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Bergin B, Ragulojan M, Trivedi A, Kesserwan M, Farrokhyar F, Sharma S. Computed Tomography Angiography Compared with Computed Tomography Perfusion in the Diagnosis of Cerebral Vasospasm: A Systematic Review and Meta-Analysis. World Neurosurg 2023; 170:e340-e350. [PMID: 36368456 DOI: 10.1016/j.wneu.2022.11.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 11/04/2022] [Accepted: 11/05/2022] [Indexed: 11/10/2022]
Abstract
INTRODUCTION Cerebral vasospasm (CV) is a serious complication after subarachnoid hemorrhage; however, swift identification can be challenging. Computed tomography perfusion (CTP) directly measures tissue perfusion and may better screen for CV compared with other modalities. This systematic review summarizes studies assessing the diagnostic performance of computed tomography angiography (CTA) and CTP in identifying CV. METHODS The search strategy drew from English language publications in the PubMed, Embase, Medline, and Cochrane databases from January 1996 to September 2021. Diagnosis of CV by digital subtraction angiography was the reference standard. Pooled sensitivity, specificity, positive predictive values (PPV), negative predictive values (NPV), positive likelihood ratios, negative likelihood ratios, and summary receiver operating characteristic curve were calculated. The methodological index for nonrandomized studies tool was employed to assess the quality of the studies. RESULTS The search generated 22 studies. Seven CTA studies and 6 CTP investigations provided sufficient data for meta-analysis. Following pooled estimates, CTA carried a sensitivity of 0.76 (95% confidence interval [CI], 0.72-0.80), specificity of 0.93 (95% CI, 0.92-0.95), PPV of 0.77 (95%, 0.76-0.79), and NPV of 0.81 (95%, 0.79-0.82). CTP carried a sensitivity of 0.86 (95%, 0.81-0.92), specificity of 0.97 (95%, 0.95-0.98), PPV of 0.94 (0.89-0.98), and NPV of 0.94 (0.91-0.97). Using the methodological index for nonrandomized studies tool, the evidence was rated as overall moderate quality. CONCLUSIONS This meta-analysis on the diagnostic performance of CTA and CTP in identifying CV suggests that CTP may carry greater diagnostic accuracy compared with CTA. The clinical significance of this difference should be delineated through future prospective studies.
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Affiliation(s)
- Brad Bergin
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada; CRANI Group, McMaster University, Hamilton, Ontario, Canada
| | - Malavan Ragulojan
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada; CRANI Group, McMaster University, Hamilton, Ontario, Canada.
| | - Arunachala Trivedi
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada; CRANI Group, McMaster University, Hamilton, Ontario, Canada
| | - Mohamad Kesserwan
- CRANI Group, McMaster University, Hamilton, Ontario, Canada; Division of Neurosurgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Forough Farrokhyar
- CRANI Group, McMaster University, Hamilton, Ontario, Canada; Division of Neurosurgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Sunjay Sharma
- CRANI Group, McMaster University, Hamilton, Ontario, Canada; Division of Neurosurgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
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Ledbetter LN, Burns J, Shih RY, Ajam AA, Brown MD, Chakraborty S, Davis MA, Ducruet AF, Hunt CH, Lacy ME, Lee RK, Pannell JS, Pollock JM, Powers WJ, Setzen G, Shaines MD, Utukuri PS, Wang LL, Corey AS. ACR Appropriateness Criteria® Cerebrovascular Diseases-Aneurysm, Vascular Malformation, and Subarachnoid Hemorrhage. J Am Coll Radiol 2021; 18:S283-S304. [PMID: 34794589 DOI: 10.1016/j.jacr.2021.08.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 08/26/2021] [Indexed: 11/22/2022]
Abstract
Cerebrovascular disease is a broad topic. This document focuses on the imaging recommendations for the varied clinical scenarios involving intracranial aneurysms, vascular malformations, and vasculitis, which all carry high risk of morbidity and mortality. Additional imaging recommendations regarding complications of these conditions, including subarachnoid hemorrhage and vasospasm, are also covered. While each variant presentation has unique imaging recommendations, the major focus of this document is neurovascular imaging techniques. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
- Luke N Ledbetter
- Director, Head and Neck Imaging, University of California Los Angeles, Los Angeles, California.
