scholarly journals Diagnostic Yield of Catheter Angiography in Patients with Subarachnoid Hemorrhage and Negative Initial Noninvasive Neurovascular Examinations

2012 ◽  
Vol 34 (4) ◽  
pp. 833-839 ◽  
Author(s):  
J.E. Delgado Almandoz ◽  
B.M. Crandall ◽  
J.L. Fease ◽  
J.M. Scholz ◽  
R.E. Anderson ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Diagnostic Yield ◽  
Catheter Angiography

Subarachnoid hemorrhage without evident cause on initial angiography studies: diagnostic yield of subsequent angiography and other neuroimaging tests

2003 ◽  
Vol 98 (6) ◽  
pp. 1235-1240 ◽  
Author(s):  
Mehmet A. Topcuoglu ◽  
Christopher S. Ogilvy ◽  
Bob S. Carter ◽  
Ferdinando S. Buonanno ◽  
Walter J. Koroshetz ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Mr Imaging ◽  
Ct Angiography ◽  
Mr Angiography ◽  
Diagnostic Yield ◽  
Catheter Angiography ◽  
Content Type ◽  
Spine Mr ◽  
Susceptibility Contrast ◽  
Fine Print

Object. The aim of this study was to assess the diagnostic yield of imaging tests performed in patients in whom the cause of subarachnoid hemorrhage (SAH) had not been demonstrated on initial angiography. Methods. By reviewing medical records of 806 patients with SAH who had been admitted during a 6.5-year period, the authors identified 86 in whom initial transfemoral catheter angiography failed to reveal the cause of SAH. Clinical and radiological data were analyzed to determine the diagnostic yield of subsequent catheter angiography, computerized tomography (CT) angiography, magnetic resonance (MR) angiography, and MR imaging of the brain and spine for various subtypes of SAH (bleeding not visualized on CT studies [CT-negative SAH], perimesencephalic SAH, and nonperimesencephalic SAH). Of 41 patients with nonperimesencephalic SAH, 36, 32, and 21 underwent repeated catheter angiography, CT angiography, and MR angiography, respectively; brain MR imaging was performed in 23 patients (18 with Gd and 15 with susceptibility contrast sequences), and spine MR imaging in 17. Of 36 patients with perimesencephalic SAH, 31, 23, and 17 underwent repeated catheter angiography, CT angiography, and MR angiography, respectively; brain MR imaging was performed in 18 patients (17 with Gd and 11 with susceptibility contrast sequences), and spine MR imaging in 14. Of nine patients with SAH not visualized on CT scanning, three, one, and six underwent repeated catheter angiography, CT angiography, and MR angiography, respectively; brain MR imaging was performed in eight patients (five with Gd and three with susceptibility contrast sequences), and spine MR imaging in seven. The cause of SAH could be determined in only four patients, all with nonperimesencephalic SAH. The only test that yielded a diagnosis was catheter angiography (three aneurysms on the second and one on the third angiography, all surgically secured). Diffusion-weighted MR imaging demonstrated small, deep infarcts in five patients. Conclusions. Repeated catheter angiography remains the most sensitive test to determine the cause of SAH that is not demonstrated on initial angiography, particularly in the subtype of nonperimesencephalic SAH. Newer, noninvasive imaging techniques provide little diagnostic yield.

scholarly journals Is there added value in obtaining cervical spine MRI in the assessment of nontraumatic angiographically negative subarachnoid hemorrhage? A retrospective study and meta-analysis of the literature

2018 ◽  
Vol 129 (3) ◽  
pp. 670-676 ◽  
Author(s):  
Gelareh Sadigh ◽  
Chad A. Holder ◽  
Jeffrey M. Switchenko ◽  
Seena Dehkharghani ◽  
Jason W. Allen
Keyword(s):  
Cervical Spine ◽  
Subarachnoid Hemorrhage ◽  
Diagnostic Yield ◽  
Vascular Malformations ◽  
Meta Analysis ◽  
Added Value ◽  
Catheter Angiography ◽  
Optimal Method ◽  
Study Heterogeneity ◽  
Spine Mri

