Computed Tomographic Angiography for the Evaluation of Aneurysmal Subarachnoid Hemorrhage (original) (raw)
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Computed Tomographic Angiography for the Evaluation of Aneurysmal Subarachnoid
2000
Objectives: Computed tomography (CT) followed by lumbar puncture (LP) is currently the criterion stan- dard for diagnosing subarachnoid hemorrhage (SAH) in the emergency department (ED); however, this is based on studies involving a limited number of patients. The authors sought to assess the ability of CT angiography (CTA), a new diagnostic modality, in conjunction with CT/LP to detect SAH. Methods:
Acta Neurochirurgica, 2003
Background. Computed tomography (CT) is the ''gold standard'' for detecting subarachnoid haemorrhage (SAH) and digital subtraction angiography (DSA) for visualising the vascular pathology. We studied retrospectively 180 patients with subarachnoid haemorrhage (SAH) who underwent first non-enhanced computed tomography (CT), then digital subtraction angiography (DSA) and finally operative aneurysm clipping. Our aim was to assess if the location of the ruptured aneurysm could be predicted on the basis of the quantity and distribution of haemorrhage on the initial CT scan.
The Efficacy of Computed Tomographic Angiography in Identification of Intracranial Aneurysms
Life Science Journal, 2014
Objective: Computed tomographic angiography (CTA) has surfaced as a valuable non-invasive diagnostic modality in the management of intracranial aneurysms (IAs). In this study, the author reports the accuracy of CTA versus digital subtraction angiography (DSA) in the assessment of patients with IAs. Methods: A retrospective review was conducted for all patients investigated for IAs with both CTA and DSA using standard imaging protocols at king Abdulaziz university hospital between January 2008 and December 2013. Thirty-one patients with IAs underwent evaluation with CTA and DSA during the study period. Comparison between the two modalities included accuracy of detection of IAs was assessed. Results: Patient's age ranged from 17 and 70 years (average 42.8 ± 7.9 years), and 20 patients (64.5%) were females. SAH was the initial presentation in 20 patients (64.5%), five patients (16%) with headache and seizures disorder had a mass lesion on CT scans demonstrating a large IAs, and CT scans were normal in 6 patients (19.4%). Both of CTA and DSA studies detected 29 IAs in 28 patients (90.3%). Three patients had no IAs detected in both CTA and DSA examinations, in one patient operated for repeated SAH with intracerbral hematoma, a small internal carotid artery blister was detected intraoperatively and clipped. Twenty-two patients (78.6%) underwent craniotomy and microsurgical clipping of IAs, and endovascular coiling was performed in 6 patients. CTA was effective in the post-treatment follow up and evaluation of IAs; however, in two patients CTA was not accurate in assessing the recurrence of the aneurysms. Conclusion: CTA provides accurate and valuable information for patients with cerebral aneurysms. It can be used alone for the diagnosis, treatment planning, and post-treatment follow up of IAs.
Journal of research in medical sciences : the official journal of Isfahan University of Medical Sciences, 2011
In order to declare the preoperative diagnostic value of brain aneurysms, two radiological modalities, computed tomographic angiography and digital subtraction angiography were compared. In this descriptive analytic study, diagnostic value of computed tomographic angiography (CTA) was compared with digital subtraction angiography (DSA). Sensitivity, specificity, positive and negative predictive values were calculated and compared between the two modalities. All data were analyzed with SPSS software, version 16. Mean age of patients was 49.5 ± 9.13 years. 57.9 % of subjects were female. CTA showed 89% sensitivity and 100% specificity whereas DSA demonstrated 74% sensitivity and 100% specificity. Positive predictive value of both methods was 100%, but negative predictive value of CTA and DSA was 85% and 69%, respectively. Based on our data, CTA is a valuable diagnostic modality for detection of brain aneurysm and subarachnoid hemorrhage.
Neuroradiology, 2007
Introduction We sought to establish whether CT angiography (CTA) can be applied to the planning and performance of clipping or coiling in ruptured intracranial aneurysms without recourse to intraarterial digital subtraction angiography (IA-DSA). Methods Over the period April 2003 to January 2006 in all patients presenting with a subarachnoid haemorrhage CTA was performed primarily. If CTA demonstrated an aneurysm, coiling or clipping was undertaken. IA-DSA was limited to patients with negative or inconclusive CTA findings. We compared CTA images with findings at surgery or coiling in patients with positive CTA findings and in patients with negative and inconclusive findings in whom IA-DSA had been performed. Results In this study, 224 consecutive patients (mean age 52.7 years, 135 women) were included. In 133 patients (59%) CTA demonstrated an aneurysm, and CTA was followed directly by neurosurgical (n=55) or endovascular treatment (n=78). In 31 patients (14%) CTA findings were categorized as inconclusive, and in 60 (27%) CTA findings were negative. One patient received surgical treatment on the basis of false-positive CTA findings. In 17 patients in whom CTA findings were inconclusive, IA-DSA provided further diagnostic information required for correct patient selection for any therapy. Five ruptured aneurysms in patients with a nonperimesencephalic SAH were negative on CTA, and four of these were also false-negative on IA-DSA. On a patient basis the positive predictive value, negative predictive value, sensitivity, specificity and accuracy of CTA for symptomatic aneurysms were 99%, 90%, 96%, 98% and 96%, respectively. Conclusion CTA should be used as the first diagnostic modality in the selection of patients for surgical or endovascular treatment of ruptured intracranial aneurysms. If CTA renders inconclusive results, IA-DSA should be performed. With negative CTA results the complementary value of IA-DSA is marginal. IA-DSA is not needed in patients with negative CTA and classic perimesencephalic SAH. Repeat IA-DSA or CTA should still be performed in patients with a nonperimesencephalic SAH.
