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ECR 2013 / C-1840
CT angiography in patients with acute spontaneous intracranial hemorrhage:detection and characterisation of intracranial aneurysms: comparison of Volumen Rendering and Maximum Intensity Projection algorithms
Congress: ECR 2013
Poster No.: C-1840
Type: Scientific Exhibit
Keywords: Neuroradiology brain, Vascular, CT-Angiography, Catheter arteriography, Diagnostic procedure, Aneurysms, Haemorrhage
Authors: Z. Merhemic1, M. Niksic1, S. Milisic1, E. Burazerovic1, I. Omerhodzic1, E. Avdagic1, D. Bulja1, M. M. Thurnher2; 1Sarajevo/BA, 2Vienna/AT


Intracranial hemorrhage is the most common cause of neurologic defficiency. It is considered as indication for emergency diagnostic procedure.

Non-traumatic intracranial hemorrhage is classified according to its localisation as subarachnoid hemorrhage (SAH), intracerebral hematoma (ICH), intraventricular hemorrhage (IVH), and subdural hematoma (SDH).

Cause of non-traumatic hemorrhage in 80-90% cases is aneurysm rupture, in young patient vascular malformation, and in eldery patients high blood pressure or hemorrhagic transformation of a cerebral infarct can cause intracranial hemorrhage. Less frequentlly, the cause of intracranial hemorrhage can be coagullopathy, or bleeding inside the tumor proces.

The objective of brain imaging is to identify the hemorrhage according to its different stages and to find a potential underlying cause because of the risk of recurrence and the possibilities of treatment.

The accuret identification and characterization of intracranial hemorrhage are among the most critical functions of a radiologist. Thay have important and immediate implications for further diagnostic workup, clinical management, and patient outcome.

In emergency, the diagnosis of intracranial hemorrhage is often obtained by CT scan. In some cases, according to the patient age, the medical history and the location of the hemorrhage, it may be necessary to perform an angiography in order to exclude an intracranial aneurysm or vascular malformation

Selective intra-arterial subtraction angiography (DSA) is considered to be the gold standard for demonstrating aneurysms or arteriovenous malformations in patients with acute spontaneous  intracracranial hemorrhage. Complications to  DSA occure in approximaly 1% of the procedures. Although the risk is small, complications such as permanent disability or even death cannot be excluded, and there is the need for non-ivasive diagnostic procedure.

During the past ten years, noninvasive imaging techniques CT angiography, MR angiography  has advanced and try to replace  DSA in patient with non-traumatic  intracranial hemorrhage.


The aim of this study is to compare maximum intensity projection (MIP) and volume rendering (VR) CT angiography in detection and characterization of intracranial aneurysms  in patients with acute non-traumatic hemorrhage, using surgical finding or digital subtraction angiography (DSA) as the “gold standard”, to reduce need for invasive procedures.

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