Hostname: page-component-cd9895bd7-gbm5v Total loading time: 0 Render date: 2024-12-27T03:39:41.453Z Has data issue: false hasContentIssue false
  • English
  • Français

Comparison of CTA to DSA in Determining the Etiology of Spontaneous ICH

Published online by Cambridge University Press:  02 December 2014

Robert Yeung ,
Tabassum Ahmad ,
Richard I. Aviv ,
Lyne Noel de Tilly ,
Allan J. Fox  and
Sean P. Symons
Robert Yeung
Affiliation:
Division of Neuroradiology, Department of Medical Imaging, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
Tabassum Ahmad
Affiliation:
Division of Neuroradiology, Department of Medical Imaging, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
Richard I. Aviv
Affiliation:
Division of Neuroradiology, Department of Medical Imaging, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
Lyne Noel de Tilly
Affiliation:
Division of Neuroradiology, Department of Medical Imaging, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
Allan J. Fox
Affiliation:
Division of Neuroradiology, Department of Medical Imaging, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
Sean P. Symons*
Affiliation:
Division of Neuroradiology, Department of Medical Imaging, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
*
Neuroradiology, Department of Medical Imaging, Sunnybrook Health Sciences Centre; Department of Medical Imaging, University of Toronto, Sunnybrook Research Institute, Section of Neuroradiology, Ontario Medical Association, 2075 Bayview Avenue, Room AG31D, Toronto, Ontario, M4N 3M5, Canada
Rights & Permissions [Opens in a new window]

Abstract

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.
Background and Purpose:

To compare the efficacy of computed tomographic angiography (CTA) to that of digital subtraction angiography (DSA) in the detection of secondary causes of intracerebral hemorrhage (ICH).

Methods:

Between January 2001 and February 2007 there were 286 patients that had both CTA and DSA for intracranial hemorrhage of all types. Those with primarily subarachnoid hemorrhage or recent trauma were excluded. Fifty-five patients formed the study cohort. Three reviewers independently analyzed the CTAs in a blinded protocol and classified them based on presence or absence of a secondary etiology. Results were compared with the reference standard DSA and kappa values determined for interobserver variability.

Results:

The overall sensitivity, specificity, positive predictive value, negative predictive value and accuracy of CTA were 89%, 92%, 91%, 91% and 91%, respectively. Kappa value for interobserver agreement ranged from 0.78 to 0.89. Two of four dural arteriovenous fistulas (dAVF) were missed on CTA by all three reviewers.

Conclusion:

CTA is nearly as effective as DSA at determining the cause of secondary intracerebral hemorrhage, but with a lower sensitivity for dAVFs. This supports the use of CTA as the first screening test in patients presenting with spontaneous ICH.

Type
Original Article
Information
Canadian Journal of Neurological Sciences , Volume 36 , Issue 2 , March 2009 , pp. 176 - 180
Copyright
Copyright © The Canadian Journal of Neurological 2009

