Contrast-enhanced and unenhanced diffusion-weighted imaging of the breast at 3 T.

AIM: To evaluate the effect of intravenous gadolinium contrast agent on diffusion-weighted sequences and apparent diffusion coefficient (ADC) measurements at 3 T. MATERIALS AND METHODS: Sixty-two biopsy-proven breast lesions were included in this prospective study. Magnetic resonance imaging (MRI) was performed at 3 T, using four echo-planar diffusion-weighted sequences (7,100 ms repetition time, 84 ms echo time) with b-values of 0 and 850, and 0 and 1,000 s/mm2. The first pair of DWI sequences was taken before intravenous contrast medium injection. The second pair of sequences was taken 6.5 minutes after intravenous contrast medium administration (right after the dynamic T1 sequence). A freeform region of interest (ROI) was drawn inside the lesion excluding adjacent normal tissue, necrotic, or cystic components and ADC values were calculated. The paired samples t-test was used to assess differences between ADC measurements before and after intravenous contrast medium administration. Sensitivity, specificity, positive predictive value, negative predictive value, and area under the curve were calculated for each diffusion sequence. RESULTS: Twenty-seven malignant and 35 benign lesions were analysed. Fifty-eight lesions were masses, and four lesions were non-mass-like enhancements (NMLEs). Two of the NMLEs were malignant, and two were benign lesions. The contrast-enhanced ADC measurements were lower than the unenhanced measurements on b=850 and 1,000 s/mm2 (p<0.05). The receiver operating characteristic (ROC) analysis displayed similar area under the curve values between the different diffusion sequences. CONCLUSION: The injection of intravenous contrast medium reduces ADC values; however, the effect of contrast medium is modest. Sensitivity and specificity are not significantly affected.

Development of malignant lymphoma after metal-on-metal hip replacement: a case report and review of the literature.

A number of previous studies have reported a potential risk of malignancy, particularly hematological malignancy, developing in patients receiving a metal-on-metal (MoM) hip replacement. We report a case of malignant lymphoma that arose in a patient who had an MoM hip arthroplasty complicated by development of a pseudotumour. The tumour was a B cell follicular lymphoma that involved lymph nodes and bone. Metal ions are known to have a genotoxic effect on lymphoid cells. Although epidemiological studies have not established that there is an increased risk of lymphoma associated with MoM implants, only a relatively short time period has elapsed since re-introduction of this type of implant and long-term follow-up of patients with MoM implants is indicated.

Articular cartilage status 2 years after arthroscopic ACL reconstruction in patients with or without concomitant meniscal surgery: evaluation with 3.0T MR imaging.

PURPOSE: To assess articular cartilage changes in the knee joint as detected on 3.0T MR imaging after 2-year follow-up in patients who underwent arthroscopic anterior cruciate ligament reconstruction (ACLR) with or without concomitant meniscal surgery. METHODS: A total of twenty-nine patients (mean age 30.3 ± 10 years), who underwent arthroscopic ACLR, received clinical and imaging follow-up at an average of 27.8 ± 4.8 months after surgery. Our patients were divided into two subgroups: eighteen patients with additional meniscal injuries at the time of arthroscopic ACLR who underwent meniscal surgery and eleven patients with intact menisci. The cartilage status of all knees at the time of arthroscopic ACLR was recorded. All patients underwent an MRI scan preoperatively and at follow-up with the same imaging protocol. Cartilage status of all knee compartments was evaluated at the time of follow-up by MR imaging and the ICRS classification. RESULTS: Deterioration of the cartilage status was found at all knee compartments of our study group, with respect to the number of cartilage defects. The cartilage of the lateral femoral condyle (LFC) was most severely affected, followed by patellar and medial femoral condyle (MFC) cartilage. A statistically significant relation was found between surgery of the medial meniscus and the development of new cartilage defects in LFC (p = 0.01) and MFC (p = 0.03) after adjusting for the site of meniscal surgery. The cartilage of LFC and the status of the medial meniscus were also found to be significantly related (p = 0.04). Partial meniscectomy was found to be associated with an increased incidence of new cartilage defects when compared to either meniscal repair or absence of meniscal surgery, although it was not statistically significant. CONCLUSION: Development of new cartilage lesions was evident after 2-year follow-up in patients with arthroscopic ACLR as detected by MR imaging. There was a multicompartmental pattern of cartilage involvement, and the lateral compartment was most severely affected. Partial meniscectomy at the time of arthroscopic ACLR could be suggested as an additional risk factor for the progression of chondral lesions. LEVEL OF EVIDENCE: Prospective comparative study, Level II.

