Purpose
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,...
Methods and Materials
In the period of one and half year,
150 patients (95 female,
55 male,
range age 15-77 years,
mean age 52.79 years) with acute non-traumatic intracranial hemorrhage was performed CT angiography on 4 row or 64 row CT unit.
Separately were evaluated MIP and VR reconstruction for presence,
location and size of aneurysm.
After CT angiography was performed,
patients were operated under CTA finding,
or DSA was performed.
Results
In 121 patients 150 aneurysms were detected. In 101 patients was detected one aneurysm (83%),
in 14 two aneurysms (12%),
in 4 patients three aneurysms (3%),
in 1 patient four and in 1 five aneurysms (1%).
Most of aneurysms were diagnose on MCA (41%),
and were medium size (60%) (Table 1.)
Table 1.
Aneurysms diagnosed on surgery and DSA („gold standard“)
≤ 3mm
4-10mm
11-24mm
≥25mm
ACA
9
33
5
0
47 31%
MCA
12
36
13
1
62 41%
PCA
0
0
1
0...
Conclusion
All aneurysms larger than 3mm were diagnosed on MIP and VR reconstruction CTangiography.
Based on our results,
the evaluation of volume rendering(VR) reconstruction only should be sufficient for detection and characterization of intracranial aneurysms.
There was significant difference between the size of aneurysms found during surgery and estimated based on MIP or VR reconstructions.
Aneurysms were found larger on surgery than measured on CT angiography.
References
1.
McKinney AM,Palmer CS,Truwit CL,Karagulle A,Teksam M.Detection of aneurysms by 64-section multidetector CT angiography in patients acutely suspected of having an intracranial aneurysm and comparison with digital subtraction and 3D rotational angiography.AJNR.2008 Mar;29(3):594-602.
2.Osborn AG.
Subarachnoid hemorrhage and aneurysms.In: Osborn AG,
Salzman KL,
Barkovich AJ.
Diagnostic imaging: Brain.
2nd.ed.Salt Lake City:Amirsys,
2010Part I;Section 3:14-16.
3.Yoon DY,
Chang CS,
Choi CS,Kim WK,
Lee JH.
Multidetector row CT angiography in spontaneous lobar intracerebral hemorrhage: A prospective comparison with conventional angiograph.
AJNR.2009May; 30:962-967.
4.Numminen J,
Tarkiainen A,
Niemela...