scholarly journals Computed Tomography Angiography Spot Sign Does Not Predict Case Fatality in Aneurysmal Subarachnoid Hemorrhage With Intraparenchymal Extension

Stroke ◽  
2013 ◽  
Vol 44 (6) ◽  
pp. 1590-1594 ◽  
Author(s):  
H. Bart Brouwers ◽  
Daan Backes ◽  
W. Taylor Kimberly ◽  
Kristin Schwab ◽  
Javier M. Romero ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Subarachnoid Hemorrhage ◽  
Computed Tomography Angiography ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Case Fatality ◽  
Spot Sign

scholarly journals Serial Quantitative Computed Tomography Perfusion in Aneurysmal Subarachnoid Hemorrhage

2016 ◽  
Vol 43 (3) ◽  
pp. 375-380 ◽  
Author(s):  
Cheemun Lum ◽  
Matthew J. Hogan ◽  
John Sinclair ◽  
Shane English ◽  
Howard Lesiuk ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Subarachnoid Hemorrhage ◽  
Middle Cerebral Artery ◽  
Transit Time ◽  
Cerebral Artery ◽  
Computed Tomography Angiography ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Mean Transit Time ◽  
Arterial Diameter ◽  
Computed Tomography Perfusion

AbstractPurpose: Computed tomography perfusion (CTP) has been performed to predict which patients with aneurysmal subarachnoid hemorrhage are at risk of developing delayed cerebral ischemia (DCI). Patients with severe arterial narrowing may have significant reduction in perfusion. However, many patients have less severe arterial narrowing. There is a paucity of literature evaluating perfusion changes which occur with mild to moderate narrowing. The purpose of our study was to investigate serial whole-brain CTP/computed tomography angiography in aneurysm-related subarachnoid hemorrhage (aSAH) patients with mild to moderate angiographic narrowing. Methods: We retrospectively studied 18 aSAH patients who had baseline and follow-up whole-brain CTP/computed tomography angiography. Thirty-one regions of interest/hemisphere at six levels were grouped by vascular territory. Arterial diameters were measured at the circle of Willis. The correlation between arterial diameter and change in CTP values, change in CTP in with and without DCI, and response to intra-arterial vasodilator therapy in DCI patients was evaluated. Results: There was correlation among the overall average cerebral blood flow (CBF; R=0.49, p<0.04), mean transit time (R=–0.48, p=0.04), and angiographic narrowing. In individual arterial territories, there was correlation between changes in CBF and arterial diameter in the middle cerebral artery (R=0.53, p=0.03), posterior cerebral artery (R=0.5, p=0.03), and anterior cerebral artery (R=0.54, p=0.02) territories. Prolonged mean transit time was correlated with arterial diameter narrowing in the middle cerebral artery territory (R=0.52, p=0.03). Patients with DCI tended to have serial worsening of CBF compared with those without DCI (p=0.055). Conclusions: Our preliminary study demonstrates there is a correlation between mild to moderate angiographic narrowing and serial changes in perfusion in patients with aSAH. Patients developing DCI tended to have progressively worsening CBF compared with those not developing DCI.

The Value of Computed Tomography Angiography in Determining Treatment Allocation for Aneurysmal Subarachnoid Hemorrhage

2008 ◽  
Vol 9 (3) ◽  
pp. 300-306 ◽  
Author(s):  
Jefferson T. Miley ◽  
Robert A. Taylor ◽  
Vallabh Janardhan ◽  
Ramachandra Tummala ◽  
Giuseppe Lanzino ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Subarachnoid Hemorrhage ◽  
Computed Tomography Angiography ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Treatment Allocation

Rebleeding of Aneurysmal Subarachnoid Hemorrhage in Computed Tomography Angiography

2012 ◽  
Vol 36 (1) ◽  
pp. 103-108 ◽  
Author(s):  
Te-Chang Wu ◽  
Yu-Kun Tsui ◽  
Tai-Yuan Chen ◽  
Chien-Jen Lin ◽  
Tai-Ching Wu ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Subarachnoid Hemorrhage ◽  
Computed Tomography Angiography ◽  
Aneurysmal Subarachnoid Hemorrhage

Computed tomography angiography spot sign predicts intraprocedural aneurysm rupture in subarachnoid hemorrhage

2017 ◽  
Vol 159 (7) ◽  
pp. 1305-1312 ◽  
Author(s):  
Jan-Karl Burkhardt ◽  
◽  
Marian Christoph Neidert ◽  
Martin Nikolaus Stienen ◽  
Daniel Schöni ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Subarachnoid Hemorrhage ◽  
Computed Tomography Angiography ◽  
Aneurysm Rupture ◽  
Spot Sign

scholarly journals Computed Tomography Angiography Spot Sign, Hematoma Expansion, and Functional Outcome in Spontaneous Cerebellar Intracerebral Hemorrhage

