Brain aneurysm with measurement calipers

Decoding Aneurysm Size: How Precise Measurements are Revolutionizing Treatment

Lena Kashyap in Health & Wellness September 2025 • 4 min read.

"A deep dive into invasive and non-invasive sizing techniques and their impact on successful endovascular aneurysm repair."

Endovascular treatment has revolutionized the approach to intracranial aneurysms, offering less invasive alternatives to traditional surgery. With the advent of intrasaccular flow diverters and other sophisticated devices, precision in aneurysm sizing has become paramount. These devices require meticulous pre-operative planning, where even a millimeter can impact the success of the procedure.

Traditional methods of aneurysm sizing have been enhanced by modern imaging technologies, including multidetector CT angiography (MDCTA), flat panel detector CT angiography (FDCTA), and 3D digital subtraction angiography (3D DSA). Each technique offers unique advantages, yet questions remain about their accuracy and reliability in determining the optimal device size for endovascular repair.

This article will explore a study investigating the accuracy of various imaging modalities—MDCTA, FDCTA, DSA, and their post-processing methods—in measuring aneurysm size. By comparing these techniques against a known standard, the study sheds light on the best practices for pre-interventional planning, ultimately improving patient outcomes in endovascular aneurysm treatment.

Navigating the Maze: Understanding Different Sizing Techniques

Brain aneurysm with measurement calipers

The quest for precise aneurysm sizing has driven innovation in imaging technologies. Each method offers distinct advantages and potential pitfalls:

Multidetector CT Angiography (MDCTA): MDCTA provides detailed 3D images of blood vessels using X-rays and contrast dye. Its high resolution allows for precise measurements of aneurysm dimensions. However, image quality can be affected by factors such as patient movement and calcification within the vessel walls.

Flat Panel Detector CT Angiography (FDCTA): FDCTA offers real-time imaging during endovascular procedures. Its ability to capture dynamic changes in blood flow makes it valuable for assessing aneurysm hemodynamics. FDCTA's lower radiation dose compared to conventional CT angiography is an added benefit.
Digital Subtraction Angiography (DSA): DSA remains a gold standard for vascular imaging. By subtracting pre-contrast images from those obtained after contrast injection, DSA provides clear visualization of blood vessels. DSA's limitations include its 2D nature, which can make it challenging to assess complex aneurysm morphology.
3D Digital Subtraction Angiography (3D DSA): 3D DSA reconstructs 3D images from a series of 2D DSA images acquired during rotational angiography. This technique provides comprehensive visualization of aneurysm shape and size. However, 3D DSA requires specialized equipment and expertise.

The accuracy of each technique depends on various factors, including image resolution, post-processing methods, and operator experience. Understanding these nuances is crucial for selecting the most appropriate imaging modality for pre-interventional planning.

The Future of Aneurysm Sizing: Achieving Millimeter Precision

As endovascular techniques evolve, the demand for precise aneurysm sizing will only intensify. The study underscores the importance of optimized 2D-DSA imaging, guided by 3D-DSA, in achieving the accuracy required for successful device deployment. By embracing these advanced imaging strategies, clinicians can optimize treatment outcomes and improve the lives of patients with intracranial aneurysms.

About this Article -

This article was crafted using a human-AI hybrid and collaborative approach. AI assisted our team with initial drafting, research insights, identifying key questions, and image generation. Our human editors guided topic selection, defined the angle, structured the content, ensured factual accuracy and relevance, refined the tone, and conducted thorough editing to deliver helpful, high-quality information.See our About page for more information.

This article is based on research published under:

DOI-LINK: 10.3174/ajnr.a5866, Alternate LINK

Title: How To Size Intracranial Aneurysms: A Phantom Study Of Invasive And Noninvasive Methods

Subject: Neurology (clinical)

Journal: American Journal of Neuroradiology

Publisher: American Society of Neuroradiology (ASNR)

Authors: D. Behme, N. Amelung, T. Khakzad, M.-N. Psychogios

Published: 2018-11-08

Everything You Need To Know

Why is precise aneurysm sizing so critical in modern treatments?

Endovascular treatment has revolutionized the approach to intracranial aneurysms. The precision in aneurysm sizing is paramount for devices like intrasaccular flow diverters. A single millimeter can significantly affect the success of the procedure, highlighting the importance of accurate measurements for patient outcomes. The article emphasizes this in the context of the advancement of less invasive alternatives to traditional surgery.

What are the key differences between MDCTA, FDCTA, DSA, and 3D DSA?

MDCTA uses X-rays and contrast dye to create detailed 3D images. While offering high resolution for precise measurements, it can be affected by factors like patient movement and vessel wall calcification. FDCTA provides real-time imaging and is beneficial for assessing aneurysm hemodynamics, and also offers a lower radiation dose. DSA, a gold standard, provides clear visualization but is 2D, which can be challenging. 3D DSA reconstructs 3D images from 2D DSA, which gives comprehensive views, however, requires specialized equipment.

What do the abbreviations MDCTA, FDCTA, DSA, and 3D DSA stand for?

MDCTA stands for Multidetector CT Angiography, FDCTA is Flat Panel Detector CT Angiography, DSA is Digital Subtraction Angiography, and 3D DSA is 3D Digital Subtraction Angiography. Each technique uses different methods to visualize blood vessels and aneurysms. Understanding the pros and cons of each technique is crucial for pre-interventional planning, as image resolution, post-processing, and operator experience all influence their accuracy. Selecting the most appropriate imaging modality ensures better outcomes.

What is the ultimate goal of accurately measuring aneurysms?

The primary goal is to improve patient outcomes in endovascular aneurysm treatment. Accurate sizing is crucial for the successful deployment of devices like intrasaccular flow diverters. Advanced imaging techniques help to fine-tune endovascular procedures. Optimized 2D-DSA imaging, guided by 3D-DSA, plays a vital role in achieving the necessary accuracy for successful device placement. Precision in these measurements directly impacts the effectiveness of the treatment and the patient's quality of life.

What factors affect the accuracy of aneurysm sizing techniques?

The accuracy depends on image resolution, post-processing methods, and operator experience. Each imaging technique has its own set of advantages and limitations. Understanding these nuances is crucial for selecting the best modality for pre-interventional planning. Operator experience contributes to the correct interpretation and application of the images, which is vital for successful treatment. The study aims to discover the best practices for pre-interventional planning through investigation of these modalities.