References

1.Dennis, MS, Burn, JP, Sandercock, PA, Bamford, JM, Wade, DT, Warlow, CP.Long-term survival after first-ever stroke: the Oxfordshire Community Stroke Project. Stroke. 1993;24(6):796–800.CrossRefGoogle ScholarPubMed
2.Halpin, SF, Britton, JA, Byrne, JV, Clifton, A, Hart, G, Moore, A.Prospective evaluation of cerebral angiography and computed tomography in cerebral haematoma. J Neurol Neurosurg Psychiatry. 1994;57(10):1180–6.CrossRefGoogle ScholarPubMed
3.Unlu, E, Temizoz, O, Albayram, S, Genchellac, H, Hamamcioglu, MK, Kurt, I, et al.Contrast-enhanced MR 3D angiography in the assessment of brain AVMs. Eur J Radiol. 2006;60(3):367–78.CrossRefGoogle ScholarPubMed
4.Chuah, KC, Stuckey, SL, Berman, IG.Silent embolism in diagnostic cerebral angiography: detection with diffusion weighted imaging. Australas Radiol. 2004;48(2):133–8.CrossRefGoogle ScholarPubMed
5.Chappell, ET, Moure, FC, Good, MC.Comparison of computed tomographic angiography with digital subtraction angiography in the diagnosis of cerebral aneurysms: a meta-analysis. Neurosurgery. 2003;52(3):624–31.CrossRefGoogle ScholarPubMed
6.Hoh, BL, Cheung, AC, Rabinov, JD, Pryor, JC, Carter, BS, Ogilvy, CS.Results of a prospective protocol of computed tomographic angiography in place of catheter angiography as the only diagnostic and pretreatment planning study for cerebral aneurysms by a combined neurovascular team. Neurosurgery. 2004;54(6):1329–42.CrossRefGoogle ScholarPubMed
7.Agid, R, Lee, SK, Willinsky, RA, Farb, RI, terBrugge, KG.Acute subarachnoid hemorrhage: using 64-slice multidetector CT angiography to “triage” patients’ treatment. Neuroradiology. 2006;48(11):787–94.CrossRefGoogle ScholarPubMed
8.Wu, J, Chen, X, Shi, Y, Chen, S.Noninvasive three-dimensional computed tomographic angiography in preoperative detection of intracranial arteriovenous malformations. Chin Med J (Engl). 2000;113(10):915–20.Google ScholarPubMed
9.Coenen, VA, Dammert, S, Reinges, MH, Mull, M, Gilsbach, JM, Rohde, V.Image-guided microneurosurgical management of small cerebral arteriovenous malformations: the value of navigated computed tomographic angiography. Neuroradiology. 2005;47(1):66–72.CrossRefGoogle ScholarPubMed
10.Sanelli, PC, Mifsud, MJ, Stieg, PE.Role of CT angiography in guiding management decisions of newly diagnosed and residual arteriovenous malformations. Am J Roentgenol. 2004;183(4):1123–6.CrossRefGoogle ScholarPubMed
11.Kwon, BJ, Han, MH, Kang, HS, Chang, KH.MR imaging findings of intracranial dural arteriovenous fistulas: relations with venous drainage patterns. Am J Neuroradiol. 2005;26(10):2500–7.Google ScholarPubMed
12.Meckel, S, Lovblad, KO, Abdo, G, Ruiz, DS, Delavelle, J, Radue, EW, et al.Arterialization of cerebral veins on dynamic MDCT angiography: a possible sign of a dural arteriovenous fistula. Am J Roentgnol. 2005;184(4):1313–6.CrossRefGoogle ScholarPubMed
13.Alatakis, S, Koulouris, G, Stuckey, S.CT-demonstrated transcalvarial channels diagnostic of dural arteriovenous fistula. Am J Neuroradiol. 2005;26(9):2393–6.Google ScholarPubMed
14.Metoki, T, Mugikura, S, Higano, S, Ezura, M, Matsumoto, Y, Hirayama, K, et al.Subcortical calcification on CT in dural arteriovenous fistula with cortical venous reflux. Am J Neuroradiol. 2006;27(5):1076–8.Google Scholar
15.Evans, AL, Coley, SC, Wilkinson, ID, Griffiths, PD.First-line investigation of acute intracerebral hemorrhage using dynamic magnetic resonance angiography. Acta Radiol. 2005;46(6): 625–30.CrossRefGoogle ScholarPubMed
16.Laissy, JP, Normand, G, Monroc, M, Duchateau, C, Alibert, F, Thiebot, J.Spontaneous intracerebral hematomas from vascular causes. Predictive value of CT compared with angiography. Neuroradiology. 1991;33(4):291–5.CrossRefGoogle ScholarPubMed
17.Zhu, XL, Chan, MS, Poon, WS.Spontaneous intracranial hemorrhage: which patients need diagnostic cerebral angiography? A prospective study of 206 cases and review of the literature. Stroke. 1997;28(7):1406–9.CrossRefGoogle ScholarPubMed