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Published on: June 3, 2021
CT and DSA for evaluation of spontaneous intracerebral lobar bleedings
Jens-Christian Altenbernd1,2, Sebastian Fischer3, Wolfram Scharbrodt4
1Department of Radiology, Gemeinschaftskrankenhaus, Herdecke, Germany.
Insights
Computed tomography angiography (CTA) is a reliable initial diagnostic tool for identifying the causes of lobar intracerebral bleeding, showing high accuracy comparable to digital subtraction angiography (DSA). This approach can help pinpoint vascular etiologies effectively in most patients.
Area of Science:
- Neurology
- Radiology
- Vascular Medicine
Background:
- Lobar intracerebral bleeding (ICH) necessitates accurate diagnosis of its underlying cause.
- Identifying the specific vascular etiology is crucial for appropriate patient management and treatment.
Purpose of the Study:
- To evaluate the diagnostic performance of computed tomography angiography (CTA) in identifying the causes of lobar intracerebral bleeding.
- To compare the effectiveness of CTA with digital subtraction angiography (DSA) in detecting macrovascular etiologies.
Main Methods:
- Retrospective analysis of 412 patients with lobar ICH (2002-2020).
- Independent review of CTA and DSA data by two neuroradiologists, with consensus for discrepancies.
- Definition of positive finding as an underlying vascular etiology.
Main Results:
- Digital subtraction angiography (DSA) identified macrovascular causes in 33% of patients (AVMs, aneurysms, vasculitis, dural fistulas).
- Computed tomography angiography (CTA) demonstrated high diagnostic accuracy compared to DSA, with sensitivity of 93%, specificity of 97%, and accuracy of 97%.
- CTA had a 100% positive predictive value, though false negatives occurred for two AVMs and one dural fistula.
Conclusions:
- Computed tomography angiography (CTA) serves as an effective initial diagnostic modality for lobar intracerebral bleeding.
- While DSA remains the gold standard, CTA can successfully identify the cause of bleeding in most cases, offering high sensitivity and specificity.
- The findings support the use of CTA as a primary investigation for lobar ICH.
Purpose:
This study retrospectively examined the extent to which computed tomography angiography (CTA) and digital subtraction angiography (DSA) can help identify the cause of lobar intracerebral bleeding.
Materials And Methods:
In the period from 2002 to 2020, data from patients who were >18 years at a university and an academic teaching hospital with lobar intracerebral bleeding were evaluated retrospectively. The CTA DSA data were reviewed separately by two neuroradiologists, and differences in opinion were resolved by consensus after discussion. A positive finding was defined as an underlying vascular etiology of lobar bleeding.
Results:
The data of 412 patients were retrospectively investigated. DSA detected a macrovascular cause of bleeding in 125/412 patients (33%). In total, sixty patients had AVMs (15%), 30 patients with aneurysms (7%), 12 patients with vasculitis (3%), and 23 patients with dural fistulas (6%). The sensitivity, specificity, positive and negative predictive values, and accuracy of CTA compared with DSA were 93, 97, 100, and 97%. There were false-negative CTA readings for two AVMs and one dural fistula.
Conclusion:
The DSA is still the gold standard diagnostic modality for detecting macrovascular causes of ICH; however, most patients with lobar ICH can be investigated first with CTA, and the cause of bleeding can be found. Our results showed higher sensitivity and specificity than those of other CTA studies.