OBJECTIVEDiagnostic algorithms for nontraumatic angiographically negative subarachnoid hemorrhage (AN-SAH) vary, and the optimal method remains subject to debate. This study assessed the added value of cervical spine MRI in identifying a cause for nontraumatic AN-SAH.METHODSConsecutive patients 18 years of age or older who presented with nontraumatic SAH between February 1, 2009, and October 31, 2014, with negative cerebrovascular catheter angiography and subsequent cervical MRI were studied. Patients with intraparenchymal, subdural, or epidural hemorrhage; recent trauma; or known vascular malformations were excluded. All cervical MR images were reviewed by two blinded neuroradiologists. The diagnostic yield of cervical MRI was calculated. A literature review was conducted to identify studies reporting the diagnostic yield of cervical MRI in patients with AN-SAH. The weighted pooled estimate of diagnostic yield of cervical MRI was calculated.RESULTSFor all 240 patients (mean age 53 years, 48% male), catheter angiography was performed within 4 days after admission (median 12 hours, interquartile range [IQR] 10 hours). Cervical MRI was performed within 19 days of admission (median 24 hours, IQR 10 hours). In a single patient, cervical MRI identified a source for SAH (cervical vascular malformation). Meta-analysis of 7 studies comprising 538 patients with AN-SAH produced a pooled estimate of 1.3% (95% confidence interval 0.5%–2.5%) for diagnostic yield of cervical MRI. No statistically significant between-study heterogeneity or publication bias was identified.CONCLUSIONSCervical MRI following AN-SAH, in the absence of findings to suggest spinal etiology, has a very low diagnostic yield and is not routinely necessary.

Diagnostic Yield of Repeat Catheter Angiography in Patients With Catheter and Computed Tomography Angiography Negative Subarachnoid Hemorrhage

Neurosurgery ◽  
2011 ◽  
Vol 70 (5) ◽  
pp. 1135-1142 ◽  
Author(s):  
Josser E. Delgado Almandoz ◽  
Bharathi D. Jagadeesan ◽  
Daniel Refai ◽  
Christopher J. Moran ◽  
DeWitte T. Cross ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Cerebrospinal Fluid ◽  
Subarachnoid Hemorrhage ◽  
Computed Tomography Angiography ◽  
Prospective Cohort ◽  
Diagnostic Yield ◽  
Catheter Angiography ◽  
Vascular Abnormality ◽  
Vascular Abnormalities ◽  
Noncontrast Ct

Abstract BACKGROUND: The yield of repeat catheter angiography in patients with subarachnoid hemorrhage (SAH) who have negative initial catheter and computed tomography (CT) angiograms is not well understood. OBJECTIVE: To determine the yield of repeat catheter angiography in a prospective cohort of patients with SAH and negative initial catheter and CT angiograms. METHODS: From January 1, 2005, until September 1, 2010, we instituted a prospective protocol in which patients with SAH documented by noncontrast CT (NCCT) or cerebrospinal fluid (CSF) xanthochromia and negative initial catheter and CT angiograms were evaluated with repeat catheter angiography 7 days and 3 months after presentation to assess for causative vascular abnormalities. RESULTS: Seventy-two patients were included, with a mean age of 53.1 years (median, 53.5 years; range, 19-88 years). Forty-six patients were female (63.9%) and 26 male (36.1%). Thirty-nine patients had nonperimesencephalic SAH (54.2%), 29 patients had perimesencephalic SAH (40.3%), and 4 patients had CSF xanthochromia (5.5%). The first repeat catheter angiogram performed 7 days after presentation demonstrated a causative vascular abnormality in 3 patients (yield of 4.2%), 2 of which had nonperimesencephalic SAH (yield of 5.1%), and 1 had perimesencephalic SAH (yield of 3.4%). The second repeat catheter angiogram performed in 43 patients (59.7%) did not demonstrate any causative vascular abnormalities. No causative abnormalities were found in patients with CSF xanthochromia. CONCLUSION: Repeat catheter angiography performed 7 days after presentation is valuable in the evaluation of patients with SAH who have negative initial catheter and CT angiograms, demonstrating a causative vascular abnormality in 4.2% of patients.