Intraosseous hibernoma: a rare adipocytic bone tumour.

Hibernoma is a benign adipose tumour that contains foetal brown fat cells. We report a case of hibernoma arising in the left ischium of a 65-year-old female with a past history of ovarian carcinoma. The patient presented with a relatively short history of left sacral/hip pain. Radiologically, the lesion, which was large (5 cm) and sclerotic, had been stable for a number of years. Histologically, it was composed mainly of plump cells with foamy, multivacuolated cytoplasm. These cells showed no reaction for epithelial, melanoma or leucocyte markers but expressed FABP4/aP2 and S100, indicating that they were brown fat cells. There was no mitotic activity or nuclear pleomorphism and the lesion was diagnosed as a benign intraosseous hibernoma (IOH). IOH is a recently identified benign adipocytic lesion that presents typically as a sclerotic bone lesion. It has characteristic morphological and immunophenotypic features and should be regarded as a discrete primary bone tumour that needs to be distinguished from metastatic carcinoma/melanoma, chondrosarcoma and metabolic storage diseases containing numerous foamy macrophages.

Primary intraosseous meningioma: an osteosclerotic bone tumour mimicking malignancy.

BACKGROUND: Sclerotic tumours of the calvarial bones are rare and may be due to primary and secondary bone tumours as well as extradural tumours of meningeal origin. CASE PRESENTATION: We report a case of primary intraosseous meningioma (PIM) which arose in the frontal bone of a 63 year old woman who complained of progressive pain and thickening of the right skull. Radiology showed a large osteosclerotic lesion in the right frontal bone. Histology showed an intraosseous lesion containing dense fibrous tissue in which there were scattered cells that expressed epithelial membrane antigen and progesterone receptor. The tumour was partially resected and 3 years after operation has not recurred. CONCLUSIONS: PIM is a rare tumour which needs to be distinguished from primary/secondary osteosclerotic calvarial bone tumours.

Primary synovial chondromatosis: a reassessment of malignant potential in 155 cases.

OBJECTIVE: Primary synovial chondromatosis (PSC) is a rare disorder characterised by cartilage formation in synovium-lined joints, tendon sheaths and bursae. It is thought that PSC cartilage arises from the proliferation of mesenchymal cells, which exhibit cartilaginous metaplasia in subintimal connective tissue. There are reports of transformation of PSC to chondrosarcoma, although the precise incidence and nature of this complication is uncertain. In this study we carried out a retrospective review PSC to determine the incidence of sarcomatous change in this condition, in addition to the clinical, radiological and pathological features that characterise this complication MATERIALS AND METHODS: We reviewed 155 cases of PSC and identified 4 cases (3 in the hip joint; 1 in the elbow joint) of aggressive behaviour and chondrosarcoma-like histology. RESULTS: Radiologically, these cases were all reported as showing features consistent with PSC and aggressive extra-articular soft tissue/bone involvement. Histologically, in addition to typical features of PSC, there was morphological evidence of peri-articular soft tissue and, in 2 cases, bone involvement by an infiltrating cartilaginous tumour. These tumours all behaved as locally aggressive neoplasms and did not give rise to metastasis. CONCLUSION: Our findings show that chondrosarcoma arises infrequently in PSC (approximately 2.5 %), and that this complication occurs most commonly in the hip joint (approximately 11 % of cases of hip PSC). These tumours behaved mainly as low-grade, locally aggressive tumours analogous to atypical cartilaginous tumour of bone/grade 1 chondrosarcoma of bone.

Elimination of motion and pulsation artifacts using BLADE sequences in shoulder MR imaging.

OBJECTIVES: To evaluate the ability of proton-density with fat-suppression BLADE (proprietary name for periodically rotated overlapping parallel lines with enhanced reconstruction in MR systems from Siemens Healthcare, PDFS BLADE) and turbo inversion recovery magnitude-BLADE (TIRM BLADE) sequences to reduce motion and pulsation artifacts in shoulder magnetic resonance examinations. MATERIALS AND METHODS: Forty-one consecutive patients who had been routinely scanned for shoulder examination participated in the study. The following pairs of sequences with and without BLADE were compared: (a) Oblique coronal proton-density sequence with fat saturation of 25 patients and (b) oblique sagittal T2 TIRM-weighed sequence of 20 patients. Qualitative analysis was performed by two experienced radiologists. Image motion and pulsation artifacts were also evaluated. RESULTS: In oblique coronal PDFS BLADE sequences, motion artifacts have been significantly eliminated, even in five cases of non-diagnostic value with conventional imaging. Similarly, in oblique sagittal T2 TIRM BLADE sequences, image quality has been improved, even in six cases of non-diagnostic value with conventional imaging. Furthermore, flow artifacts have been improved in more than 80% of all the cases. CONCLUSIONS: The use of BLADE sequences is recommended in shoulder imaging, especially in uncooperative patients because it effectively eliminates motion and pulsation artifacts.

