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Three-dimensional CT angiography of intracranial vasospasm following subarachnoid haemorrhage
R Takagi1, H Hayashi, H Kobayashi
1Department of Radiology, Nippon Medical School Hospital, Tokyo, Japan. ryota@nms.ac.jp
Insights
Three-dimensional CT angiography (3D-CTA) effectively diagnoses intracranial vasospasm after subarachnoid hemorrhage (SAH). This imaging technique identified vasospasm in most patients, confirmed by catheter angiography.
Area of Science:
- Neurology
- Radiology
- Neurosurgery
Background:
- Subarachnoid hemorrhage (SAH) frequently leads to delayed cerebral vasospasm, a significant cause of morbidity and mortality.
- Early and accurate diagnosis of intracranial vasospasm is crucial for timely intervention and improved patient outcomes.
Purpose of the Study:
- To evaluate the diagnostic utility of three-dimensional CT angiography (3D-CTA) in identifying intracranial vasospasm in patients following SAH.
- To compare 3D-CTA findings with conventional catheter angiography in a subset of patients.
Main Methods:
- Retrospective analysis of 13 patients with suspected intracranial vasospasm post-SAH.
- Three-dimensional CT angiography (3D-CTA) was performed to visualize intracranial vessels.
- Catheter angiography was used as a confirmatory diagnostic tool in selected cases.
- Follow-up 3D-CTA was conducted in nine patients after one week.
Main Results:
- 3D-CTA clearly depicted intracranial vessels in 12 out of 13 patients.
- Vasospasm was identified by 3D-CTA in nine patients.
- Catheter angiography confirmed vasospasm in seven of these patients.
- Ischemic lesions secondary to vasospasm were noted in two patients on CT.
- Follow-up 3D-CTA showed resolution of vasospasm in nine patients; three showed no change.
Conclusions:
- Three-dimensional CT angiography (3D-CTA) is a valuable, non-invasive tool for diagnosing intracranial vasospasm following subarachnoid hemorrhage (SAH).
- 3D-CTA findings correlate well with conventional angiography, aiding in clinical decision-making.
- The technique allows for serial assessment of vasospasm, facilitating monitoring of treatment efficacy.
Abstract:
We evaluated the usefulness of three-dimensional CT angiography (3D-CTA) in the diagnosis of intracranial vasospasm following subarachnoid haemorrhage (SAH) in 13 patients suspected of having vasospasm on clinical grounds. The intracranial vessels were clearly shown by 3D-CTA in 12 patients. 3D-CTA revealed spasm in the vessels of nine patients. Catheter angiography performed in seven of these patients immediately after 3D-CTA confirmed vasospasm. A low-attenuation area was seen on CT in the other two patients, representing an ischaemic lesion due to the spasm. In nine patients, a second 3D-CTA was performed using the same technique 1 week after the first, showing no vasospasm. Initial 3D-CTA revealed no vasospasm change in three patients. Following 3D-CTA, one of these had conventional angiography, which also demonstrated no spasm.