Value of three-dimensional fusion imaging of non-contrast CT and CTA in identifying the culprit aneurysm in patients with multiple ruptured intracranial aneurysms

DENG Xi-qing; YIN Can; HU Li-nan; LUO Zheng-mao

doi:10.13798/j.issn.1009-153X.2025.05.007

Abstract：Objective To explore the application value of three-dimensional fusion imaging of non-contrast CT and CTA in identifying the culprit aneurysm in patients with multiple ruptured intracranial aneurysms.Methods The imaging data of 68 patients with multiple ruptured intracranial aneurysms admitted between March 2018 and December 2023 were retrospectively analyzed.First,the culprit aneurysm is determined based on the distribution of subarachnoid hemorrhage(SAH)observed on CT and its correlation with the aneurysm detected by CT angiography(CTA).If SAH presents with a diffuse pattern or the aneurysms are too closely spaced to identify the responsible lesion,the integrated post-processing tools in the PACS system are utilized to perform 3D reconstruction of both non-contrast CT and CTA images.Through multi-angle rotation viewing,the three-dimensional spatial relationship between SAH and the aneurysm is evaluated to ultimately determine the culprit aneurysm.Intraoperative findings served as the gold standard for identifying the culprit aneurysm.Results A total of 155 aneurysms were detected in 68 patients.In 19 cases,the culprit aneurysm could not be determined based solely on SAH distribution and its relationship with the aneurysms.Three-dimensional fusion imaging revealed diffuse SAH in 11 cases and closely spaced aneurysms in 8 cases.Through multi-directional and multi-angle observation of the spatial relationship between SAH and aneurysms,the culprit aneurysm was accurately identified in 16 cases,consistent with intraoperative findings;3 cases remained undetermined.The performance metrics of 3D fusion imaging for identifying the culprit aneurysm were as follows:the sensitivity was 84.2%(16/19),the specificity was 84.2%(16/19),the accuracy was 84.2%(32/38),the false positive rate was 15.8%(3/19),the false negative rate was 15.8%(3/19),the positive predictive value was 84.2%(16/19),and the negative predictive value was 84.2%(16/19).Conclusions Three-dimensional fusion imaging of non-contrast CT and CTA data using the built-in post-processing workstation of the PACS system can effectively identify the culprit aneurysm in patients with multiple ruptured intracranial aneurysms.