RhBMP-7 for the treatment of nonunion of fractures of long bones.

We report the outcome of 84 nonunions involving long bones which were treated with rhBMP-7, in 84 patients (60 men: 24 women) with a mean age 46 years (18 to 81) between 2003 and 2011. The patients had undergone a mean of three previous operations (one to 11) for nonunion which had been present for a mean of 17 months (4 months to 20 years). The nonunions involved the lower limb in 71 patients and the remainder involved the upper limb. A total of 30 nonunions were septic. Treatment was considered successful when the nonunion healed without additional procedures. The relationship between successful union and the time to union was investigated and various factors including age and gender, the nature of the nonunion (location, size, type, chronicity, previous procedures, infection, the condition of the soft tissues) and type of index procedure (revision of fixation, type of graft, amount of rhBMP-7) were analysed. The improvement of the patients' quality of life was estimated using the Short Form (SF) 12 score. A total of 68 nonunions (80.9%) healed with no need for further procedures at a mean of 5.4 months (3 to 10) post-operatively. Multivariate logistic regression analysis of the factors affecting union suggested that only infection significantly affected the rate of union (p = 0.004).Time to union was only affected by the number of previous failed procedures (p = 0.006). An improvement of 79% and 32.2% in SF-12 physical and mental score, respectively, was noted within the first post-operative year. Rh-BMP-7 combined with bone grafts, enabled healing of the nonunion and improved quality of life in about 80% of patients. Aseptic nonunions were much more likely to unite than septic ones. The number of previous failed operations significantly delayed the time to union.

Autologous (non-vascularised) fibular grafting with recombinant bone morphogenetic protein-7 for the treatment of femoral head osteonecrosis: preliminary report.

This preliminary study evaluates a combination of bone morphogenetic protein (BMP)-7 and non-vascularised autologous fibular grafting (AFG) for the treatment of osteonecrosis of the femoral head. BMP-7/AFG combination was applied in seven pre-collapse femoral heads (five Steinberg stage II, two stage III) in six patients. Pre- and post-operative evaluation included clinical (Harris hip score (HHS), visual analogue scale (VAS) for pain) and radiological assessment (radiographs, quantitative CT) at a mean follow-up of 4 years (2 to 5.5). A marked improvement of function (mean HHS increase of 49.2) and decrease of pain level (mean VAS decrease of 5) as well as retention of the sphericity of the femoral head was noted in five hips at the latest follow-up, while signs of consolidation were apparent from the third post-operative month. One patient (two hips) required bilateral total hip replacement at one year post-operatively. In the series as a whole, quantitative-CT evaluation revealed similar densities between affected and normal bone. Heterotopic ossification was observed in four hips, without compromise of the clinical outcome. In this limited series AFG/BMP-7 combination proved a safe and effective method for the treatment of femoral head osteonecrosis, leading to early consolidation of the AFG and preventing collapse in five of seven hips, while the operative time and post-operative rehabilitation period were much shorter compared with free vascularised fibular grafts.

Celiomesenteric trunk demonstrated by multi-detector computed tomography angiography: two cases of a rare vascular variation.

We present two cases of patients with celiomesenteric trunk in whom the celiac trunk and the superior mesenteric artery arise off a common vessel from the ventral part of the aorta, which was demonstrated by multi-detector (16 slices) computed tomography angiography (MDCTA) and confirmed by digital subtraction angiography (DSA). This is a very rare congenital vascular anomaly and its imaging demonstration is of great importance in several interventional procedures. These cases demonstrate the capability of MDCTA in the evaluation of abdominal aorta and its branches and shows that this method might replace diagnostic DSA.

Radiation doses to paediatric patients and comforters undergoing chest X rays.