Blister Aneurysm of the Internal Carotid Artery

2019 ◽  
pp. 5-13
Author(s):  
Peter Nakaji ◽  
Michael R. Levitt
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Surgical Management ◽  
Medical Management ◽  
Internal Carotid ◽  
Conventional Imaging ◽  
Catheter Angiography ◽  
Intraoperative Rupture ◽  
Open Management

Abstract: Blister aneurysms are a rare cause of subarachnoid hemorrhage. They are easily overlooked on conventional imaging and catheter angiography due to their small size and unusual anatomic location. Whereas the medical management of subarachnoid hemorrhage is similar to that of saccular aneurysms, the surgical management of blister aneurysms is more challenging due to their unique pathology and higher risk of intraoperative rupture. Special consideration should be made for open management such as preparation of the option of bypass or the emerging use of endovascular techniques such as flow diversion. This chapter reviews the diagnosis and medical and surgical management of blister aneurysms.

Diagnostic Yield of Cerebral Angiography in Patients With Computed Tomography-Negative, Lumbar Puncture-Positive Subarachnoid Hemorrhage

Neurosurgery ◽  
2013 ◽  
Vol 73 (2) ◽  
pp. 282-288 ◽  
Author(s):  
Nohra Chalouhi ◽  
Samantha Witte ◽  
David L. Penn ◽  
Pranay Soni ◽  
Robert M. Starke ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Subarachnoid Hemorrhage ◽  
Blood Cell ◽  
Lumbar Puncture ◽  
Red Blood Cell ◽  
Cerebral Angiography ◽  
Diagnostic Yield ◽  
Cerebral Aneurysms ◽  
Vascular Abnormality ◽  
Cell Counts

Abstract BACKGROUND: Cerebral angiography is generally recommended in patients with subarachnoid hemorrhage (SAH) by positive lumbar puncture (LP) but negative findings on computed tomography (CT). Existing data on the yield of angiography in these patients are very limited. OBJECTIVE: To retrospectively assess the diagnostic yield of cerebral angiography in patients with CT−/LP+ SAH and to determine the clinical and laboratory predictors of a vascular abnormality on angiography. METHODS: A total of 35 patients with CT−/LP+ SAH underwent cerebral angiography at our institution between 2008 and 2011. Patient clinical characteristics and LP findings were entered into a multivariate logistic regression analysis to identify predictors of vascular abnormalities. RESULTS: Twenty-five patients (71.4%) were female and 10 (28.6%) were male, with a mean age of 53 years. Twenty-six patients (74.3%) had cerebrospinal fluid xanthochromia. Sixteen patients (45.7%) were found to have an aneurysm on cerebral angiography. The median CSF red blood cell count of both the first (7790/mm3 vs 4700/mm3), and last collection tubes (6800/mm3 vs 3219/mm3) were higher in patients with cerebral aneurysms vs those without aneurysms (P = .3). On multivariate analysis, there were no clinical or laboratory parameters that predicted the presence of aneurysm on cerebral angiography. CONCLUSION: The diagnostic yield of cerebral angiography is high (45.7%) in patients with CT−/LP+ SAH. Higher red blood cell counts were noted in patients with cerebral aneurysms but no clinical or laboratory parameter can reliably predict the presence of a vascular anomaly. Thus, it is reasonable to perform cerebral angiography in all patients with CT−/LP+ SAH.

The negative predictive value of CT angiography in the setting of perimesencephalic subarachnoid hemorrhage

2015 ◽  
Vol 8 (7) ◽  
pp. 728-731 ◽  
Author(s):  
Alex M Mortimer ◽  
Auke PA Appelman ◽  
Shelley A Renowden
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Negative Predictive Value ◽  
Ct Angiography ◽  
Predictive Value ◽  
Diagnostic Yield ◽  
False Negative ◽  
Significant Finding ◽  
Perimesencephalic Subarachnoid Hemorrhage ◽  
Cisterna Magna ◽  
Definition Of

