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CT angiography for evaluation of cerebral vasospasm following acute subarachnoid haemorrhage

  • Diagnostic Neuroradiology
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Abstract

Introduction

Cerebral vasospasm (CV) is one of the most dreaded complications in patients who survive acute subarachnoid haemorrhage (SAH), and conventional cerebral angiography (DSA) is the gold standard for its diagnosis. We evaluated CT angiography (CTA) as a non-invasive alternative for diagnosis of CV and assessed if CTA could have a role in choosing appropriate treatment.

Methods

Consecutive patients with SAH and suspected vasospasm were included when DSA was performed within 24 h from CTA. Two neuro-radiologists retrospectively analysed CTA and DSA studies independently. Assessment included presence of central and peripheral vasospasm and grading of severity of central CV. A treatment recommendation based on CTA was compared to actual treatment received.

Results

Final analysis included 34 patients. CTA was more accurate for diagnosis of central then for peripheral CV with high sensitivity (reader 1, 91%; reader 2, 92%), specificity (reader 1, 73%; reader 2, 90%), accuracy, positive predictive value and negative predictive value for central vasospasm. For grading the severity of CV CTA’s sensitivity, specificity and accuracy were high for most central arteries. The reader’s recommendation of angioplasty according to CTA was significantly predictive of actual receipt of angioplasty but overestimated actual receipt of triple H treatment.

Conclusion

CTA is adequate for detecting central vasospasm in symptomatic SAH patients. A negative result should not prevent further investigation especially when evaluating arterial segments adjacent to metal artefacts from coils or clips. CTA is helpful in treatment decision making specifically regarding the need for balloon angioplasty.

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We declare that we have no conflict of interest.

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Authors and Affiliations

  1. Division of Neuroradiology, Department of Diagnostic Imaging, QEII Health Sciences Center, Dalhousie University, Halifax, Canada

    Jai Jai Shiva Shankar

  2. Division of Neuroradiology, Department of Medical Imaging, Toronto Western Hospital, 399 Bathurst Street, 3 McLaughlin wing, Room 425, Toronto, Ontario, M5T 2S8, Canada

    Irene Y. L. Tan, Timo Krings, Karel Terbrugge & Ronit Agid

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  1. Jai Jai Shiva Shankar
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  2. Irene Y. L. Tan
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  3. Timo Krings
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  4. Karel Terbrugge
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  5. Ronit Agid
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Correspondence to Ronit Agid.

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Shankar, J.J.S., Tan, I.Y.L., Krings, T. et al. CT angiography for evaluation of cerebral vasospasm following acute subarachnoid haemorrhage. Neuroradiology 54, 197–203 (2012). https://doi.org/10.1007/s00234-011-0876-9

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  • DOI: https://doi.org/10.1007/s00234-011-0876-9

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