Detection and evaluation of intracranial aneurysms with 16-row multislice CT angiography
Geoffrey TipperJ. U-King-ImStephen J. PriceRikin TrivediJustin CrossNicholas J. HigginsRoger W. FarmerJosephine WatRamez KirollosPeter J. KirkpatrickNagui M. AntounJonathan H. Gillard
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Keywords:
Digital subtraction angiography
Multislice
Computed Tomography Angiography
Objective
To estimate the cognitive function of subarachnoid hemorrhage patients with negative digital subtraction angiography (DSA), and analyse its relevant factors and clinical characteristics.
Methods
96 subarachnoid hemorrhage patients were selected, and the disease condition were classfied into different grades by Fisher scale, Hunt-Hess scale and the cognitive function were estimated by mini-mental state examination(MMSE), then calculated its incidence, analysed the relationship between the classification and cognitive impairments.
Results
The incidences of cognitive impairment in subarachnoid hemorrhage patients with negative DSA were 51.04%. Cognitive impairment was closely related to Hunt-Hess and Fisher grade (P<0.01).
Conclusion
Subarachnoid hemorrhage patients with negative DSA exist different extent of cognitive impairment.The higher Hunt-Hess or Fisher grade, the more serious cognitive impairment.
Key words:
Subarachnoid hemorrhage; Cognitive impairment; Digital subtraction angiography
Digital subtraction angiography
Subtraction
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Abstract The purpose of writing this case study was to compare the accuracy of computed tomography angiography (CTA) and 3D rotational digital subtraction angiography (3D DSA) in demonstrating a giant cerebral aneurysm and its relationship to the parent artery. The patient was a 36‐year‐old female who presented to our department with a suspected cerebral aneurysm as seen on a non‐contrast computerised tomography (CT) brain scan. The CTA and 3D DSA were performed on consecutive days and both demonstrated a giant aneurysm arising from the right posterior cerebral artery. A series of 3D images were produced from both modalities, with each possessing sub‐millimeter spatial resolution. After comparison between the two 3D data sets, it was evident that the 3D DSA was superior in delineating the relationship between the aneurysm and its parent artery. The CTA suffered from partial voluming in this area and it seemed as though a connection was present between the aneurysm and posterior cerebral artery distal to the aneurysm neck. Based on the CTA alone, an incorrect report would have resulted. Surgery later confirmed the absence of this connection and, thereby, proved that 3D DSA was more accurate in the visualisation of this patient's aneurysm. Treatment for this patient could therefore be planned more confidently based on the 3D DSA findings.
Digital subtraction angiography
Rotational angiography
Computed Tomography Angiography
Subtraction
Anterior cerebral artery
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Objective To analyse the clinical features and cerebral angiography of subarachnoid hemorrhage(SAH). Methods 110 patients with SAH were reviewed retrospectively to determine the symptoms,etiology and cerebral angiography. Results Major clinical features of SAH were headache,vomiting and positive meniugimus.65 cases obtained etiological diagnosis by cerebral angiography including cerebral aneurysm in 64 cases,vascular malformation in 17 cases,arterial stenosis in 11 cases. Conclusion The cerebral aneurysm is the most common cause for SAH,and the effective diagnostic method of SAH is cerebral angiography.
Etiology
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The necessity of cerebral angiography was assessed in patients with thunderclap headache in whom subarachnoid hemorrhage had been ruled out on CT findings and the color of cerebrospinal fluid (CSF).The subjects of this study were 350 patients with thunderclap headache in whom subarachnoid hemorrhage was ruled out at our clinic based on CT findings and the color of CSF. The time span from the onset of thunderclap headache to the first visit to our clinic ranged from 1 to 9 days (mean: 2.5 days). The ages of the patients ranged from 22 to 64 years. 147 were male and 203 female. All patients underwent CT angiography. Percutaneous cerebral angiography was also performed in cases in which cerebral aneurysms were suspected on CT angiography or the CSF cell count was elevated (over 10/3mm3 on white blood cells).(1) Of the 350 patients, 162 were suspected to have cerebral aneurysms when examined by CT angiography. When these 162 patients were examined by percutaneous cerebral angiography, cerebral aneurysms were found in 34 patients (9.7%). (2) Four patients had an elevated CSF cell count. Cerebral aneurysms were found in all these patients. (3) Of the 34 patients with cerebral aneurysms, 31 consented to and underwent direct surgery. Localized subarachnoid hemorrhage around their aneurysms was found in seven (22.6%) of these 31 patients intraoperatively. Elevation in CSF cell count was shown in three of these patients.Even when CT and CSF studies reveal no abnormalities in the early stage after the onset of thunderclap headache, subarachnoid hemorrhage can not be ruled out. Therefore, cerebral angiography is recommended in patients with thunderclap headache.