| | - Judah Burns
- Panel Chair and Program Director, Diagnostic Radiology Residency Program, Montefiore Medical Center, Bronx, New York
| | - Robert Y Shih
- Panel Vice-Chair, Uniformed Services University, Bethesda, Maryland
| | - Amna A Ajam
- Ohio State University, Columbus, Ohio; Chief of Neuroradiology & MRI at WRNMMC; and Associate Chief of Neuroradiology for AIRP
| | - Michael D Brown
- Michigan State University, East Lansing, Michigan, American College of Emergency Physicians
| | - Santanu Chakraborty
- Ottawa Hospital Research Institute and the Department of Radiology, The University of Ottawa, Ottawa, Ontario, Canada, Canadian Association of Radiologists
| | - Melissa A Davis
- Director of Quality, Radiology, Emory University, Atlanta, Georgia; ACR YPS Communications Liaison
| | - Andrew F Ducruet
- Barrow Neurological Institute, Phoenix, Arizona, Neurosurgery expert
| | | | - Mary E Lacy
- University of New Mexico, Albuquerque, New Mexico, American College of Physicians
| | - Ryan K Lee
- Chair, Department of Radiology, Einstein Healthcare Network, Philadelphia, Pennsylvania
| | - Jeffrey S Pannell
- University of California San Diego Medical Center, San Diego, California
| | | | - William J Powers
- University of North Carolina School of Medicine, Chapel Hill, North Carolina; American Academy of Neurology; Chair, Writing Group, American Heart Association/American Stroke Association Guidelines for the Early Management of Patients with Acute Ischemic Stroke, 2016-2019
| | - Gavin Setzen
- Albany ENT & Allergy Services, PC, Albany, New York; American Academy of Otolaryngology-Head and Neck Surgery; President, Albany ENT & Allergy Services, PC
| | - Matthew D Shaines
- Associate Chief, Hospital Medicine, Albert Einstein College of Medicine Montefiore Medical Center, Bronx, New York; Internal medicine physician
| | - Pallavi S Utukuri
- Clinical Site Director, Department of Radiology, Allen Hospital, New York Presbyterian, New York, New York; and Columbia University Medical Center, New York, New York
| | - Lily L Wang
- University of Cincinnati Medical Center, Cincinnati, Ohio
| | - Amanda S Corey
- Specialty Chair, Atlanta VA Health Care System and Emory University, Atlanta, Georgia
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Sebök M, Dufour JP, Cenzato M, Kaku Y, Tanaka M, Tsukahara T, Regli L, Esposito G. When Is Diagnostic Subtraction Angiography Indicated Before Clipping of Unruptured and Ruptured Intracranial Aneurysms? An International Survey of Current Practice. ACTA NEUROCHIRURGICA. SUPPLEMENT 2021; 132:9-17. [PMID: 33973023 DOI: 10.1007/978-3-030-63453-7_2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/03/2023]
Abstract
INTRODUCTION The goal of this survey is to investigate the indications for preoperative digital subtraction angiography (DSA) before clipping of ruptured and unruptured intracranial aneurysms in an international panel of neurovascular specialists. METHODS An anonymous survey of 23 multiple-choice questions relating to indications for DSA before clipping of an intracranial aneurysm was distributed to the international panel of attendees of the European-Japanese Cerebrovascular Congress (EJCVC), which took place in Milan, Italy on 7-9 June 2018. The survey was collected during the same conference. Descriptive statistics were used to analyze the data. RESULTS A total of 93 surveys were distributed, and 67 (72%) completed surveys were returned by responders from 13 different countries. Eighty-five percent of all responders were neurosurgeons. For unruptured and ruptured middle cerebral artery (MCA) aneurysms without life-threatening hematoma, approximately 60% of responders perform surgery without preoperative DSA. For aneurysms in other locations than MCA, microsurgery is done without preoperative DSA in 68% of unruptured and in 73% of ruptured cases. In cases of ruptured MCA or ruptured non-MCA aneurysms with life-threatening hematoma, surgery is performed without DSA in 97% and 96% of patients, respectively. Factors which lead to preoperative DSA being performed were: aneurysmal shape (fusiform, dissecting), etiology (infectious), size (>25 mm), possible presence of perforators or efferent vessels arising from the aneurysm, intra-aneurysmal thrombus, previous treatment, location (posterior circulation and paraclinoid aneurysm) and flow-replacement bypass contemplated for final aneurysm treatment. These are all factors that qualify an aneurysm as a complex aneurysm. CONCLUSION There is still a high variability in the surgeons' preoperative workup regarding the indication for DSA before clipping of ruptured and unruptured intracranial aneurysms, except for ruptured aneurysms with life-threatening hematoma. There is a general consensus among cerebrovascular specialists that any angioanatomical feature indicating a complex aneurysm should lead to a more detailed workup including preoperative DSA.