Pneumonia is an important cause of hospital admission among children in the developed world and it is estimated to be responsible for 3-18 % of all paediatric admissions. Chest X ray is an important examination for pneumonia diagnosis and for evaluation of complications. This study aims to determine the entrance surface dose (ESD), organ, effective doses and propose a local diagnostic reference level. The study was carried out at the university hospital of Larissa, Greece. Patients were divided into three groups: organ and effective doses were estimated using National Radiological Protection Board software. The ESD was determined by thermoluminescent dosemeters for 132 children and 76 comforters. The average ESD value was 55 ± 8 µGy. The effective dose for patients was 11.2 ± 5 µSv. The mean radiation dose for comforter is 22 ± 3 µGy. The radiation dose to the patients is well within dose constraint, in the light of the current practice.

Radiation doses to patients undergoing enteroclysis.

Enteroclysis is a minimally invasive radiographic examination of the small intestine. During the procedure, considerable radiation dose is delivered to the patients. This study intends to: (a) evaluate the radiation dose to the patient using thermoluminescent dosemeters (TLDs, according to the protocol used at Radiology Department, University Hospital of Larissa, Greece; (b) estimate the thyroid surface dose (TSD) and doses to some radiosensitive organs located in the irradiation field. A total of 46 patients was examined. Patients were divided into two groups according to the digital X-ray machine used. The mean entrance surface dose (ESD) was 601.2 ± 96.2 mGy and the mean fluoroscopy time was 8.5 ± 3 min, while the mean TSD was 0.34 ± 0.6 mGy. The ESD for group A was lower by 20 % than group B due to fluoroscopic mode used. The dose values were higher than those in the literature. A local diagnostic reference level was introduced for further patient dose optimisation.

128-detector-row computed tomography coronary angiography assessing differences in morphology and distribution of atherosclerotic plaques between patients with and without pre-test probability of significant coronary artery disease.

OBJECTIVES: To evaluate and compare morphology, distribution and orientation of atherosclerotic plaques at the coronary arteries between patients with low and intermediate pre-test probability of significant coronary artery disease (CAD) by non-invasive coronary angiography using 128-Multi Detector Computed Tomography (MDCT). MATERIALS AND METHODS: The study included 120 patients divided into two groups according to their clinical pre-test probability of having significant CAD: 38 patients (group A) with intermediate pre-test probability and 82 patients (group B) with low pre-test probability of significant CAD. Atherosclerotic plaques were characterized according to their morphology, distribution and orientation. RESULTS: A total of 482 plaques were analyzed. In group A, we found statistically significant higher percentages of RCA plaques (p=0.0005), of concentric (p<0.0001) and non-branching (p=0.013) plaques, of myocardial plaques (p=0.029), of plaques in distal RCA (p=0.0009) and distal LAD (p=0.001). In group B, we found statistically significant higher percentages of LAD plaques (p<0.0001), of eccentric (p<0.0001) and branching (p=0.013) plaques, of lateral plaques (p=0.012), of Medina 1.0.0 (p=0.0069), 0.1.0 (p=0.022) and 1.1.1 (p=0.0068) branching plaques, and of plaques in proximal LAD (p=0.02). CONCLUSION: 128-MDCT coronary angiography can provide important information on morphology and distribution of atherosclerotic plaques and may in the future play a potential role in patient management.

Osteoclast-like cells in soft tissue leiomyosarcomas.

Giant cell-rich leiomyosarcoma of soft tissues is an unusual variant of malignant smooth muscle tumor characterized by the presence of numerous multinucleated giant cells (MNGCs). The nature of MNGCs and the cellular mechanisms underlying their accumulation in this tumor are poorly understood. Analysis of the expression of osteoclast, macrophage, and smooth muscle markers in two cases of giant cell-rich leiomyosarcoma revealed that the MNGCs in giant cell-rich leiomyosarcoma were negative for smooth muscle markers and that these cells expressed an osteoclast-like phenotype, being positive for CD45, CD68, tartrate-resistant acid phosphatase, and CD51 but negative for CD14 and HLA-DR. Scattered tumor-associated macrophages (TAMs) also expressed this phenotype. Leiomyosarcoma tumor cells strongly reacted for CD51 but were negative for CD14, CD45, and CD68. An analysis of 25 conventional (nongiant cell-containing) leiomyosarcomas found isolated CD68(+) MNGCs in three cases (12%), all of which were grade II/III leiomyosarcomas containing a prominent TAM infiltrate. Leiomyosarcoma-derived TAMs in the presence of receptor activator for nuclear factor kappa B ligand (RANKL) and macrophage colony-stimulating factor were capable of differentiating into osteoclast-like cells capable of resorbing bone. Reverse transcription polymerase chain reaction studies showed that RANKL, osteoprotegerin, and TNF-related apoptosis-inducing ligand were expressed by leiomyosarcoma cells. Our findings indicate that the giant cells found in leiomyosarcomas are osteoclast-like and that they are formed from TAMs by a RANKL-dependent mechanism.

