms were confirmed during surgery and treated successfully. The authors stress that 3D-CTA could replace CCA in the diagnosis of saccular aneurysms and that surgery could be performed in almost all ruptured and unruptured aneurysms by using only 3D-CTA without CCA.