Journal of Clinical Neuroscience, 2014
Current management guidelines for CT scan-negative subarachnoid haemorrhage (SAH) patients recommend cerebral digital subtraction angiography (DSA). We aimed to investigate the utility of CT angiography (CTA) as a substitute for DSA in these patients. We included patients who presented with SAH confirmed by spectrophotometric xanthochromia analysis of cerebrospinal fluid (CSF) whereby the CT scan was negative. Electronic records were reviewed to collect data on non-contrast CT scan, CTA and DSA results. Patients without DSA or with other explanations for CSF xanthochromia were excluded. Sixty-three patients with CT scan-negative SAH were included. The diagnosis of SAH was confirmed by CSF analysis. All 63 patients underwent both DSA and CTA. Using DSA as the benchmark, CTA demonstrated a negative predictive value, positive predictive value, sensitivity and specificity of 98%, 82%, 90% and 96%, respectively, for the detection of intracranial aneurysms. CTA correctly identified patients in whom there were no underlying aneurysms responsible for SAH, with one patient with suspected dissection referred for further evaluation using MRI and DSA.
Stroke, 2013
A neurysmal subarachnoid hemorrhage (SAH) is associated with high morbidity and case fatality. 1 Twenty percent of patients develop intraparenchymal extension of the hemorrhage, which is associated with worse outcome. 2 In addition, many patients develop expansion of the parenchymal hematoma in the initial 48 hours after aneurysmal rupture, but this can be attributed to rerupture of their aneurysms in only half of patients. 3 The mechanism for hematoma expansion in the remaining patients is unclear but might be similar to that involved in expansion in primary intracerebral hemorrhage (ICH). In such patients, expansion of the hematoma is an important predictor of poor outcome. 4,5 During recent years, contrast extravasation following computed tomography angiography (CTA), termed the spot sign, has been shown to be an important and independent predictor of both hematoma expansion and poor clinical outcome (Figure). 6-9 The presence of a CTA spot sign marks those patients at highest risk for hematoma expansion, and may, therefore, provide a similar marker in patients with aneurysmal SAH with intraparenchymal extension. The aim of this study was to assess the occurrence of a CTA spot sign in patients with ICH from aneurysmal rupture and to assess whether the spot sign is a predictor of poor outcome, as it is in patients with primary ICH. We, therefore, conducted a 2-center study to assess the prevalence and predictive value of the CTA spot sign in those patients. Methods Study Design We studied prospectively collected data from 2 consecutive series of patients with aneurysmal SAH and ICH: 1 at Massachusetts General Hospital Boston and
Computed Tomographic Angiography for Cerebral Aneurysms in Spontaneous Subarachnoid Hemorrhage
Arquivos Brasileiros de Neurocirurgia: Brazilian Neurosurgery, 2016
Computed tomographic angiography (CTA) has recently gained popularity as an initial imaging test for spontaneous subarachnoid hemorrhage (SAH). This study evaluated 59 patients presenting aneurysmal SAH who underwent microsurgical clipping based on CTA findings alone and digital subtraction angiography (DSA) at postoperative follow-up. Multiple aneurysms were identified by CTA in 27% of patients and in 10% of patients, DSA identified aneurysms in addition to those diagnosed with CTA. The time between CTA and surgical treatment ranged from 0-4 days. Postoperative DSA revealed that 24% of patients had residual neck. The use of CTA alone may not be enough to detect small unruptured aneurysms in patients with multiple lesions or aneurysm remnants adjacent to an aneurysm clip. However, the advantages of CTA compared with DSA include its rapidity, reduced invasiveness, and lower cost, which allow us to proceed to ruptured aneurysm repair entirely on the basis of good-quality CTA studies.
Spiral CT angiography in diagnosis of cerebral aneurysms of cases with acute subarachnoid hemorrhage
M ortality is high in subarachnoid hemorrhages (SAH) due to rupture of aneurysms. Most deaths occur due to the first bleeding or repetitive bleeding (1, 2). For this reason, fast and accurate evaluation of the patients is of great importance in planning the therapeutic interventions. For the time being, selective digital subtraction angiography (DSA) is used as the standard method in diagnosis and preoperative evaluation of cerebral aneurysms. Although the permanent neurologic complication risk is low (0.07%-0.5%) in DSA exams performed in cases with suspected cerebral aneurysms, this method is invasive, time consuming and expensive (3). DSA has high sensitivity and specificity values in diagnosis of cerebral aneurysms while false negative results ranging from 5% to 10% have been reported in the literature (4). The main reason for this is, not being able to obtain the optimal projections necessary for diagnosis of some aneurysms due to physical limitations rather than the insufficiency of spatial resolution of the angiography machine (5). When compared to DSA, spiral CT angiography (CTA) is a faster and a more easily applied method. In contrast to another non-invasive imaging method, magnetic resonance angiography (MRA), spiral CTA enables faster acquisition of three dimensional images related to the cerebral vascular anatomy without patient motion artifacts or artifacts due to flow rate. Another advantage of CTA is its applicability following routine non-enhanced cranial computed tomography (CT) in patients with suspected SAH in emergency conditions. In this study, we aimed to compare the effectiveness of single detector spiral CTA to DSA in diagnosis and evaluation of intracranial aneurysms in cases with acute SAH.