A rare type of false negative three-dimensional CT angiography of a cerebral aneurysm

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A 70-year-old man complained of mild headache but neurological examination and conventional computed tomography (CT) findings were normal. Magnetic resonance angiography (MRA) with time-of-flight technique revealed bilateral middle cerebral artery (MCA) aneurysms (Fig. 1: upper left). Three-dimensional CT angiography (CTA) demonstrated the right MCA aneurysm but the one on the left side appeared to be a sharp bend in the second segment of the MCA (Fig. 1: lower). CTA was performed with a Siemens Somatom Plus-S using spiral scanning. A dose of 90 ml non-ionic contrast medium was pump-injected into a peripheral vein at the rate of 3 ml/min, and scanning was performed after a 15 s delay. The CT table was withdrawn through the gantry at a velocity of 2 mm/s while scanning was performed (120 kV, 210 mA). The slice thickness was 2 mm. Three-dimensional images were obtained by shaded surface reconstruction. The images were displayed as a series of projections rotated at 15 ° intervals around the x, y and z axes. Intra-arterial digital subtraction angiography (DSA) revealed MCA aneurysms on both sides (Fig. 1: upper right). The patient underwent surgery for bilateral MCA aneurysms after informed consent was obtained. Saccular aneurysms without subarachnoid hemorrhage were confirmed on both sides intraoperatively and were

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