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Affiliation(s)
- Martina Sebök
- Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Jean-Philippe Dufour
- Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Marco Cenzato
- Department of Neurosurgery, Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Yasuhiko Kaku
- Department of Neurosurgery, Asahi University Murakami Memorial Hospital, Gifu, Japan
| | | | - Tetsuya Tsukahara
- Department of Neurosurgery, National Hospital Organization, Kyoto Medical Center, Kyoto, Japan
| | - Luca Regli
- Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Giuseppe Esposito
- Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
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Sui RD, Wang CG, Han DW, Zhang XQ, Li Q, Xu CF, Gong PB. Application of computed tomography angiography for evaluating clinical morphology in intracranial aneurysms - monocentric study. J Int Med Res 2019; 48:300060519894790. [PMID: 31884845 PMCID: PMC7783282 DOI: 10.1177/0300060519894790] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Objective To examine the clinical effect of computed tomography angiography (CTA) on
parameters of intracranial aneurysms in different locations and with
different sizes using digital subtraction angiography (DSA) as the
standard. Methods Patients with intracranial aneurysms who underwent CTA examinations at the
same center and received DSA examinations within 3 days were analyzed
retrospectively. The morphological parameters of the aneurysms and parent
arteries were measured with these two methods. Results Mean aneurysm size and parent artery diameter were not different between CTA
and DSA. The size of microaneurysms was significantly smaller with DSA than
with CTA. The aneurysmal neck width was not different between CTA and DSA.
DSA could clearly evaluate the relationship between the aneurysmal neck and
the parent artery in all cases. However, CTA had a 90% accuracy rate of
visualizing this relationship. Conclusion The accuracy rates of evaluating aneurysm size and the aneurysmal neck width
and parent artery diameter are similar between CTA and DSA. A DSA
examination is essential for evaluating the relationship among
microaneurysms, the aneurysmal neck, and the parent artery. CTA is widely
applied and more safe in clinical practice, while DSA has a better guiding
effect than CTA for some complicated aneurysms.
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Affiliation(s)
- Ru-de Sui
- Department of Imaging, Linyi Central
Hospital, Linyi, Shandong, P. R. China
| | - Chun-guo Wang
- CT/MRI Room, Women’s and Children’s
Health Care Hospital of Linyi, Shandong, P. R. China
- Chun-guo Wang, CT/MRI Room, Women’s and
Children’s Health Care Hospital of Linyi, No. 1 Qinghe South Road, Linyi City,
276000, Shandong, P. R. China.
