Multidetector-row CT angiography of cerebral vasospasm after aneurysmal subarachnoid hemorrhage: comparison of volume-rendered images and digital subtraction angiography.

BACKGROUND AND PURPOSE Cerebral vasospasm remains a major problem in patients recovering after surgical treatment of cerebral aneurysms. The purpose of this study was to evaluate cerebral vasospasm at multidetector-row spiral CT angiography (MDCTA) compared with digital subtraction angiography (DSA) in patients with aneurysmal subarachnoid hemorrhages (SAHs). METHODS Seventeen patients suspected of having vasospasm on clinical findings underwent both postoperative MDCTA and DSA. MDCTA was analyzed by using volume-rendered images as well as axial images. A total of 251 arterial segments were analyzed for vasospasm by using a 5-point grading system. The MDCTA results were then compared with findings on the corresponding DSA images. Sensitivity, specificity, and accuracy of MDCTA for detection of hemodynamically significant spasms were also calculated, with findings at DSA used as the reference standard. RESULTS On DSA, 74 spasmatic segments were found among the 251 segments evaluated, and 40 segments with hemodynamically significant vasospasms were present. The overall agreement between MDCTA and DSA was 95.2%. We had 12 (4.8%) cases of disagreement between MDCTA and DSA. In 11 segments, the degree of stenosis was overestimated at MDCTA. Overall accuracy, sensitivity and specificity of MDCTA in the detection of hemodynamically significant vasospasm were 97.5%, 98.1%, and 98.0%, respectively, with positive and negative predictive values of 90.7% and 99.5%. CONCLUSION MDCTA appears to be a reliable alternative imaging technique to DSA in the assessment of patients with cerebral vasospasm after aneurysmal SAH.

[1]  S. Aoki,et al.  Cerebral aneurysm; Detection and delineation using 3D-CT angiography , 1992 .

[2]  Elliott Jp,et al.  Neuroradiologic diagnosis and treatment of vasospasm. , 1997 .

[3]  M S van Leeuwen,et al.  Subarachnoid hemorrhage: aneurysm detection and preoperative evaluation with CT angiography. , 1998, Radiology.

[4]  J. Dion,et al.  Risk of cerebral angiography in patients with subarachnoid hemorrhage, cerebral aneurysm, and arteriovenous malformation: a meta-analysis. , 1999, Stroke.

[5]  J. Krejza,et al.  Importance of angle correction in the measurement of blood flow velocity with transcranial Doppler sonography. , 2001, AJNR. American journal of neuroradiology.

[6]  T Faillot,et al.  Three-dimensional computed tomographic angiography in detection of cerebral aneurysms in acute subarachnoid hemorrhage. , 1997, Neurosurgery.

[7]  N. Kassell,et al.  Sensitivity and specificity of transcranial Doppler ultrasonography in the diagnosis of vasospasm following subarachnoid hemorrhage , 1989, Neurology.

[8]  M. Costanza,et al.  Transcranial Doppler Versus Angiography in Patients With Vasospasm due to a Ruptured Cerebral Aneurysm: A Systematic Review , 2001, Stroke.

[9]  R. Klucznik,et al.  Placement of a ferromagnetic intracerebral aneurysm clip in a magnetic field with a fatal outcome. , 1993, Radiology.

[10]  J E Heiserman,et al.  Titanium aneurysm clips: Part III--Clinical application in 16 patients with subarachnoid hemorrhage. , 1996, Neurosurgery.

[11]  J. M. Findlay,et al.  CT angiography for the detection of cerebral vasospasm in patients with acute subarachnoid hemorrhage. , 2000, AJNR. American journal of neuroradiology.

[12]  Role of transcranial Doppler monitoring in the diagnosis of cerebral vasospasm after subarachnoid hemorrhage , 1999, Neurosurgery.

[13]  J. Pryor,et al.  Complications of diagnostic cerebral angiography and tips on avoidance. , 1996, Neuroimaging clinics of North America.

[14]  K. Ogasawara,et al.  Evaluation of Vasospasm after Subarachnoid Hemorrhage by Use of Multislice Computed Tomographic Angiography , 2002, Neurosurgery.

[15]  P. Stieg,et al.  Evaluation of cerebral aneurysms with helical CT: correlation with conventional angiography and MR angiography. , 1994, Radiology.

[16]  S. Aoki,et al.  Cerebral aneurysms: detection and delineation using 3-D-CT angiography. , 1992, AJNR. American journal of neuroradiology.

[17]  B. Weir,et al.  Time course of vasospasm in man. , 1978, Journal of neurosurgery.

[18]  C. Truwit,et al.  Multi‐slice computed tomography angiography in the detection of residual or recurrent cerebral aneurysms after surgical clipping , 2004, Acta radiologica.

[19]  R. Aaslid,et al.  Evaluation of cerebrovascular spasm with transcranial Doppler ultrasound. , 1984, Journal of neurosurgery.

[20]  L. Puybasset,et al.  Intra-arterial nimodipine for the treatment of symptomatic cerebral vasospasm after aneurysmal subarachnoid hemorrhage: preliminary results. , 2004, AJNR. American journal of neuroradiology.

[21]  D C Levin,et al.  Renal artery stenosis: CT angiography--comparison of real-time volume-rendering and maximum intensity projection algorithms. , 1999, Radiology.

[22]  R. Macdonald,et al.  Role of angiography following aneurysm surgery. , 1993, Journal of neurosurgery.

[23]  H. Steiger,et al.  Postoperative spiral computed tomography and magnetic resonance angiography after aneurysm clipping with titanium clips. , 1997, Neurosurgery.

[24]  N. Kassell,et al.  Treatment of cerebral vasospasm with intra-arterial papaverine. , 1992, Journal of neurosurgery.

[25]  W. Sorteberg,et al.  Cerebral vasospasm diagnosis by means of angiography and blood velocity measurements , 2005, Acta Neurochirurgica.

[26]  R. Takagi,et al.  Three-dimensional CT angiography of intracranial vasospasm following subarachnoid haemorrhage , 1998, Neuroradiology.

[27]  R. Armonda,et al.  Therapeutic modalities for the management of cerebral vasospasm: timing of endovascular options. , 1999, Neurosurgery.

[28]  J. Krejza,et al.  Transcranial color Doppler sonography of basal cerebral arteries in 182 healthy subjects: age and sex variability and normal reference values for blood flow parameters. , 1999, AJR. American journal of roentgenology.