Low Diagnostic Yield of Non-Invasive Imaging In Angiogram-Negative Subarachnoid Hemorrhage

10.5580/1516 ◽  
2011 ◽  
Vol 6 (1) ◽  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Diagnostic Yield ◽  
Non Invasive

Yield of diagnostic imaging in atraumatic convexity subarachnoid hemorrhage

2019 ◽  
Vol 11 (12) ◽  
pp. 1222-1226
Author(s):  
Katarina Dakay ◽  
Ali Mahta ◽  
Shyam Rao ◽  
Michael E Reznik ◽  
Linda C Wendell ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Diagnostic Yield ◽  
Brain Mri ◽  
Clinical History ◽  
Amyloid Angiopathy ◽  
Testing Strategy ◽  
Diagnostic Challenge ◽  
Non Invasive ◽  
Vessel Imaging ◽  
Spontaneous Subarachnoid Hemorrhage

IntroductionAtraumatic convexity subarachnoid hemorrhage is a subtype of spontaneous subarachnoid hemorrhage that often presents a diagnostic challenge. Common etiologies include cerebral amyloid angiopathy, vasculopathies, and coagulopathy; however, aneurysm is rare. Given the broad differential of causes of convexity subarachnoid hemorrhage, we assessed the diagnostic yield of common tests and propose a testing strategy.MethodsWe performed a single-center retrospective study on consecutive patients with atraumatic convexity subarachnoid hemorrhage over a 2-year period. We obtained and reviewed each patient’s imaging and characterized the frequency with which each test ultimately diagnosed the cause. Additionally, we discuss clinical features of patients with convexity subarachnoid hemorrhage with respect to the mechanism of hemorrhage.ResultsWe identified 70 patients over the study period (mean (SD) age 64.70 (16.9) years, 35.7% men), of whom 58 patients (82%) had a brain MRI, 57 (81%) had non-invasive vessel imaging, and 27 (38.5%) underwent catheter-based angiography. Diagnoses were made using only non-invasive imaging modalities in 40 patients (57%), while catheter-based angiography confirmed the diagnosis in nine patients (13%). Further clinical history and laboratory testing yielded a diagnosis in an additional 17 patients (24%), while the cause remained unknown in four patients (6%).ConclusionThe etiology of convexity subarachnoid hemorrhage may be diagnosed in most cases via non-invasive imaging and a thorough clinical history. However, catheter angiography should be strongly considered when non-invasive imaging fails to reveal the diagnosis or to better characterize a vascular malformation. Larger prospective studies are needed to validate this algorithm.

scholarly journals Reassessing the value of gastroscopy for the investigation of dyspepsia

2017 ◽  
Vol 9 (1) ◽  
pp. 62-66 ◽  
Author(s):  
Hey-Long Ching ◽  
Melissa F Hale ◽  
Reena Sidhu ◽  
Mark E McAlindon
Keyword(s):  
Patient Management ◽  
Diagnostic Yield ◽  
Evaluation Study ◽  
Service Evaluation ◽  
Proton Pump Inhibitor Therapy ◽  
Endoscopic Examination ◽  
Teaching Hospitals ◽  
Outpatient Basis ◽  
Non Invasive ◽  
Royal Hallamshire Hospital

ObjectiveTo evaluate the diagnostic yield of investigating dyspepsia with oesophagogastroduodenoscopy (OGD) with or without mucosal biopsy.DesignRetrospective service evaluation study.SettingTwo teaching hospitals: The Royal Hallamshire Hospital and Northern General Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, UK.Patients500 patients, 55 years of age and over, who underwent OGD to investigate dyspepsia were included. The study period included a 3-month window. All OGDs were performed on an outpatient basis.InterventionsData were extracted from electronic OGD records within the study period.Main outcome measuresDiagnostic yield provided by endoscopic examination and histological assessment.Results378 patients (75.6%) were reported to have some form of endoscopic abnormality, and 417 patients (83.4%) had biopsies taken. The most common findings at OGD were gastritis (47.2%) and oesophagitis (24.4%). Oesophagogastric malignancy was seen in 1%. Diagnoses made endoscopically or histologically that would not have been appropriately managed by empirical therapies were seen in 16.2%.ConclusionOGD in dyspepsia influences patient management in approximately one-sixth of cases. However, the majority of patients are sufficiently managed with Helicobacter pylori testing and eradication and/or a trial of proton pump inhibitor therapy. Further non-invasive approaches are needed to identify patients who need endoscopy for biopsy or therapy.

NON-INVASIVE MONITORING OF CARDIAC OUTPUT BY DOPPLER ECHOCARDIOGRAPHY IN PATIENTS TREATED WITH VOLUME EXPANSION FOLLOWING SUBARACHNOID HEMORRHAGE

1994 ◽  
Vol 22 (1) ◽  
pp. A203
Author(s):  
Stephan A. Mayer ◽  
David Sherman ◽  
Matthew E. Fink ◽  
Shunichi Homma ◽  
Robert Solomon ◽  
...  
Keyword(s):  
Cardiac Output ◽  
Subarachnoid Hemorrhage ◽  
Doppler Echocardiography ◽  
Volume Expansion ◽  
Invasive Monitoring ◽  
Non Invasive

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.

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.

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

Genetics-first approach improves diagnostics of ESKD patients younger than 50 years

2020 ◽  
Author(s):  
Rozemarijn Snoek ◽  
Richard H van Jaarsveld ◽  
Tri Q Nguyen ◽  
Edith D J Peters ◽  
Martin G Elferink ◽  
...  
Keyword(s):  
Genetic Testing ◽  
Genetic Disease ◽  
Diagnostic Yield ◽  
Diagnostic Value ◽  
Monogenic Disease ◽  
Kidney Transplant Recipients ◽  
Clear Cut ◽  
Non Invasive ◽  
Transplant Patients ◽  
Whole Exome

Abstract Background Often only CKD patients with high likelihood of genetic disease are offered genetic testing. Early genetic testing could obviate the need for kidney biopsies, allowing for adequate prognostication and treatment. To test the viability of a ‘genetics first’ approach for CKD, we performed genetic testing in a group of kidney transplant recipients <50 years, irrespective of cause of transplant. Methods From a cohort of 273 transplant patients, we selected 110 that were in care in the UMC Utrecht, had DNA available and were without clear-cut non-genetic disease. Forty patients had been diagnosed with a genetic disease prior to enrollment, in 70 patients we performed a whole exome sequencing based 379 gene panel analysis. Results Genetic analysis yielded a diagnosis in 51%. Extrapolated to the 273 patient cohort, who did not all fit the inclusion criteria, the diagnostic yield was still 21%. Retrospectively, in 43% of biopsied patients the kidney biopsy would not have had added diagnostic value if genetic testing had been performed as a first tier diagnostic. Conclusions Burden of monogenic disease in transplant patients with ESKD of any cause prior to the age of 50 is between 21 and 51%. Early genetic testing can provide a non-invasive diagnostic, impacting prognostication and treatment and obviating the need for an invasive biopsy. We conclude that in patients who one expects to develop ESKD prior to the age of 50, genetic testing should be considered as first mode of diagnostics.

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.

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