| | - Dong-wei Han
- Department of Imaging, Huangdao
District Central Hospital of Qingdao, Shandong, P. R. China
| | - Xiu-qing Zhang
- Department of Orthopaedics, Yishui
County People’s Hospital, Yishui, Shandong, P. R. China
| | - Qing Li
- Department of Nephrology, Yishui
County People’s Hospital, Yishui, Shandong, P. R. China
| | - Chun-fu Xu
- Department of Orthopaedics, Yishui
County People’s Hospital, Yishui, Shandong, P. R. China
| | - Pi-bao Gong
- Department of Radiology, Daigu Town
Central Health Hospital, Mengyin, Shandong, P. R. China
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Magnetic Resonance Imaging in Aneurysmal Subarachnoid Hemorrhage: Current Evidence and Future Directions. Neurocrit Care 2019; 29:241-252. [PMID: 29633155 DOI: 10.1007/s12028-018-0534-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Aneurysmal subarachnoid hemorrhage (aSAH) is associated with an unacceptably high mortality and chronic disability in survivors, underscoring a need to validate new approaches for treatment and prognosis. The use of advanced imaging, magnetic resonance imaging (MRI) in particular, could help address this gap given its versatile capacity to quantitatively evaluate and map changes in brain anatomy, physiology and functional activation. Yet there is uncertainty about the real value of brain MRI in the clinical setting of aSAH. METHODS In this review, we discuss current and emerging MRI research in aSAH. PubMed was searched from inception to June 2017, and additional studies were then chosen on the basis of relevance to the topics covered in this review. RESULTS Available studies suggest that brain MRI is a feasible, safe, and valuable testing modality. MRI detects brain abnormalities associated with neurologic examination, outcomes, and aneurysm treatment and thus has the potential to increase knowledge of aSAH pathophysiology as well as to guide management and outcome prediction. Newer pulse sequences have the potential to reveal structural and physiological changes that could also improve management of aSAH. CONCLUSION Research is needed to confirm the value of MRI-based biomarkers in clinical practice and as endpoints in clinical trials, with the goal of improving outcome for patients with aSAH.
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ACR Appropriateness Criteria ® Cerebrovascular Disease. J Am Coll Radiol 2018; 14:S34-S61. [PMID: 28473091 DOI: 10.1016/j.jacr.2017.01.051] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Revised: 01/27/2017] [Accepted: 01/31/2017] [Indexed: 11/23/2022]
Abstract
Diseases of the cerebral vasculature represent a heterogeneous group of ischemic and hemorrhagic etiologies, which often manifest clinically as an acute neurologic deficit also known as stroke or less commonly with symptoms such as headache or seizures. Stroke is the fourth leading cause of death and is a leading cause of serious long-term disability in the United States. Eighty-seven percent of strokes are ischemic, 10% are due to intracerebral hemorrhage, and 3% are secondary to subarachnoid hemorrhage. The past two decades have seen significant developments in the screening, diagnosis, and treatment of ischemic and hemorrhagic causes of stroke with advancements in CT and MRI technology and novel treatment devices and techniques. Multiple different imaging modalities can be used in the evaluation of cerebrovascular disease. The different imaging modalities all have their own niches and their own advantages and disadvantages in the evaluation of cerebrovascular disease. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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7
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Philipp LR, McCracken DJ, McCracken CE, Halani SH, Lovasik BP, Salehani AA, Boulter JH, Cawley CM, Grossberg JA, Barrow DL, Pradilla G. Comparison Between CTA and Digital Subtraction Angiography in the Diagnosis of Ruptured Aneurysms. Neurosurgery 2018; 80:769-777. [PMID: 28201559 DOI: 10.1093/neuros/nyw113] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Accepted: 12/08/2016] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Computerized tomography angiography (CTA) is commonly used to diagnose ruptured cerebral aneurysms with sensitivities reported as high as 97% to 100%. Studies validating CTA accuracy in the setting of subarachnoid hemorrhage (SAH) are scarce and limited by small sample sizes. OBJECTIVE To evaluate the diagnostic accuracy of CTA in detecting intracranial aneurysms in the setting of SAH. METHODS A single-center, retrospective cohort of 643 patients was reviewed. A total of 401 patients were identified whose diagnostic workup included both CTA and confirmatory digital subtraction angiography (DSA). Aneurysms missed by CTA but diagnosed by DSA were further stratified by size and location. RESULTS Three hundred and thirty aneurysms were detected by CTA while DSA detected a total of 431 aneurysms. False positive CTA results were seen for 24 aneurysms. DSA identified 125 aneurysms that were missed by CTA and 83.2% of those were <5 mm in diameter. The sensitivity of CTA was 57.6% for aneurysms smaller than 5 mm in size, and 45% for aneurysms originating from the internal carotid artery. The overall sensitivity of CTA in the setting of SAH was 70.7%. CONCLUSION The accuracy of CTA in the diagnosis of ruptured intracranial aneurysm may be lower than previously reported. CTA has a low sensitivity for aneurysms less than 5 mm in size, in locations adjacent to bony structures, and for those arising from small caliber parent vessels. It is our recommendation that CTA should be used with caution when used alone in the diagnosis of ruptured intracranial aneurysms.