Stroke ◽  
2021 ◽  
Author(s):  
Sanjula D. Singh ◽  
Marco Pasi ◽  
Floris H.B.M. Schreuder ◽  
Andrea Morotti ◽  
Jasper R. Senff ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Functional Outcome ◽  
Computed Tomography Angiography ◽  
Odds Ratio ◽  
Multivariable Analysis ◽  
Case Fatality ◽  
Hematoma Expansion ◽  
Day Case ◽  
Poor Functional Outcome ◽  
Spot Sign

Background and Purpose: The computed tomography angiography spot sign is associated with hematoma expansion, case fatality, and poor functional outcome in spontaneous supratentorial intracerebral hemorrhage (ICH). However, no data are available on the spot sign in spontaneous cerebellar ICH. Methods: We investigated consecutive patients with spontaneous cerebellar ICH at 3 academic hospitals between 2002 and 2017. We determined patient characteristics, hematoma expansion (>33% or 6 mL), rate of expansion, discharge and 90-day case fatality, and functional outcome. Poor functional outcome was defined as a modified Rankin Scale score of 4 to 6. Associations were tested using univariable and multivariable logistic regression. Results: Three hundred fifty-eight patients presented with cerebellar ICH, of whom 181 (51%) underwent a computed tomography angiography. Of these 181 patients, 121 (67%) were treated conservatively of which 15 (12%) had a spot sign. Patients with a spot sign treated conservatively presented with larger hematoma volumes (median [interquartile range]: 26 [7–41] versus 6 [2–13], P =0.001) and higher speed of expansion (median [interquartile range]: 15 [24–3] mL/h versus 1 [5–0] mL/h, P =0.034). In multivariable analysis, presence of the spot sign was independently associated with death at 90 days (odds ratio, 7.6 [95% CI, 1.6–88], P =0.037). With respect to surgically treated patients (n=60, [33%]), 14 (23%) patients who underwent hematoma evacuation had a spot sign. In these 60 patients, patients with a spot sign were older (73.5 [9.2] versus 66.6 [15.4], P =0.047) and more likely to be female (71% versus 37%, P =0.033). In a multivariable analysis, the spot sign was independently associated with death at 90 days (odds ratio, 2.1 [95% CI, 1.1–4.3], P =0.033). Conclusions: In patients with spontaneous cerebellar ICH treated conservatively, the spot sign is associated with speed of hematoma expansion, case fatality, and poor functional outcome. In surgically treated patients, the spot sign is associated with 90-day case fatality.

scholarly journals Diagnostic Performance of Computed Tomography Angiography and Computed Tomography Perfusion Tissue Time‐to‐Maximum in Vasospasm Following Aneurysmal Subarachnoid Hemorrhage

2021 ◽  
Author(s):  
Jason W. Allen ◽  
Adam Prater ◽  
Omar Kallas ◽  
Syed A. Abidi ◽  
Brian M. Howard ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Subarachnoid Hemorrhage ◽  
Computed Tomography Angiography ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
High Specificity ◽  
Residue Function ◽  
Screening Tests ◽  
Computed Tomography Perfusion ◽  
Logistic Regression Models ◽  
Sensitivity Specificity

Background Vasospasm is a treatable cause of deterioration following aneurysmal subarachnoid hemorrhage. Cerebral computed tomography perfusion mean transit times have been proposed as a predictor of vasospasm but suffer from well‐known technical limitations. We evaluated fully automated, thresholded time‐to‐maxima of the tissue residue function ( T max ) for determination of vasospasm following aneurysmal subarachnoid hemorrhage. Methods and Results Retrospective analysis of 540 arterial segments from 36 encounters in 31 consecutive patients with aneurysmal subarachnoid hemorrhage undergoing computed tomography angiography (CTA), computed tomography perfusion, and digital subtraction angiography (DSA) within 24 hours. T max at 4, 6, 8, and 10 s was generated using RAPID (iSchemaView Inc., Menlo Park, CA). Dual‐reader CTA and computed tomography perfusion interpretations were compared for patients with and without vasospasm on DSA (DSA+ and DSA−). Logistic regression models were developed using CTA and T max as input predictors and DSA vasospasm as outcome in adjusted and unadjusted models. Imaging studies from all 31 subjects (mean age 47.3±11.1, 77% female, 65% with single aneurysm with mean size of 6.0±2.9 mm) were included. Vasospasm was identified in 42 segments on DSA and 59 segments on CTA, with significant associations across individual vessel segments ( P <0.001). In adjusted analyses, DSA vasospasm was associated with CTA (odds ratio [OR], 2.43; 95% CI, 0.94–6.32; P =0.068) as well as territory‐specific T max >6 seconds delays (OR, 3.57; 95% CI, 1.36–9.35; P =0.009). Sensitivity/specificity for DSA vasospasm was 31%/91% for CTA, 26%/89% for T max >6 seconds, and 12%/99% for CTA+ T max >6 seconds. Conclusions CTA and T max offer high specificity for presence of vasospasm; their utility, even in combination, as screening tests is, however, limited by poor sensitivity.

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