Diagnostic yield of computed tomography angiography and magnetic resonance angiography in patients with catheter angiography–negative subarachnoid hemorrhage

Clinical article

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  • 1 Division of Neuroradiology, Mallinckrodt Institute of Radiology,
  • 2 Department of Neurological Surgery,
  • 3 Department of Neurology, and
  • 4 Neurology/Neurosurgery Intensive Care Unit, Washington University School of Medicine, Saint Louis, Missouri;
  • 5 Division of Interventional Neuroradiology, Abbott Northwestern Hospital, and
  • 6 Division of Interventional Neuroradiology, University of Minnesota School of Medicine, Minneapolis, Minnesota; and
  • 7 Department of Neurological Surgery, Emory University, Atlanta, Georgia
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Object

The yield of CT angiography (CTA) and MR angiography (MRA) in patients with subarachnoid hemorrhage (SAH) who have a negative initial catheter angiogram is currently not well understood. This study aims to determine the yield of CTA and MRA in a prospective cohort of patients with SAH and a negative initial catheter angiogram.

Methods

From January 1, 2005, until September 1, 2010, the authors instituted a prospective protocol in which patients with SAH—as documented by noncontrast CT or CSF xanthochromia and a negative initial catheter angiogram— were evaluated using CTA and MRA to assess for causative cerebral aneurysms. Two neuroradiologists independently evaluated the noncontrast CT scans to determine the SAH pattern (perimesencephalic or not) and the CT and MR angiograms to assess for causative cerebral aneurysms.

Results

Seventy-seven patients were included, with a mean age of 52.8 years (median 54 years, range 19–88 years). Fifty patients were female (64.9%) and 27 male (35.1%). Forty-three patients had nonperimesencephalic SAH (55.8%), 29 patients had perimesencephalic SAH (37.7%), and 5 patients had CSF xanthochromia (6.5%). Computed tomography angiography demonstrated a causative cerebral aneurysm in 4 patients (5.2% yield), all of whom had nonperimesencephalic SAH (9.3% yield). Mean aneurysm size was 2.6 mm (range 2.1–3.3 mm). Magnetic resonance angiography demonstrated only 1 of these aneurysms. No causative cerebral aneurysms were found in patients with perimesencephalic SAH or CSF xanthochromia.

Conclusions

Computed tomography angiography is a valuable adjunct in the evaluation of patients with nonperimesencephalic SAH who have a negative initial catheter angiogram, demonstrating a causative cerebral aneurysm in 9.3% of patients.

Abbreviations used in this paper:ACoA = anterior communicating artery; CTA = CT angiography; LOS = length of stay; MRA = MR angiography; PCA = posterior cerebral artery; PCoA = posterior communicating artery; PICA = posterior inferior cerebellar artery; SAH = subarachnoid hemorrhage.

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Contributor Notes

Address correspondence to: Josser E. Delgado Almandoz, M.D., Division of Interventional Neuroradiology, Abbott Northwestern Hospital, 800 East 28th Street, Minneapolis, Minnesota 55407. email: josser.delgado@crlmed.com.

Please include this information when citing this paper: published online June 8, 2012; DOI: 10.3171/2012.4.JNS112306.

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