BackgroundPerimesencephalic subarachnoid hemorrhage (PMSAH) is only rarely associated with a ruptured cerebral aneurysm and CT angiography (CTA) has very good sensitivity and specificity for aneurysm detection. The necessity for invasive imaging with digital subtraction angiography (DSA) is therefore debatable. We chose to assess the negative predictive value (NPV) of CTA in a series of patients with PMSAH treated at our institution over a 9-year period.MethodsWe retrospectively assessed the diagnostic yield of DSA after initial negative CTA in patients with a PMSAH pattern defined as blood centered anterior to the midbrain and/or pons within the pre-pontine or interpeduncular cistern with possible quadrigeminal or ambient cistern extension; possible extension into the basal parts of the sylvian fissures but not the lateral sylvian fissures; possible extension to the cisterna magna but not centered on the cisterna magna; and possible extension into the fourth ventricle and occipital horns of the lateral ventricles.ResultsUsing this definition of PMSAH, of 72 patients, one patient showed a potentially significant finding on DSA that was not demonstrated on initial CTA (NPV 98.61% (95% CI 92.47% to 99.77%)). However, when cisterna magna extension was excluded from the definition of PMSAH, no false negative CTAs in 56 patients were encountered (NPV 100% (95% CI 93.56% to 100.00%)).ConclusionsThe NPV of normal CTA for an arterial abnormality in patients with PMSAH is high and our results therefore question the role of invasive imaging. The findings also suggest that a prospective study designed to clarify the necessity of performing DSA in this population would be feasible.

Diagnostic yield of computed tomography angiography and magnetic resonance angiography in patients with catheter angiography–negative subarachnoid hemorrhage

2012 ◽  
Vol 117 (2) ◽  
pp. 309-315 ◽  
Author(s):  
Josser E. Delgado Almandoz ◽  
Bharathi D. Jagadeesan ◽  
Daniel Refai ◽  
Christopher J. Moran ◽  
DeWitte T. Cross ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Subarachnoid Hemorrhage ◽  
Magnetic Resonance ◽  
Magnetic Resonance Angiography ◽  
Cerebral Aneurysm ◽  
Computed Tomography Angiography ◽  
Diagnostic Yield ◽  
Cerebral Aneurysms ◽  
Valuable Adjunct ◽  
Noncontrast Ct

Object The yield of CT angiography (CTA) and MR angiography (MRA) in patients with subarachnoid hemorrhage (SAH) who have a negative initial catheter angiogram is currently not well understood. This study aims to determine the yield of CTA and MRA in a prospective cohort of patients with SAH and a negative initial catheter angiogram. Methods From January 1, 2005, until September 1, 2010, the authors instituted a prospective protocol in which patients with SAH—as documented by noncontrast CT or CSF xanthochromia and a negative initial catheter angiogram— were evaluated using CTA and MRA to assess for causative cerebral aneurysms. Two neuroradiologists independently evaluated the noncontrast CT scans to determine the SAH pattern (perimesencephalic or not) and the CT and MR angiograms to assess for causative cerebral aneurysms. Results Seventy-seven patients were included, with a mean age of 52.8 years (median 54 years, range 19–88 years). Fifty patients were female (64.9%) and 27 male (35.1%). Forty-three patients had nonperimesencephalic SAH (55.8%), 29 patients had perimesencephalic SAH (37.7%), and 5 patients had CSF xanthochromia (6.5%). Computed tomography angiography demonstrated a causative cerebral aneurysm in 4 patients (5.2% yield), all of whom had nonperimesencephalic SAH (9.3% yield). Mean aneurysm size was 2.6 mm (range 2.1–3.3 mm). Magnetic resonance angiography demonstrated only 1 of these aneurysms. No causative cerebral aneurysms were found in patients with perimesencephalic SAH or CSF xanthochromia. Conclusions Computed tomography angiography is a valuable adjunct in the evaluation of patients with nonperimesencephalic SAH who have a negative initial catheter angiogram, demonstrating a causative cerebral aneurysm in 9.3% of patients.

Repeat Catheter Angiography in Patients with Aneurysmal-Pattern Angiographically Negative Subarachnoid Hemorrhage

2021 ◽  
Author(s):  
Cody L. Nesvick ◽  
Soliman Oushy ◽  
Krishnan Ravindran ◽  
Lorenzo Rinaldo ◽  
Panagiotis Kerezoudis ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Catheter Angiography
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