Subarachnoid hemorrhage other imaging findings
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Subarachnoid Hemorrhage Microchapters |
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Subarachnoid hemorrhage other imaging findings On the Web |
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Risk calculators and risk factors for Subarachnoid hemorrhage other imaging findings |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Sara Mehrsefat, M.D. [2]
Overview
Other imaging findings
Once a subarachnoid hemorrhage is confirmed, the next question is about its origin. CT angiography (using radiocontrast) to identify aneurysms is generally the first step, as invasive angiography (injecting radiocontrast through a catheter advanced to the brain arteries) has a small rate of complications but is useful if there are plans to obliterate the source of bleeding, such as an aneurysm, at the same time.
Digital-subtraction cerebral angiography
Digital-subtraction cerebral angiography is used in the following conditions:[1][2][3]
- Uncertain diagnosis after CT scan and LP
- In patients with septic endocarditis and SAH to search for mycotic aneurysms
- To provide surgical information such as:
- Cerebrovascular anatomy
- Aneurysm location and source of bleeding
- Aneurysm size and shape
- Relation of the aneurysm to the parent artery and perforating arteries
- Presence of multiple or mirror aneurysms
CT angiography
CT angiography of the intracranial vessels is noninvasive test which is routinely performed in patients presenting with acute subarachnoid hemorrhage.[4][5]
- Useful for screening and pre surgical planning
- Identifying aneurysms 3 to 5 mm or larger with a high degree of sensitivity
Advantages of CTA may include:[6]
- The speed and ease by which it can be obtained
- Usefulness in the acute setting in a rapidly declining patient who needs emergent craniotomy
- Offers a more practical approach to acute diagnosis
MR angiography
MR angiography of the intracranial vessels is noninvasive test which is routinely performed in patients presenting with acute subarachnoid hemorrhage.[4]
- Useful for screening and pre surgical planning
- Identifying aneurysms 3 to 5 mm or larger with a high degree of sensitivity
Indications for magnetic resonance angiography in aSAH are still few because of the limitations, such as:
- Difficulty in scanning acutely ill patients
- predisposition to motion artifact
- Patient compliance
- Longer study time
- Cost
Repeat angiography
Around 25% all cases of subarachnoid hemorrhage (SAH) with initial negative angiography may have positive result on repeat angiogram. It is necessary to repeat digital subtraction angiography within 4 to 14 days in all cases of subarachnoid hemorrhage with negative initial angiogram.[8][9][10]
False negative angiography may result from:[9][10][11][12]
- Technical or reading errors
- Small aneurysm size
- Obscuration of the aneurysm secondary to thrombosis, vasospasm,or hematoma
- Patients with perimesencephalic SAH
References
- ↑ Lu L, Zhang LJ, Poon CS, Wu SY, Zhou CS, Luo S; et al. (2012). "Digital subtraction CT angiography for detection of intracranial aneurysms: comparison with three-dimensional digital subtraction angiography". Radiology. 262 (2): 605–12. doi:10.1148/radiol.11110486. PMID 22143927.
- ↑ Li Q, Lv F, Li Y, Luo T, Li K, Xie P (2009). "Evaluation of 64-section CT angiography for detection and treatment planning of intracranial aneurysms by using DSA and surgical findings". Radiology. 252 (3): 808–15. doi:10.1148/radiol.2523081911. PMID 19508992.
- ↑ Cloft HJ, Joseph GJ, Dion JE (1999). "Risk of cerebral angiography in patients with subarachnoid hemorrhage, cerebral aneurysm, and arteriovenous malformation: a meta-analysis". Stroke. 30 (2): 317–20. PMID 9933266.
- ↑ 4.0 4.1 Li MH, Cheng YS, Li YD, Fang C, Chen SW, Wang W; et al. (2009). "Large-cohort comparison between three-dimensional time-of-flight magnetic resonance and rotational digital subtraction angiographies in intracranial aneurysm detection". Stroke. 40 (9): 3127–9. doi:10.1161/STROKEAHA.109.553800. PMID 19556531.
- ↑ Chappell ET, Moure FC, Good MC (2003). "Comparison of computed tomographic angiography with digital subtraction angiography in the diagnosis of cerebral aneurysms: a meta-analysis". Neurosurgery. 52 (3): 624–31, discussion 630-1. PMID 12590688.
- ↑ Papke K, Kuhl CK, Fruth M, Haupt C, Schlunz-Hendann M, Sauner D; et al. (2007). "Intracranial aneurysms: role of multidetector CT angiography in diagnosis and endovascular therapy planning". Radiology. 244 (2): 532–40. doi:10.1148/radiol.2442060394. PMID 17641372.
- ↑ Radiopedia, CT angiphraphy in subarachnoid hemorrhage https://radiopaedia.org/cases/mca-trifurcation-aneurysm-cta-1
- ↑ Rinkel GJ, van Gijn J, Wijdicks EF (1993). "Subarachnoid hemorrhage without detectable aneurysm. A review of the causes". Stroke. 24 (9): 1403–9. PMID 8362440.
- ↑ 9.0 9.1 Tatter SB, Crowell RM, Ogilvy CS (1995). "Aneurysmal and microaneurysmal "angiogram-negative" subarachnoid hemorrhage". Neurosurgery. 37 (1): 48–55. PMID 8587690.
- ↑ 10.0 10.1 Urbach H, Zentner J, Solymosi L (1998). "The need for repeat angiography in subarachnoid haemorrhage". Neuroradiology. 40 (1): 6–10. PMID 9493179.
- ↑ Rinkel GJ, Wijdicks EF, Hasan D, Kienstra GE, Franke CL, Hageman LM; et al. (1991). "Outcome in patients with subarachnoid haemorrhage and negative angiography according to pattern of haemorrhage on computed tomography". Lancet. 338 (8773): 964–8. PMID 1681340.
- ↑ Schwartz TH, Solomon RA (1996). "Perimesencephalic nonaneurysmal subarachnoid hemorrhage: review of the literature". Neurosurgery. 39 (3): 433–40, discussion 440. PMID 8875472.