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CT angiography for evaluation of cerebral vasospasm following acute subarachnoid haemorrhage
Jai Jai Shiva Shankar1, Irene Y L Tan, Timo Krings
1Division of Neuroradiology, Department of Diagnostic Imaging, QEII Health Sciences Center, Dalhousie University, Halifax, Canada. shivajai1@rediffmail.com
Insights
CT angiography (CTA) effectively diagnoses central cerebral vasospasm (CV) after subarachnoid hemorrhage (SAH), aiding treatment decisions like angioplasty. This non-invasive method shows high accuracy for central CV, guiding clinical management.
Area of Science:
- Neurology
- Radiology
- Neurosurgery
Background:
- Cerebral vasospasm (CV) is a significant complication following acute subarachnoid hemorrhage (SAH).
- Conventional cerebral angiography (DSA) is the diagnostic gold standard but is invasive.
- CT angiography (CTA) offers a non-invasive alternative for diagnosing CV.
Purpose of the Study:
- To evaluate CT angiography (CTA) as a non-invasive diagnostic tool for cerebral vasospasm (CV).
- To assess CTA's accuracy in diagnosing central and peripheral CV.
- To determine if CTA findings can guide appropriate treatment decisions for CV.
Main Methods:
- Consecutive SAH patients with suspected CV underwent both CTA and DSA within 24 hours.
- Two independent neuro-radiologists retrospectively analyzed CTA and DSA studies.
- Assessment included presence and severity grading of central and peripheral CV; treatment recommendations based on CTA were compared to actual treatment.
Main Results:
- CTA demonstrated high sensitivity and specificity for diagnosing central CV (e.g., sensitivity 91-92%, specificity 73-90%).
- Accuracy for grading the severity of central CV was high in most major arteries.
- CTA-based angioplasty recommendations correlated significantly with actual treatment, though overestimated 'triple H' therapy.
Conclusions:
- CT angiography (CTA) is adequate for detecting central cerebral vasospasm (CV) in symptomatic SAH patients.
- A negative CTA result should not preclude further investigation, especially near metallic artifacts.
- CTA is valuable in guiding treatment decisions, particularly for the need for balloon angioplasty.
Introduction:
Cerebral vasospasm (CV) is one of the most dreaded complications in patients who survive acute subarachnoid haemorrhage (SAH), and conventional cerebral angiography (DSA) is the gold standard for its diagnosis. We evaluated CT angiography (CTA) as a non-invasive alternative for diagnosis of CV and assessed if CTA could have a role in choosing appropriate treatment.
Methods:
Consecutive patients with SAH and suspected vasospasm were included when DSA was performed within 24 h from CTA. Two neuro-radiologists retrospectively analysed CTA and DSA studies independently. Assessment included presence of central and peripheral vasospasm and grading of severity of central CV. A treatment recommendation based on CTA was compared to actual treatment received.
Results:
Final analysis included 34 patients. CTA was more accurate for diagnosis of central then for peripheral CV with high sensitivity (reader 1, 91%; reader 2, 92%), specificity (reader 1, 73%; reader 2, 90%), accuracy, positive predictive value and negative predictive value for central vasospasm. For grading the severity of CV CTA's sensitivity, specificity and accuracy were high for most central arteries. The reader's recommendation of angioplasty according to CTA was significantly predictive of actual receipt of angioplasty but overestimated actual receipt of triple H treatment.
Conclusion:
CTA is adequate for detecting central vasospasm in symptomatic SAH patients. A negative result should not prevent further investigation especially when evaluating arterial segments adjacent to metal artefacts from coils or clips. CTA is helpful in treatment decision making specifically regarding the need for balloon angioplasty.
