Journal Mobile Options
Table of Contents
Vol. 25, No. 1-2, 2008
Issue release date: February 2008
Cerebrovasc Dis 2008;25:144–150
(DOI:10.1159/000112325)

Prospective Evaluation of Multidetector-Row CT Angiography for the Diagnosis of Vasospasm following Subarachnoid Hemorrhage: A Comparison with Digital Subtraction Angiography

Chaudhary S.R. · Ko N. · Dillon W.P. · Yu M.B. · Liu S. · Criqui G.I. · Higashida R.T. · Smith W.S. · Wintermark M.
To view the fulltext, log in and/or choose pay-per-view option

Individual Users: Register with Karger Login Information

Please create your User ID & Password





Contact Information











I have read the Karger Terms and Conditions and agree.

To view the fulltext, please log in

To view the pdf, please log in

Abstract

Purpose: To evaluate the accuracy of multidetector-row CT angiography (CTA) for the diagnosis of large-vessel vasospasm following subarachnoid hemorrhage by comparison to digital subtraction angiography (DSA). Methods: Thirty-three patients with acute subarachnoid hemorrhage were enrolled in a prospective study and underwent a total of 40 CTA and DSA examinations within 24 h of each other. Two neuroradiologists reviewed the CTA examinations independently. A third neuroradiologist blinded to the CTA results reviewed the DSA examinations. In each patient, for both techniques, 23 arterial segments were evaluated for their degree of narrowing; the reviewers were asked to attribute every narrowing to ‘vasospasm’ or ‘hypoplasia’. Agreement between CTA and DSA for the degree of narrowing, and agreement between the two CTA readers, were calculated using weighted ĸ-coefficients. Sensitivity, specificity, accuracy, positive and negative predictive value (NPV) of CTA to detect large-vessel vasospasm were calculated considering DSA as the gold standard. Results: Substantial correlation (ĸ = 0.638) was found between CTA and DSA for the detection of arterial narrowing. Interobserver agreement between the two CTA reviewers for the degree of luminal narrowing was substantial (ĸ = 0.712).CTA was 87% accurate for the diagnosis of large-vessel vasospasm; the NPV of CTA was 95%. CTA was more accurate, and interobserver agreement higher, for the proximal arterial segments (basilar and vertebral arteries) than for the distal ones (P2 segments). Using CTA as a screening modality, 83% of unnecessary DSA would have been avoided. Conclusion: Compared to the gold standard of DSA, CTA is accurate for the detection of large-vessel vasospasm, and has a very high NPV.



Copyright / Drug Dosage

Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher or, in the case of photocopying, direct payment of a specified fee to the Copyright Clearance Center.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in goverment regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

References

  1. Hop JW, Rinkel GJ, Algra A, van Gijn J: Case-fatality rates and functional outcome after subarachnoid hemorrhage: a systematic review. Stroke 1997;28:660–664.
  2. Biller J, Godersky JC, Adams HP Jr: Management of aneurysmal subarachnoid hemorrhage. Stroke 1988;19:1300–1305.
  3. Findlay JM, Deagle GM: Causes of morbidity and mortality following intracranial aneurysm rupture. Can J Neurol Sci 1998;25:209–215.
  4. Lindegaard KF: The role of transcranial Doppler in the management of patients with subarachnoid haemorrhage: a review. Acta Neurochir Suppl 1999;72:59–71.
  5. Cesarini KG, Hardemark HG, Persson L: Improved survival after aneurysmal subarachnoid hemorrhage: review of case management during a 12-year period. J Neurosurg 1999;90:664–672.
  6. Higashida RT, Halbach VV, Dowd CF, Dormandy B, Bell J, Hieshima GB: Intravascular balloon dilatation therapy for intracranial arterial vasospasm: patient selection, technique, and clinical results. Neurosurg Res 1992;15:89–95.
  7. Eskridge JM, McAuliffe W, Song JK, Deliganis AV, Newell DW, Lewis DH, Mayberg MR, Winn HR: Balloon angioplasty for the treatment of vasospasm: results of first 50 cases. Neurosurgery 1998;42:510–516.
  8. Kassell NF, Helm G, Simmons N, Phillips CD, Cail WS: Treatment of cerebral vasospasm with intra-arterial papaverine. J Neurosurg 1992;77:848–852.
  9. Sloan MA, Haley EC Jr, Kassell NF, Henry ML, Stewart SR, Beskin RR, Sevilla EA, Torner JC: Sensitivity and specificity of transcranial Doppler ultrasonography in the diagnosis of vasospasm following subarachnoid hemorrhage. Neurology 1989;39:1514–1518.
  10. American Academy of Neurology: Assessment: transcranial Doppler. Neurology 1990;40:680–681.

