Acute subarachnoid haemorrhage

detection of aneurysms of intracranial arteries by computed tomographic angiography

Abstract

Background. We wanted to determine the diagnostic accuracy, sensitivity and specificity of computed tomographic angiography (CTA) of intracranial vessels,and to establish the advantages and disadvantages of CTA compared to digital subtraction angiography (DSA) as the gold standard in patients with acute subarachnoid haemorrhage (SAH). Patients and methods. We prospectively studied 52 patients with acute SAH. Confirmation of the haemorrhage by a conventional computed tomography (CT) scan was immediately followed by intracranial CTA. DSA was performed after the CTA examination and so did not influence the interpretation of CTA images. The sensitivity, specificity and diagnostic accuracy of CTA were determined by comparing the results with the data from DSA and with the surgical findings. Cases where the CTA and DSA results did not match were analysed, and the advantages and disadvantages of intracranial CTA were determined. Results. The diagnostic accuracy of CTA was 95%, its sensitivity was 93%, and its specificity was 98%. False-negative results were obtained in three patients who harboured small aneurysms, two in the region of the cavernous sinus and one at the division of pericallosal and callosomarginal arteries. In one patient with a false-positive result, DSA showed an infundibular widening of the posterior communicating artery. In all seven patients who underwent operations on the basis of CTA results, the surgical findings confirmed the presence of aneurysms as well as the intracranial vessel anatomy demonstrated by CTA. Conclusions. Intracranial CTAis a fast and minimally invasive method with a high diagnostic accuracy, sensitivity and specificity, which has an important place in the detection andpreoperative evaluation of intracranial aneurysms in patients with acute SAH.

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Data

Language:	English
Year of publishing:	1999
Typology:	1.01 - Original Scientific Article
Organization:	OI - Institute of Oncology
Publisher:	Slovenian Medical Association - Slovenian Association of Radiology, Nuclear Medicine Society, Slovenian Society far Radiotherapy and Oncology, and Slovenian Cancer Society
UDC:	616-006
COBISS:	11070681
ISSN:	1318-2099
Views:	13
Downloads:	2
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Secondary language:	Slovenian
Secondary title:	Akutna subarohnoidna krvavitev
Secondary abstract:	Izhodišče. Namen študije je bil oceniti diagnostično zanesljivost, občutljivost in specifičnost ter prednosti in slabosti računalniškotomografskepreiskave arterij (CTA) intrakranialnih žil glede na digitalno subtrakcijsko angiografsko preiskavo (DSA) (zlati standard) pri bolnikih z akutno subarahnoidno krvavitvijo (SAK). Bolniki in matode. V prospektivno študijo smo vključili 52 bolnikov z akutno subarahnoidno krvavitvijo, pri katerih smo takoj, ko smo krvavitev dokazali s konvencionalnoračunalniško tomografijo (CT) glave, naredili še CTA preiskavo intrakranialnih arterij, tako da rezultati DSA preiskave niso mogli vplivati na rezultate CTA preiskave. Glede na rezultate DSA preiskave in nevrokirurške rezultate smo ocenili diagnostično zanesljivost, senzitivnost in specifičnost CTA preiskave intrakranialnih arterij. Analizirali smo primere, kjer se rezultati CTA preiskave in DSA preiskave niso ujemali. Opredelili smo prednosti in slabosti CTA preiskave. Rezultati. Diagnostična zanesljivost CTA preiskave je bila 95%, občutljivost 93% in specifičnost 98%. Pri treh bolnikihje bila CTA preiskava lažno negativna. Pri dveh bolnikih z lažno negativnim izvidom CTA preiskave je bila manjša anevrizma v področju kavernoznega sinusa, pri enem pa ob razcepišču perikalozne in kalozomarginalnearterije. Pri bolniku z lažno pozitivnim izvidom CTA preiskavesmo z DSA preiskavo pokazali, da gre za infundibularno razširjenje posteriorne komunikantne arterije. Pri vseh sedmih bolnikih, ki so bili operirani samo na podlagi rezultatov CTA preiskave, smo dobro prikazali anevrizmo in intrakranialne arterije. Zaključek. Pri bolnikih z akutno SAK imalahko CTA preiskava pomembno vlogo pri odkrivanju in preoperativni evaluaciji intrakranialnih anevrizem, ker dobimo rezultate hitro in na minimalno invaziven način. CTA preiskava intrakranialnega žilja ima visoko diagnostično zanesljivost, občutljivost in specifičnost.
Secondary keywords:	Subarachnoid hemorrhage;Cerebral aneurysm;Radiography;Cerebral angiography;Angiography, digital subtraction;Tomography, x-ray computed;Carotid artery, internal;
Source comment:	BSDOCID49506;
Pages:	str. 275-282
Volume:	ǂLetn. ǂ33
Issue:	ǂšt. ǂ4
Chronology:	december 1999
ID:	22530232