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  • Detection of Pulsation in Unruptured Cerebral Aneurysms by ECG-Gated 3D-CT Angiography (4D-CTA) with 320-Row Area Detector CT (ADCT) and Follow-Up Evaluation Results: Assessment Based on Heart Rate at

    Final Number:

    Motoharu Hayakawa MD; Teppei Tanaka MD; Kazuhide Adachi; Akiyo Sadato MD, PhD; Kohei Ishihara; Keisuke Ito; Motoki Oeda; Kazuhiro Murayama; Katada Kazuhiro; Yoko Kato MD; Yuichi Hirose MD DSc

    Study Design:
    Clinical Trial

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2013 Annual Meeting

    Introduction: ECG-gated 3D-CT angiography (4D-CTA) was used to detect aneurysmal pulsation in patients with unruptured cystiform cerebral aneurysms. The differences in the clinical course of patients in whom aneurysmal pulsation was or was not detected by 4D-CTA were then evaluated.

    Methods: 42 patients with 62 aneurysms who underwent follow-up 3D-CTA more than 4 months (120 days) later were randomly selected as the subjects of this study. The tube voltage, tube current, and tube rotation speed were set to 120 kV, 270 mA, and 0.35 s/rot., respectively. ECG-gated reconstruction was performed, and a single cardiac cycle was divided into 20 phases to detect aneurysmal pulsation. Patients with a heart rate higher than 80 bpm at the time of scanning were excluded, so analysis was performed for 37 patients with 56 aneurysms.

    Results: Pulsation was detected in 20 of the 56 unruptured aneurysms. Of the 20 aneurysms in which pulsation was detected, 6 showed a change in shape at the time of follow-up 3D-CTA. Of the 36 aneurysms in which pulsation was not detected, 2 showed a change in shape at follow-up. There was no significant difference in the follow-up interval between aneurysms in which pulsation was or was not detected. Therefore, a change in shape was observed in a significantly higher percentage of the aneurysms in which pulsation was detected (p = 0.039). In addition, the aneurysms in which pulsation was detected showed a higher odds ratio of 7.286.

    Conclusions: 4D-CTA was performed in patients with unruptured cerebral aneurysms to detect aneurysmal pulsation. Unruptured aneurysms in which pulsation was detected were more likely to show a change in shape at follow-up. The results of this study suggest that 4D-CTA may be useful for identifying unruptured aneurysms with a higher risk of rupture.

    Patient Care: We will divide critical unruptured cerebaral aneurysms and achieve the clipping or coil embolization preferentially.

    Learning Objectives: 4D-CTA for cerebral aneurysms


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