    External Resources

  11. Manno EM, Gress DR, Schwamm LH, Diringer MN, Ogilvy CS: Effects of induced hypertension on transcranial Doppler ultrasound velocities in patients after subarachnoid hemorrhage. Stroke 1998;29:422–428.
  12. Takagi R, Hayashi H, Kobayashi H, Kumazaki T, Isayama K, Ikeda Y, Teramoto A: Three-dimensional CT angiography of intracranial vasospasm following subarachnoid hemorrhage. Neuroradiology 1998;40:631–635.
  13. Anderson GB, Ashforth R, Steinke DE, Findlay JM: CT Angiography for the detection of cerebral vasospasm in patients with acute subarachnoid hemorrhage. Am J Neuroradiol 2000;21:1011–1015.
  14. Otawara Y, Ogasawara K, Ogawa A, Sasaki M, Takahashi K: Evaluation of vasospasm after subarachnoid hemorrhage by use of multislice computed tomographic angiography. Neurosurgery 2002;51:939–942.
  15. Yoon DY, Choi CS, Kim KH, Cho BM: Multidetector-row CT angiography of cerebral vasospasm after aneurysmal subarachnoid hemorrhage: comparison of volume-rendered images and digital subtraction angiography. Am J Neuroradiol 2006;27:370–377.
  16. Samuels OB, Joseph GJ, Lynn MJ, Smith HA, Chimowitz MI: A standardized method for measuring intracranial arterial stenosis. AJNR 2000;21:643–646.
  17. Goddard AJP, Tan G, Becker J: Computed tomography angiography for the detection and characterization of intra-cranial aneurysms: current status. Clin Radiol 2005;60:1221–1236.
  18. Wang G, Frei T, Vannier MW: Fast iterative algorithm for metal artifact reduction in X-ray CT. Acad Radiol 2000;7:607–614.
  19. Wintermark M, Ko NU, Smith WS, Liu S, Higashida RT, Dillon WP: Vasospasm after subarachnoid hemorrhage: utility of perfusion CT and CT angiography of diagnosis and management. AJNR 2006;27:26–34.
  20. Laslo AM, Eastwood JD, Chen FX, Lee TY: Dynamic CT perfusion imaging in subarachnoid hemorrhage-related vasospasm. AJNR 2006;27:624–631.
  21. Binaghi S, Colleoni ML, Maeder P, Uske A, Regli L, Dehdashti AR, Schnyder P, Meuli R: CT angiography and perfusion CT in cerebral vasospasm after subarachnoid hemorrhage. AJNR 2007;28:750–758.
  22. Gahn G, Gerber J, Hallmeyer S, Reichmann H, von Kummer R: Noninvasive assessment of the circle of Willis in cerebral ischemia: the potential of CT angiography and contrast-enhanced transcranial color-coded duplexsonography. Cerebrovasc Dis 1999;9:290–294.


Pay-per-View Options
Direct payment This item at the regular price: USD 38.00
Payment from account With a Karger Pay-per-View account (down payment USD 150) you profit from a special rate for this and other single items.
This item at the discounted price: USD 26.50