Ultrasonographic evidence of inflammation is frequent in hands of patients with erosive osteoarthritis.

OBJECTIVE: Erosive osteoarthritis (OA) (EOA) is considered an aggressive form of primary OA that is defined radiographically by intra-articular erosions of the inter-phalangeal joints of the hand and characteristic deformities. The aim of the present study was the sonographic investigation of hand small joints in patients with EOA and comparison of the imaging findings with conventional radiography (CR). METHOD: Twenty-two patients (20 women, mean age 62.5 years) with clinical and radiographic diagnosis of EOA formed our study group. A total of 660 joints were assessed by both radiographs and ultrasound (US). US and plain films were evaluated by two different physicians on a blinded fashion. Erosions, osteophytes and deformities were evaluated by both US and plain films. Synovial thickening, effusion, and power Doppler signal indicative of abnormal vascularity were recorded in each joint during US scanning. RESULTS: Erosions were detected in 231/660 (35%) small joints by US and in 115/660 (17.4%) small joints by conventional radiographs (P<0.05). Osteophytes were detected in 360/660 (54.5%) small joints by US, and in 310/660 (47.0%) small joints by conventional radiographs (P<0.05). Thickened synovium was detected in 19 of 22 patients and increased intra-articular power Doppler signal, indicative of active inflammation, was detected in 18 of 22 patients. Thickened synovium was found in 159/660 (24.1%), effusion in 119/660 (18%) and increased power Doppler in 148/660 (22.4%) small joints. Intra-observer kappa value for agreement regarding US was 0.81 and plain films 0.86. In 31 instances extensive finger tenosynovitis was also evident. CONCLUSION: In patients with EOA, US is a reliable and a more sensitive imaging modality than CR in detecting erosions and osteophytes. US detects inflammatory changes in small hand joints in the vast majority of patients with EOA and suggests that current treatment modalities are inadequate treatment for this disease.

Symptomatic partial rotator cuff tears: diagnostic performance of ultrasound and magnetic resonance imaging with surgical correlation.

BACKGROUND: The painful shoulder is a relatively common clinical entity that may be attributed to a variety of pathologies, including partial rotator cuff tears. Conservative treatment or surgical intervention may be offered, depending on the extent of the partial tear and the degree of patient discomfort. PURPOSE: To apply ultrasound (US) imaging in order to evaluate the prevalence of partial rotator cuff tears in patients with painful shoulders. MATERIAL AND METHODS: Fifty-six patients (17 men, 39 women; mean age 53.7 years) were included in the study, with symptomatic impingement syndrome of the shoulder after having failed to respond to conservative treatment. All patients underwent US and magnetic resonance imaging (MRI) scans prior to surgical intervention. RESULTS: Arthroscopy or mini-open surgery revealed 53 cases with partial tears of the rotator cuff and three with extensive tendinopathy. Both imaging modalities detected successfully 44 cases of partial tears of the supraspinatus tendon. US imaging yielded a sensitivity of 95.6%, a specificity of 70%, an accuracy of 91%, and a positive predictive accuracy of 93.6%. The corresponding values for MRI were 97.7%, 63.6%, 91%, and 91.7%, respectively. CONCLUSION: US imaging can be considered almost equally effective in detecting partial tears of the rotator cuff compared to MRI, particularly located in the area of the supraspinatus tendon. MRI may be reserved for doubtful or complex cases, in which delineation of adjacent structures is mandatory prior to surgical intervention.

Necrotic granulomatous pseudotumours in bilateral resurfacing hip arthoplasties: evidence for a type IV immune response.

