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Related Experiment Video

Updated: Jun 23, 2026

Endovascular Perforation Model for Subarachnoid Hemorrhage Combined with Magnetic Resonance Imaging (MRI)
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Published on: December 16, 2021

Aneurysmal and non-aneurysmal SAH--is initial computed tomography predictive?

A Weyerbrock1, M Woznica, S K Rosahl

  • 1Allgemeine Neurochirurgie, Universitätsklinikum Freiburg. astrid.weyerbrock@uniklinikfreiburg.de

Rofo : Fortschritte Auf Dem Gebiete Der Rontgenstrahlen Und Der Nuklearmedizin
|April 30, 2009
PubMed
Summary

CT bleeding patterns can predict angiographic results in subarachnoid hemorrhage (SAH). Type 0-1 SAH patterns may allow omitting repeat angiography if initial digital subtraction angiography (DSA) is high-quality.

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Last Updated: Jun 23, 2026

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Published on: December 9, 2021

Area of Science:

  • Neuroradiology
  • Diagnostic Imaging
  • Neurosurgery

Background:

  • Subarachnoid hemorrhage (SAH) diagnosis can be challenging, particularly when initial angiography is negative.
  • Predicting angiographic findings in negative SAH cases is crucial for appropriate patient management.

Purpose of the Study:

  • To evaluate the predictive value of CT-based bleeding patterns for angiographic results in patients with subarachnoid hemorrhage.
  • To determine if specific CT findings can help stratify patients and guide further diagnostic workup.

Main Methods:

  • A CT-based grading system (Type 0-4) was used to classify bleeding patterns.
  • 112 CT scans of non-aneurysmal SAH (non-ASAH) and 104 CT scans of aneurysmal SAH (ASAH) were analyzed.
  • Bleeding patterns were compared between ASAH and non-ASAH groups.

Main Results:

  • Significant differences in bleeding patterns were observed between ASAH and non-ASAH patients (p < 0.0001).
  • 40% of non-ASAH patients showed no or prepontine blood (Type 0+1), while 60% had Sylvian fissure involvement (Type 2+3).
  • No intracerebral hemorrhage (Type 4) was noted in non-ASAH patients. All Type 0 and 1 patients had negative initial and repeat angiographies.

Conclusions:

  • CT classification of bleeding patterns is a valuable tool for predicting angiographic outcomes in SAH.
  • Digital subtraction angiography (DSA) remains the gold standard for identifying non-aneurysmal bleeding sources.
  • Repeat angiography may be safely omitted in Type 0 and 1 bleeding cases following a complete, high-quality initial DSA.