INITIAL CLINICAL-EXPERIENCE WITH SPIRAL CT AND 3D ARTERIAL RECONSTRUCTION IN INTRACRANIAL ANEURYSMS AND ARTERIOVENOUS-MALFORMATIONS

We studied 32 consecutive patients with known or suspected cerebrovasc ular abnormalities studied with spiral CT following a intravenous bolu s injection of iodinated contrast medium with a power injector. Flow w as 3 or 4 ml/s. In an attempt to define the appropriate delay time and scan duration a cranial angio-CT without table increment was performe d on 10 patients. Enhancement was measured by manually placed regions of interest within the left middle cerebral artery and the inferior sa gittal sinus, All patients except one had intraarterial angiography (D SA) for comparison. In 6 patients with an arteriovenous malformation ( AVM) follow-up was possible after one and/or two embolisation procedur es. These patients had plain and contrast-enhanced spiral CT. The diag nosis was aneurysm in 9 (8 berry aneurysms, one giant fusiform aneurys m), AVM in 13 (all supratentorial) and traumatic arteriovenous fistula in one. In 9 patients there were no detectable pathological vascular findings, After 3D reconstruction the size (between 5 and 28 mm), loca tion and the relationship to the parent vessel of the aneurysms, the e xtent of the AVMs and the distribution of the embolisation material co uld be demonstrated clearly. The main feeding vessel(s), nidus and dra ining veins were reliably shown. The decreased extent of the AVMs afte r embolisation was clearly demonstrated. There was no difference in di agnosis when DSA and 3D-CT were compared by two independent radiologis ts. We consider arterial spiral CT with 3D reconstruction to have the potential of offering important diagnostic information for the treatme nt of intracranial AVMs and aneurysms.