AJDRAJNR - American Journal of Neuroradiology

Published ahead of print on February 7, 2008
doi: 10.3174/ajnr.A0972
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Additional Value of 3D Rotational Angiography in Angiographically Negative Aneurysmal Subarachnoid Hemorrhage: How Negative Is Negative?

W.J. van Rooija, J.P.P. Pelusoa, M. Sluzewskia and G.N. Beuteb

a Department of Radiology, St. Elisabeth Ziekenhuis, Tilburg, the Netherlands
b Department of Neurosurgery, St. Elisabeth Ziekenhuis, Tilburg, the Netherlands


Figure 1
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  		Fig 1. Flow chart of 298 patients with suggested ruptured intracranial aneurysm referred for cerebral angiography. Asterisk indicates no additional imaging because of advanced age in 4 and death soon after admission in 1. PMH indicates perimesencephalic hemorrhage; IPH, intraparenchymal hemorrhage; IVH, intraventricular hemorrhage; SDH, subdural hemorrhage.


Figure 2
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  		Fig 2. A 48-year-old man presenting 4 days after headache of sudden onset in good clinical condition. A, CT scan shows a small amount of blood in the left Sylvian fissure (arrow). B–D, DSA in 3 projections fails to show a middle cerebral artery aneurysm. E and F, 3DRA depicts a 1-mm aneurysm on a M2-M3 junction (arrow). G and H, Operative view (compare with F) before (G) and after (H) clipping. Blood remnants are proof of rupture of the small aneurysm.


Figure 3
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  		Fig 3. A 67-year-old woman admitted with grade IV SAH, comatose and ventilated. CT scan showed diffuse subarachnoid blood. A–C, Right internal carotid artery angiogram in 3 projections fails to demonstrate an aneurysm. Note filling of both A2s and A1s. D, Posterior view of 3DRA depicts a 1.6-mm anterior communicating artery aneurysm (arrow). This aneurysm was clipped 1 week later.





Copyright © 2009 by the American Society of Neuroradiology. Print ISSN: 0195-6108 Online ISSN: 1936-959X