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Value of the quantity and distribution of subarachnoid haemorrhage on CT in the localization of a ruptured cerebral aneurysm.
Acta Neurochir (Wien). 2003 Aug; 145(8):655-61; discussion 661.AN

Abstract

BACKGROUND

Computed tomography (CT) is the "gold standard" for detecting subarachnoid haemorrhage (SAH) and digital subtraction angiography (DSA) for visualising the vascular pathology. We studied retrospectively 180 patients with subarachnoid haemorrhage (SAH) who underwent first non-enhanced computed tomography (CT), then digital subtraction angiography (DSA) and finally operative aneurysm clipping. Our aim was to assess if the location of the ruptured aneurysm could be predicted on the basis of the quantity and distribution of haemorrhage on the initial CT scan.

METHODS

180 patients with SAH were retrospectively studied. All the CT and DSA examinations were performed at the same hospital. CT was performed within 24 hours after the initial haemorrhage. DSA was performed after the CT, within 48 hours after the initial haemorrhage. Two neuroradiologists, blind to the DSA results, analysed and scored independently the quantity and distribution of the haemorrhage and predicted the site of the ruptured aneurysm on the basis of the non-enhanced CT. DSA provided the location of the ruptured aneurysm. All the patients were operated upon, and the location of the ruptured aneurysm was determined.

FINDINGS

The overall reliability value (kappa-value) between the two neuroradiologists for locating all ruptured aneurysms was 0.780. The corresponding value for the right MCA was 0.911, that for the left MCA 0.877 and that for the AcoA 0.736. Not all of the kappa-values were calculated, either because the location of the rupture was constant or because the number of ruptures in the vessel was too small. Subarachnoid haemorrhage with a parenchymal hematoma is an excellent predictor of the site of the ruptured aneurysm with a statistical significance of p=0.003.

INTERPRETATION

The quantity and pattern of the blood clot on CT within the day of onset of SAH is a reliable and quick tool for locating a ruptured MCA or AcoA aneurysm. It is not, however, reliable for locating other ruptured aneurysms. Subarachnoid haemorrhage with a parenchymal hematoma is an excellent predictor of the site of a ruptured aneurysm.

Authors+Show Affiliations

Karttunen AI
Department of Diagnostic and Interventional Radiology, Oulu University Hospital, PI-50 90029 Oulu, Finland. ari.karttunen@ppshp.fi
Jartti PH
No affiliation info available
Ukkola VA
No affiliation info available
Sajanti J
No affiliation info available
Haapea M
No affiliation info available

MeSH

AdultAgedAneurysm, RupturedAngiography, Digital SubtractionFemaleHumansIntracranial AneurysmMaleMiddle AgedPredictive Value of TestsReproducibility of ResultsRetrospective StudiesSensitivity and SpecificitySubarachnoid HemorrhageTomography, X-Ray Computed

Pub Type(s)

Journal Article
Validation Study

Language

eng

PubMed ID

14520544

Citation

Karttunen, A I., et al. "Value of the Quantity and Distribution of Subarachnoid Haemorrhage On CT in the Localization of a Ruptured Cerebral Aneurysm." Acta Neurochirurgica, vol. 145, no. 8, 2003, pp. 655-61; discussion 661.
Karttunen AI, Jartti PH, Ukkola VA, et al. Value of the quantity and distribution of subarachnoid haemorrhage on CT in the localization of a ruptured cerebral aneurysm. Acta Neurochir (Wien). 2003;145(8):655-61; discussion 661.
Karttunen, A. I., Jartti, P. H., Ukkola, V. A., Sajanti, J., & Haapea, M. (2003). Value of the quantity and distribution of subarachnoid haemorrhage on CT in the localization of a ruptured cerebral aneurysm. Acta Neurochirurgica, 145(8), 655-61; discussion 661.
Karttunen AI, et al. Value of the Quantity and Distribution of Subarachnoid Haemorrhage On CT in the Localization of a Ruptured Cerebral Aneurysm. Acta Neurochir (Wien). 2003;145(8):655-61; discussion 661. PubMed PMID: 14520544.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Value of the quantity and distribution of subarachnoid haemorrhage on CT in the localization of a ruptured cerebral aneurysm. AU - Karttunen,A I, AU - Jartti,P H, AU - Ukkola,V A, AU - Sajanti,J, AU - Haapea,M, PY - 2003/10/2/pubmed PY - 2003/11/7/medline PY - 2003/10/2/entrez SP - 655-61; discussion 661 JF - Acta neurochirurgica JO - Acta Neurochir (Wien) VL - 145 IS - 8 N2 - BACKGROUND: Computed tomography (CT) is the "gold standard" for detecting subarachnoid haemorrhage (SAH) and digital subtraction angiography (DSA) for visualising the vascular pathology. We studied retrospectively 180 patients with subarachnoid haemorrhage (SAH) who underwent first non-enhanced computed tomography (CT), then digital subtraction angiography (DSA) and finally operative aneurysm clipping. Our aim was to assess if the location of the ruptured aneurysm could be predicted on the basis of the quantity and distribution of haemorrhage on the initial CT scan. METHODS: 180 patients with SAH were retrospectively studied. All the CT and DSA examinations were performed at the same hospital. CT was performed within 24 hours after the initial haemorrhage. DSA was performed after the CT, within 48 hours after the initial haemorrhage. Two neuroradiologists, blind to the DSA results, analysed and scored independently the quantity and distribution of the haemorrhage and predicted the site of the ruptured aneurysm on the basis of the non-enhanced CT. DSA provided the location of the ruptured aneurysm. All the patients were operated upon, and the location of the ruptured aneurysm was determined. FINDINGS: The overall reliability value (kappa-value) between the two neuroradiologists for locating all ruptured aneurysms was 0.780. The corresponding value for the right MCA was 0.911, that for the left MCA 0.877 and that for the AcoA 0.736. Not all of the kappa-values were calculated, either because the location of the rupture was constant or because the number of ruptures in the vessel was too small. Subarachnoid haemorrhage with a parenchymal hematoma is an excellent predictor of the site of the ruptured aneurysm with a statistical significance of p=0.003. INTERPRETATION: The quantity and pattern of the blood clot on CT within the day of onset of SAH is a reliable and quick tool for locating a ruptured MCA or AcoA aneurysm. It is not, however, reliable for locating other ruptured aneurysms. Subarachnoid haemorrhage with a parenchymal hematoma is an excellent predictor of the site of a ruptured aneurysm. SN - 0001-6268 UR - https://www.unboundmedicine.com/medline/citation/14520544/Value_of_the_quantity_and_distribution_of_subarachnoid_haemorrhage_on_CT_in_the_localization_of_a_ruptured_cerebral_aneurysm_ DB - PRIME DP - Unbound Medicine ER -