1093 Diagnostic Utility of 3D Volume Rendered Images in CTA Head Scans for Aneurysm Detection in Subarachnoid Hemorrhage Patients

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INTRODUCTION: Generating 3D-Volume Rendered (3DVR) images of computed tomography angiography (CTA) scans is often time-intensive and typically requires skilled technical staff. However, the diagnostic value of 3DVR images for identifying aneurysms in patients with subarachnoid hemorrhage (SAH) remains unclear. METHODS: We conducted a retrospective review of patients who presented with SAH, underwent 64-detector row CTA, and had follow-up digital subtraction angiography (DSA) between 2013 and 2020. Two experienced, fellowship-trained neuroradiologists, blinded to the DSA findings, independently reviewed the CTA source and maximum intensity projection (MIP) images without 3DVR (CTA-3DVR) followed by a review with 3DVR images (CTA + 3DVR). The results of DSA scans were then cross-referenced as a gold standard. Disagreements were settled through consensus. Aneurysm size was documented based on DSA measurements. RESULTS: 200 patients met inclusion criteria, with DSA identifying 140 aneurysms in 114 patients. CTA-3DVR detected 135 of 140 aneurysms (96.4%), and CTA + 3DVR detected 136 of 140 (97.1%). All missed aneurysms measured between 2-4 mm; three of the four missed aneurysms occurred in patients with multiple aneurysms, and one was an isolated 2 mm M3 segment aneurysm. The addition of CTA + 3DVR resulted in the detection of one additional 3 mm aneurysm in a left A3 segment. No false positives were identified in either method. CONCLUSIONS: The addition of 3DVR resulted in the detection of one additional distal A3 aneurysm but did not significantly improve overall aneurysm detection. These results support the conclusion that 3DVR may not be essential for emergent aneurysm detection in patients with SAH.

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