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AJNR - American Journal of Neuroradiology

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Role of Multisection CT Angiography in the Evaluation of Vertebrobasilar Vasospasm in Patients with Subarachnoid Hemorrhage

Dorith Goldsher^a,c, Reuven Shreiber^a, Venyamin Shik^b, Yonit Tavor^b and Jean F. Soustiel^b,c

^a Department of Radiology, Rambam Medical Center, Haifa
^b Department of Neurosurgery, Rambam Medical Center, Haifa
^c Technion-Israel Institute of Technology, Faculty of Medicine, Haifa

View larger version (76K): [in a new window]   FIG 1. Bilateral vertebral spasm in a patient with posttraumatic SAH. Posteroanterior volume-rendered MCTA scan shows diffuse arterial spasm of the right intracranial segment and focal spasm in the left intracranial VA.

View larger version (175K): [in a new window]   FIG 2. Same patient as in Figure 1. A, Mastercut view through the right VA with straightening of both extracranial and intracranial portions shows diffuse narrowing of the intracranial segment from the level of the foramen magnum. B, Mastercut through the left VA shows focal narrowing (arrow) at the intracranial segment C–E, Sections perpendicular to the arterial long axis below (C), at (D), and above (E) the focal spasm provide accurate measurements of vascular diameter at each location. Note the evenly narrowed diameter of the diffusely spastic right VA.

View larger version (54K): [in a new window]   FIG 3. MCTA obtained in a 68-year-old patient with SAH. A, Severe bilateral vertebral spasm. B, Widening of the vessel toward its normal diameter 3 days later, after treatment.

View larger version (22K): [in a new window]   FIG 4. Correlations. A, BA diameter (BA D) and BA FV (BA FV). B, Intracranial VA diameter (IVA D) and IV FV (IVA FV).

View larger version (64K): [in a new window]   FIG 5. Patient with an AVM. Volume rendering of a right thalamic AVM (A) on MCTA explains the high FV found on TCD imaging. VAs (B) and BAs (C) were wide in diameter, as measured on the sections.