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CT angiography in non-traumatic subarachnoid hemorrhage: the importance of arterial attenuation for the detection of intracranial aneurysms.
Acta Radiol. 2015 Oct; 56(10):1248-55.AR

Abstract

BACKGROUND

Computed tomography angiography (CTA) is today the primary method for the detection of intracranial aneurysms. The technique has evolved considerably during the last decade, and it is important to establish criteria for high image quality, especially with regard to improving the diagnosis of small aneurysms.

PURPOSE

To evaluate diagnostic accuracy and image quality by arterial attenuation of CTA in patients with non-traumatic subarachnoid hemorrhage (SAH).

MATERIAL AND METHODS

Between 2005 and 2011, CTA and digital subtraction angiography (DSA) were performed in 326 patients with non-traumatic SAH. Sensitivity and specificity for aneurysm detection were evaluated per patient, per aneurysm, and per ruptured aneurysm. The image quality of CTA was evaluated by arterial attenuation measurements (mean Hounsfield units [HU]) in the internal carotid artery (ICA).

RESULTS

In all, 285 aneurysms in 235 patients were detected by DSA, 19 aneurysms were missed on CTA, and 223 aneurysms were classified as ruptured. In 91 patients, no aneurysm was found. Correct diagnosis with CTA was made in 28 patients with perimesencephalic hemorrhage. Sensitivity and specificity (95% confidence interval) calculated per patient were 91.6% (87.3-94.9) and 87.9% (79.8-93.6), respectively, per aneurysm 93.3% (89.7-95.9) and 88% (79.9-93.6), and per ruptured aneurysm 94.9% (91.3-97.3) and 96.7% (90.7-99.3). Arterial attenuation (in HU) in CTA revealing true positive ruptured aneurysms and true negative aneurysms (mean 535 ± 110 HU) differed significantly (P = 0.02) from false negative ruptured aneurysms (mean 424 ± 30 HU).

CONCLUSION

CTA has high sensitivity and specificity for the detection of ruptured aneurysms. The sensitivity is related to arterial attenuation in the ICA.

Links

Publisher Full Text (DOI)

Authors+Show Affiliations

Ramgren B
Department for Medical Imaging and Physiology, Department of Radiology, Skåne University Hospital and Lund University, Sweden birgitta.ramgren@med.lu.se.
Siemund R
Department for Medical Imaging and Physiology, Department of Radiology, Skåne University Hospital and Lund University, Sweden.
Nilsson OG
Department of Neurosurgery, Skåne University Hospital and Lund University, Sweden.
Höglund P
Competence Centre for Clinical Research, Skåne University Hospital and Lund University, Sweden.
Larsson EM
Uppsala University Hospital, Department of Radiology, Uppsala, Sweden.
Abul-Kasim K
Department for Medical Imaging and Physiology, Department of Radiology, Skåne University Hospital and Lund University, Sweden.
Björkman-Burtscher IM
Department for Medical Imaging and Physiology, Department of Radiology, Skåne University Hospital and Lund University, Sweden Lund University Bioimaging Center (LBIC), Lund University, Sweden.

MeSH

AdolescentAdultAgedAged, 80 and overAneurysm, RupturedAngiography, Digital SubtractionCerebral AngiographyContrast MediaFemaleHumansIntracranial AneurysmIopamidolMaleMiddle AgedSensitivity and SpecificitySubarachnoid HemorrhageTomography, X-Ray Computed

Pub Type(s)