Clinical, radiological and histological findings were analysed in four patients who developed bilateral pseudotumours following metal-on-metal (MoM) resurfacing arthroplasties of both hips. Using a panel of monoclonal antibodies directed against HLA-DR, macrophages (CD14, CD68), dendritic cells (DC-SIGN, S100, CD11c), B cells (CD20), and T cells (CD3, CD4, CD8), the nature of the heavy inflammatory response seen in these cases was examined. Bilateral masses developed in periprosthetic soft tissues following the second MoM arthroplasty; these were characterised histologically by extensive coagulative necrosis, a heavy macrophage infiltrate and the presence of granulomas containing macrophages and giant cells; there was also a diffuse lymphocyte and variable plasma cell and eosinophil polymorph infiltrate. Immunohistochemistry showed strong expression of HLA-DR, CD14 and CD68 in both granulomatous and necrotic areas; lymphocytes were predominantly CD3+/CD4+ T cells. The clinical, morphological and immunophenotypic features of these necrotic granulomatous pseudotumours, which in all cases develop following a second resurfacing hip arthroplasty, is suggestive of a type IV immune response, possibly to MoM metal alloy components.

The role of Doppler Perfusion Index as screening test in the characterization of focal liver lesions.

PURPOSE: Doppler Perfusion Index (DPI) has been used in the detection of overt liver metastatic disease. In the present prospective study we evaluated the use of DPI in the differential diagnosis of liver tumours. MATERIALS AND METHODS: We have included in our study 76 patients with focal hepatic lesion and 39 subjects as control group. All patients were evaluated by Color Doppler Ultrasound, and/or Spiral Computerised Tomography, Magnetic Resonance Imaging and biopsy. The radiologist performed DPI measurements was blind from the final diagnosis of the other methods. RESULTS: DPI measurements in the control group ranged from 0.07 to 0.22 (mean value 0.14), in 42 cases with benign lesions (group A) ranged from 0.05 to 0.53 (mean 0.15) and in 34 cases with malignant lesions (group B) ranged from 0.39 to 0.75 (mean 0.53). There was a statistically significant difference in DPI measurements between the control group and group B. CONCLUSIONS: Our results suggest that the DPI may differentiate malignant from benign focal hepatic lesions and therefore can be used as a screening test in the routine clinical practice.

Radiological and pathological diagnosis of paediatric bone tumours and tumour-like lesions.

Primary bone tumours are rare but account for a significant proportion of cancers occurring in childhood and adolescence. Malignant bone tumours need to be distinguished not only from their benign counterparts but also from tumour-like lesions, many of which are developmental or reactive in nature and are found commonly in the paediatric population. Taking note of the age of the patient and the site of the lesion within bone (aided by several imaging techniques including plain radiographs, ultrasound, computed tomography, bone scintigraphy and magnetic resonance imaging) is essential for pathological diagnosis. Immunohistochemistry, cytogenetics, molecular analysis and other techniques are now powerful diagnostic tools in bone pathology. This review aims to provide an approach to the radiological and pathological diagnosis of paediatric bone tumours. It also provides a brief overview of some of the more common bone tumours and tumour-like lesions, both benign and malignant, which occur in childhood and adolescence.

The role of 3D-computed tomography angiography (3D-CTA) in investigation of spontaneous subarachnoid haemorrhage: comparison with digital subtraction angiography (DSA) and surgical findings.

Spontaneous subarachnoid haemorrhage is a clinical condition that may be attributed to various underlying causes, such as rupture of intracranial aneurysms and arteriovenous malformations (AVMs). Suspected cerebrovascular abnormalities can be detected either with digital subtraction angiography (DSA) or with computed tomography angiography (CTA) combined with postprocessing tools, namely multiplanar reformation, maximum intensity projection, shaded surface display, virtual endoscopy and direct volume rendering. We prospectively studied a group of 205 patients with spontaneous subarachnoid haemorrhage. One-hundred-ninety-eight patients underwent both DSA and CTA, and formed our study group. Patients with intracranial aneurysms underwent surgical or endovascualar treatment. DSA was negative for 35 patients, detected 178/179 aneurysms and 15 AVMs. CTA correctly detected 176/179 aneurysms and all 15 cases of AVMs, whereas it was negative in 35 cases. After 3D reconstruction the size, location and the relationship to the parent vessel of the aneurysms, the extent of the AVMs with the main feeding vessel(s), nidus and draining veins were reliably shown by CTA, although DSA provided more anatomic details related to the anatomy of the adjacent vessels. The accuracy, sensitivity, positive predictive accuracy and negative predictive accuracy for CTA was 98, 97.9, 100 and 94.3% and for DSA was 99, 99.3, 100 and 98%, respectively. It is suggested that CTA is a reliable alternative to DSA in detecting intracranial aneurysms. The role of CTA in demonstrating AVMs can be considered complementary to that of DSA.