Intracranial aneurysms: Clinical value of 3D digital subtraction angiography in the therapeutic decision and endovascular treatment

PURPOSE: To evaluate three-dimensional (3D) digital subtraction angiography (DSA) as a supplement to two-dimensional (2D) DSA in the endovascular trea tment (EVT) of intracranial aneurysms. MATERIALS AND METHODS: In 22 ruptured aneurysms, neck visualization, aneury sm shape, and EVT feasibility were analyzed at 2D DSA (anteroposterior, lat eral, and rotational views) and at maximum intensity projection (MIP) and s urface shaded display (SSD) 3D DSA. The possibility of obtaining a working view for EVT at 3D DSA and the relevance of measurements in choosing the fi rst coil also were assessed. RESULTS: Two-dimensional DSA images clearly depicted the aneurysm neck in f our of 22 aneurysms; MIP images, in 10; and SSD images, in 21, but SSD led to overestimation of the neck size in one aneurysm. Aneurysm shape was prec isely demonstrated in five of 22 aneurysms at 2D DSA, in eight at MIP, and in all cases at SSD. In two of 22 aneurysms, EVT seemed to be nonfeasible a t 2D DSA; however, SSD demonstrated feasibility and EVT was successfully pe rformed. In one aneurysm, only SSD demonstrated the extension of the neck t o a parent vessel, which was proved at surgery. Working views for EVT were deduced from 3D DSA findings in 20 of 21 aneurysms. The choice of the first coil was correct in 19 of 21 aneurysms. CONCLUSION: Three-dimensional DSA is valuable for evaluating the potential for EVT, finding a working view, and performing accurate measurements.