Journal Article

Language

eng

PubMed ID

25293950

Citation

Ramgren, Birgitta, et al. "CT Angiography in Non-traumatic Subarachnoid Hemorrhage: the Importance of Arterial Attenuation for the Detection of Intracranial Aneurysms." Acta Radiologica (Stockholm, Sweden : 1987), vol. 56, no. 10, 2015, pp. 1248-55.
Ramgren B, Siemund R, Nilsson OG, et al. CT angiography in non-traumatic subarachnoid hemorrhage: the importance of arterial attenuation for the detection of intracranial aneurysms. Acta Radiol. 2015;56(10):1248-55.
Ramgren, B., Siemund, R., Nilsson, O. G., Höglund, P., Larsson, E. M., Abul-Kasim, K., & Björkman-Burtscher, I. M. (2015). CT angiography in non-traumatic subarachnoid hemorrhage: the importance of arterial attenuation for the detection of intracranial aneurysms. Acta Radiologica (Stockholm, Sweden : 1987), 56(10), 1248-55. https://doi.org/10.1177/0284185114551976
Ramgren B, et al. CT Angiography in Non-traumatic Subarachnoid Hemorrhage: the Importance of Arterial Attenuation for the Detection of Intracranial Aneurysms. Acta Radiol. 2015;56(10):1248-55. PubMed PMID: 25293950.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - CT angiography in non-traumatic subarachnoid hemorrhage: the importance of arterial attenuation for the detection of intracranial aneurysms. AU - Ramgren,Birgitta, AU - Siemund,Roger, AU - Nilsson,Ola G, AU - Höglund,Peter, AU - Larsson,Elna-Marie, AU - Abul-Kasim,Kasim, AU - Björkman-Burtscher,Isabella M, Y1 - 2014/10/07/ PY - 2014/05/11/received PY - 2014/08/27/accepted PY - 2014/10/9/entrez PY - 2014/10/9/pubmed PY - 2015/11/17/medline KW - CTA KW - DSA KW - Subarachnoid hemorrhage KW - image quality KW - intracranial aneurysm SP - 1248 EP - 55 JF - Acta radiologica (Stockholm, Sweden : 1987) JO - Acta Radiol VL - 56 IS - 10 N2 - BACKGROUND: Computed tomography angiography (CTA) is today the primary method for the detection of intracranial aneurysms. The technique has evolved considerably during the last decade, and it is important to establish criteria for high image quality, especially with regard to improving the diagnosis of small aneurysms. PURPOSE: To evaluate diagnostic accuracy and image quality by arterial attenuation of CTA in patients with non-traumatic subarachnoid hemorrhage (SAH). MATERIAL AND METHODS: Between 2005 and 2011, CTA and digital subtraction angiography (DSA) were performed in 326 patients with non-traumatic SAH. Sensitivity and specificity for aneurysm detection were evaluated per patient, per aneurysm, and per ruptured aneurysm. The image quality of CTA was evaluated by arterial attenuation measurements (mean Hounsfield units [HU]) in the internal carotid artery (ICA). RESULTS: In all, 285 aneurysms in 235 patients were detected by DSA, 19 aneurysms were missed on CTA, and 223 aneurysms were classified as ruptured. In 91 patients, no aneurysm was found. Correct diagnosis with CTA was made in 28 patients with perimesencephalic hemorrhage. Sensitivity and specificity (95% confidence interval) calculated per patient were 91.6% (87.3-94.9) and 87.9% (79.8-93.6), respectively, per aneurysm 93.3% (89.7-95.9) and 88% (79.9-93.6), and per ruptured aneurysm 94.9% (91.3-97.3) and 96.7% (90.7-99.3). Arterial attenuation (in HU) in CTA revealing true positive ruptured aneurysms and true negative aneurysms (mean 535 ± 110 HU) differed significantly (P = 0.02) from false negative ruptured aneurysms (mean 424 ± 30 HU). CONCLUSION: CTA has high sensitivity and specificity for the detection of ruptured aneurysms. The sensitivity is related to arterial attenuation in the ICA. SN - 1600-0455 UR - https://www.unboundmedicine.com/medline/citation/25293950/CT_angiography_in_non_traumatic_subarachnoid_hemorrhage:_the_importance_of_arterial_attenuation_for_the_detection_of_intracranial_aneurysms_ DB - PRIME DP - Unbound Medicine ER -