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Affiliation(s)
| | - D Jay McCracken
- Department of Neu-rosurgery, Emory University School of Medicine, Atlanta, Georgia
| | | | | | | | | | | | - C Michael Cawley
- Department of Neu-rosurgery, Emory University School of Medicine, Atlanta, Georgia
| | - Jonathan A Grossberg
- Department of Neu-rosurgery, Emory University School of Medicine, Atlanta, Georgia
| | - Daniel L Barrow
- Department of Neu-rosurgery, Emory University School of Medicine, Atlanta, Georgia
| | - Gustavo Pradilla
- Department of Neu-rosurgery, Emory University School of Medicine, Atlanta, Georgia
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Stroke and Its Imaging Evaluation. Emerg Radiol 2018. [DOI: 10.1007/978-3-319-65397-6_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Bianchi C, Clerc D, Yersin B. Revue de littérature et dérivation d’un algorithme clinique diagnostique pour une suspicion d’hémorragie sous-arachnoïdienne. ANNALES FRANCAISES DE MEDECINE D URGENCE 2017. [DOI: 10.1007/s13341-017-0727-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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10
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Moore SA, Rabinstein AA, Stewart MW, David Freeman W. Recognizing the signs and symptoms of aneurysmal subarachnoid hemorrhage. Expert Rev Neurother 2015; 14:757-68. [PMID: 24949896 DOI: 10.1586/14737175.2014.922414] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Subarachnoid hemorrhage (SAH) is a devastating neurologic condition with a high mortality and long term neurological morbidity in 50% of survivors. In addition, SAH commonly affects young patients causing substantial loss of productive life years and resulting in significant long term healthcare costs. Early recognition of the signs and symptoms of SAH is absolutely critical to earlier intervention, and delays in diagnosis can have devastating consequences. To avoid such delays in SAH diagnosis, the medical provider should recognize its signs and symptoms. Neuroimgaging, cerebrospinal fluid examination and angiography (invasive or non-invasive) facilitate early diagnosis of SAH. The purpose of this review is not to provide an exhaustive critique of the available literature, rather, it is to provide an overview that will better enable a provider to recognize and initiate the workup of patients with SAH.
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Affiliation(s)
- S Arthur Moore
- Department of Neurology, Critical Care, Mayo Clinic, Rochester, MN 55902, USA
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11
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Advanced imaging modalities in the detection of cerebral vasospasm. Neurol Res Int 2013; 2013:415960. [PMID: 23476766 PMCID: PMC3580927 DOI: 10.1155/2013/415960] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2012] [Accepted: 12/09/2012] [Indexed: 11/24/2022] Open
Abstract
The pathophysiology of cerebral vasospasm following aneurysmal subarachnoid hemorrhage (SAH) is complex and is not entirely understood. Mechanistic insights have been gained through advances in the capabilities of diagnostic imaging. Core techniques have focused on the assessment of vessel caliber, tissue metabolism, and/or regional perfusion parameters. Advances in imaging have provided clinicians with a multifaceted approach to assist in the detection of cerebral vasospasm and the diagnosis of delayed ischemic neurologic deficits (DIND). However, a single test or algorithm with broad efficacy remains elusive. This paper examines both anatomical and physiological imaging modalities applicable to post-SAH vasospasm and offers a historical background. We consider cerebral blood flow velocities measured by Transcranial Doppler Ultrasonography (TCD). Structural imaging techniques, including catheter-based Digital Subtraction Angiography (DSA), CT Angiography (CTA), and MR Angiography (MRA), are reviewed. We examine physiologic assessment by PET, HMPAO SPECT, 133Xe Clearance, Xenon-Enhanced CT (Xe/CT), Perfusion CT (PCT), and Diffusion-Weighted/MR Perfusion Imaging. Comparative advantages and limitations are discussed.
