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Computerized tomography in vascular malformations of the brain
Insights
Computerized tomography (CT) scans effectively identify intracranial hemorrhage sources, particularly in angiomatous malformations. CT excels in diagnosing hemorrhage origin compared to angiography, especially for certain aneurysm and angioma types.
Area of Science:
- Neuroradiology
- Diagnostic Imaging
- Neurology
Background:
- Intracranial hemorrhage diagnosis relies on imaging modalities.
- Aneurysms and angiomatous malformations are common causes of hemorrhage.
- Differentiating between these vascular lesions is crucial for patient management.
Purpose of the Study:
- To evaluate the diagnostic accuracy of computerized tomography (CT) scans in identifying the source of intracranial hemorrhage.
- To compare CT findings with angiographic and clinical data for aneurysms and angiomatous malformations.
- To assess CT's utility in detecting specific features like vasogenic edema and calcifications.
Main Methods:
- Retrospective review of CT scans from 166 patients (99 with aneurysms, 67 with angiomatous malformations).
- Correlation of CT findings with angiographic and clinical data.
- Analysis of CT scan performance in diagnosing hemorrhage source, lesion size, and associated findings.
Main Results:
- CT identified intracranial hemorrhage in 103 patients.
- CT diagnosed the hemorrhage source with higher certainty in angiomatous malformations (40%) compared to aneurysms (12%).
- CT detected low density lesions (vasogenic edema) in 18 cases and calcifications in 10 angiomas; contrast enhancement aided visualization of smaller lesions.
Conclusions:
- CT is valuable for diagnosing intracranial hemorrhage and its source, especially in angiomatous malformations.
- CT provides complementary information to angiography, particularly for thrombosed giant aneurysms.
- CT can identify angiographically occult angiomas and associated findings like calcifications in Sturge-Weber's disease.
Abstract:
Computerized tomography scans of 166 patients - 99 cases with 117 aneurysms, and 67 cases with angiomatous malformations - were reviewed and correlated with angiographic and clinical findings. An intracranial hemorrhage was identified by CT scan in 103 patients, in 60 cases with aneurysms (17 only subarachnoid, 43 intracerebral), and in 43 cases with angiomas (6 only subarachnoid, 37 intracerebral). The source of hemorrhage was diagnosed with varying degrees of certainty with CT scan in 12 (12%) cases with aneurysms and in 27 (40%) cases with angiomas. Further CT findings were low density lesions in 18 cases indicating vasogenic edma, and calcifications in 10 angiomas. Intravenous infusion of contrast material was necessary to distinguish smaller aneurysms and angiomas. CT scan demonstrated the presence and location of thrombosed portions of giant aneurysms; these findings were less apparent with angiography. In 29 angiomas of medium or large size (macroangiomas) the malformation was demonstrated with CT scan in 25 (86%) cases and with angiography in 26 cases. 3 angiographically occult angiomas were diagnosed with CT as low density lesions and misinterpreted as gliomas. In all 36 microangiomas only the hemorrhage was precisely diagnosed with CT. The microangioma was identified angiographically in 24 cases and histologically in 21. In Sturge-Weber's disease the calcifications may be seen earlier with CT than with skull x-ray.