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Introduction: CT angiography (CTA) is the initial modality for diagnosing the
Carotid Cavernous Fistula (CCF), identifying the type of CCF, measuring the
diameter of the fistula and the diameter of the internal carotid artery (ICA) pre and
post fistula, and then confirmed by Digital Subtraction Angiography (DSA) as the
gold standard. CTA is expected to provide more information to improve the
accuracy of CCF diagnosis to benefit therapy and prevent complications. This
study aimed to determine the diagnostic value of CTA in CCF patients in Dr.
Soetomo General Hospital Surabaya, using the DSA as a gold standard. Methods:
An observational retrospective study of CCF patients met the inclusion and
exclusion criteria and underwent CTA and DSA examinations at the Radiology
Installation of Dr. Soetomo General Hospital, Surabaya, from January 2016 to
July 2020. Results: In the comparison of types of CCF CTA to DSA, the direct
group was 53.8% and 57.7%, respectively, while the indirect group was 46.1% and
42.3% with a very strong correlation (κ = 0.922; p = 0.000), sensitivity was 93.3%,
specificity was 100 %, PPV of 100%, NPV of 91.7% and accuracy of 96.15%. Direct
type evaluation on the DSA showed a large picture of the fistula diameter; the ICA
pre fistula's size was enlarged; therefore, the ICA post fistula diameter was
reduced or absent. There was a strong correlation of fistula diameter
measurement results between CTA and DSA (r = 0.695, p = 0.006).
Conclusion: CTA has a similarity rate of 92.2% with DSA in identifying the type
of CCF. The accuracy value of CTA is close to DSA in fistula diameter


CT Angiography (CTA) Carotid-Cavernous Fistula (CCF) Digital Subtraction Angiography (DSA) Internal Carotid Artery (ICA) Direct Indirect

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How to Cite
Amalia, L., Hartono Yudi Sarastika, & Bambang Soeprijanto. (2021). Diagnostic Value of CT Angiography (CTA) in Carotid Cavernous Fistula (CCF) Patients Using the Digital Subtraction Angiography (DSA) as The Gold Standard: Observation in Dr. Soetomo General Hospital Surabaya from January 2016 to July 2020. Bioscientia Medicina : Journal of Biomedicine and Translational Research, 5(3), 533-563.