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Stroke and Its Imaging Evaluation. Emerg Radiol 2013. [DOI: 10.1007/978-1-4419-9592-6_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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13
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Improved diagnosis of actively bleeding aneurysm on CT angiography using delayed CT images. Eur J Radiol 2011; 79:328-31. [DOI: 10.1016/j.ejrad.2010.01.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2009] [Accepted: 01/20/2010] [Indexed: 11/23/2022]
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14
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Macht S, Beseoglu K, Eicker S, Rybacki K, Braun S, Mathys C, Antoch G, Turowski B. Safety and feasibility in highly concentrated contrast material power injections for CT-perfusion studies of the brain using central venous catheters. Eur J Radiol 2011; 81:1883-5. [PMID: 21601402 DOI: 10.1016/j.ejrad.2011.04.043] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2011] [Revised: 04/11/2011] [Accepted: 04/13/2011] [Indexed: 10/18/2022]
Abstract
INTRODUCTION CT perfusion studies play an important role in the early detection as well as in therapy monitoring of vasospasm after subarachnoid hemorrhage. High-flow injections via central venous catheters are not recommended but may sometimes be the only possibility to obtain high-quality images. MATERIALS AND METHODS We retrospectively analyzed our data for CT perfusions performed with power injection of contrast material with an iodine concentration of 400mg/ml via the distal 16G lumen of the Arrow three and five lumen central venous catheter with preset flow rates of 5ml/s. RESULTS 104 examinations with central venous catheters were evaluated (67 with five lumen and 37 with three lumen). No complications were observed. Mean flow rates were 4.4±0.5ml/s using the three lumen catheter and 4.6±0.6ml/s using the five lumen catheter respectively. The mean injection pressure measured by the power injector was 200.7±17.5psi for the three lumen central venous catheter and 194.5±6.5psi for the five lumen catheter, respectively. CONCLUSION Following a strict safety protocol there were no complications associated with power injections of contrast material containing 400mg iodine/ml with preset flow rates up to 5ml/s via the distal 16G lumen of the Arrow multi-lumen central venous catheter. However, since power-injections are off-label use with Arrow central venous catheters, this procedure cannot be recommended until potential safety hazards have been ruled out by the manufacturer.
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Affiliation(s)
- Stephan Macht
- University Dusseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology, D-40225 Dusseldorf, Germany.
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Chen W, Yang Y, Xing W, Peng Y, Qiu J, He Z, Wang Q. Applications of multislice CT angiography in the surgical clipping and endovascular coiling of intracranial aneurysms. J Biomed Res 2010; 24:467-73. [PMID: 23554664 PMCID: PMC3596695 DOI: 10.1016/s1674-8301(10)60062-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2010] [Revised: 10/08/2010] [Accepted: 11/16/2010] [Indexed: 11/19/2022] Open
Abstract
Prompt diagnosis and therapy of aneurysms are critical for patients with nontraumatic subarachnoid hemorrhage (SAH). The aim of our study was to assess the clinical usefulness of multislice computed tomography angiography (CTA) in the surgical and endovascular treatment of intracranial aneurysms. A total of 195 cases with 206 intracranial aneurysms underwent CTA. Fifty (24%) aneurysms underwent surgical clipping while 156 (76%) aneurysms underwent endovascular coiling. In the five missed aneurysms at digital substraction angiography and the nine aneurysms with mass intracerebral hematomas, surgical treatment was successfully performed based on 16-slice CTA alone, and the other 36 aneurysms were clipped on the main basis of the CTA. The intraoperative findings correlated well with the CTA findings and all aneurysms were clipped successfully. Sixteen-slice CTA image information has been shown to determine the choice of aneurysm therapy and assist the surgical and endovascular treatment of intracranial aneurysms.
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Affiliation(s)
| | - Yilin Yang
- Departments of Neurosurgery, the Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu 213003, China
| | | | - Ya Peng
- Departments of Neurosurgery, the Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu 213003, China
| | | | | | - Qi Wang
- Department of Radiology,
- *Corresponding author: Qi Wang, MD, Departments of Radiology, the Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu 213003, China. Tel: 86-0519-68871111, E-mail address:
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