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Poster: ECR 2015 / C-1947 / The role of CT-angiography in the diagnostic of cerebral aneurysm as a cause of subarachnoid hemorrhage by: T. Gramada, B. I. Dobrovat, D. Negru; Iasi/RO
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Objective:To study the character of cerebral angiography for spontaneous subarachnoid hemorrhage(SAH).Methods: 66 patients with SAH were reviewed retrospectively in terms of clinical symptoms,cerebral CT and cerebral angiography.Results: The major etiology of SAH was identified as intracranial aneurysm,with medium-sized or small-sized intracranial aneurysm as majority. Rotary digital subtraction angiography showed the special relationship of the intracranial aneurysm to anatomic position.The amount of subarachnoid blood from computed tomography(CT) scan were not necessarily matched with the size of aneurysm.The seriousness of cerebral vasospasm in young adults was greater compared with the older.Conclusion: The intracranial aneurysm is the most common cause for SAH,cerebral angiography can make accurate diagnosis of the intracranial aneurysm to anatomic position,appearance and size,and it is chief instrument to ascertain the cause of subarachnoid hemorrhage.
Digital subtraction angiography
Cerebral Vasospasm
Etiology
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Objective To compare computed tomography angiography (CTA) with digital subtraction angiography (DSA) in diagnosis and pre-operative evaluation of aortic dissection(AD). Methods The data of sixty patients with AD who were examined by both CTA and DSA were analyzed retrospectively. Some outcomes, including the anchoring distance proximal to the intimal tear, the aortic diameter of the left side of the left subclavian artery(LSA), the extent of AD and involvement of main aortic branches, were compared between CTA and DSA. Results The anchoring distance more than 15 mm from the tears to the origin of the LSA was found in 44 (44/51, 86.2%) and 46(46/56,82.1%)cases by CTA and DSA, respectively, and anchoring distance less than 15 mm in 7(7/51,13.7%) by CTA and 10(10/56,17.8%) by DSA,respectiely. There were no significant distances in anchoring distance between CTA and DSA (P0.05). Involvement of the left iliac artery (LIA) and the right iliac artery (RIA) was found in 36 cases (36/60,60.0%) and 28 cases(28/60,46.7%) by CTA, and only in 14 cases (14/60,23.0%) and 13 cases(13/60,21.7%) by DSA, respectively, and there were statistical differences(P=0.012,P=0.022). There were no statistical differences in the aortic diameter of the left side of the LSA and involvement of visceral arteries detected by between CTA and DSA. Conclusion The two methods (CTA, DSA) are coincident with each other. Because of non-invasion, CTA has significant value for pre-operative evaluation before endovascular aortic repair.
Digital subtraction angiography
Computed Tomography Angiography
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Cerebral panangiography was performed in 594 patients with subarachnoid hemorrhage from intracranial aneurysms. Aneurysm of the middle cerebral arteries was the most frequent location of aneurysms in this material. Multiple aneurysms of the middle cerebral arteries are far more frequent than the combination of other locations. Judged from this material there is a 7 per cent possibility of finding a contralateral aneurysm of the middle cerebral arteries if one is found. Multiple aneurysms were found in 51 (8.6%) of the 594 patients. We conclude that the results of this study are typical for Norwegians, although some selection exists since the patients were first admitted to other hospitals. The frequency of complications with cerebral panangiography in subarachnoid hemorrhage was less than that of cerebral angiography in patients with other diseases.
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Abstract: Brain computed tomography angiography (CTA) is a useful tool for detecting subarachnoid hemorrhage (SAH) and cerebral aneurysms, but less reliably when cerebral aneurysms which are smaller than 2 mm. We present a case of spontaneous SAH and intraventricular hemorrhage (IVH) with negative findings on brain CTA. Due to the clinical presentation and positive neurologic examination, lumbar puncture was performed and xanthochromia of cerebrospinal fluid (CSF) had been noted. Cerebral angiography was performed and showed a small unruptured saccular cerebral aneurysm (<2 mm).
Computed Tomography Angiography
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In this study, the authors' goal was to minimize false-negative results in the detection of ruptured cerebral aneurysms.The authors retrospectively reviewed the clinical and radiological information in consecutive adult patients admitted with acute subarachnoid hemorrhage (SAH) to their hospital between January 1, 2002, and January 1, 2008. Patients were grouped based on the presence or absence of a ruptured aneurysm, which was detected by catheter angiography. Multivariate logistic regression analysis was used to identify factors predicting detection of aneurysmal rupture by angiography.The authors identified 199 patients (121 women [61%]). A ruptured aneurysm was detected in 167 patients (84%). In multivariate analysis, loss of consciousness at the onset of SAH was a strong predictive factor associated with detection of a ruptured aneurysm on subsequent angiography (OR > 100, p = 0.0002). The positive predictive value of loss of consciousness at the onset of SAH for detection of a ruptured aneurysm was 100%.Loss of consciousness at the onset of SAH is highly predictive of aneurysm rupture. A negative CT angiography study in these patients may be a false result, and a high-quality catheter angiography should be performed.
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