Skip to main content

Advertisement

SpringerLink
Log in

Multiplanar CT evaluation of aneurysm rupture signs in subarachnoid hemorrhage

  • Original Article
  • Published:
Emergency Radiology Aims and scope Submit manuscript

Abstract

Purpose

In subarachnoid hemorrhage, noncontrast CT features are used to guide the localization of ruptured aneurysms on CT angiography and DSA. Multiplanar CT may improve the localization of aneurysm rupture sites over axial plane CT alone.

Methods

Multiplanar CT in three orthogonal planes was used to evaluate 94 cases of SAH. Two investigators independently evaluated each imaging plane for focal thick SAH with mass effect, intracerebral hemorrhage, focal edema, filling defect, subdural hemorrhage, and dominant intraventricular hemorrhage. Also, rupture site was qualitatively identified by combining these variables in each plane and combination of three planes. DSA served as the gold standard to locate the rupture sites.

Results

Interobserver agreement was k 0.60 to 0.79 for axial, k 0.43 to 0.86 for coronal and k 0.43 to 0.74 for sagittal planes. Good to substantial agreement was observed for the localization of rupture site in three planes (focal SAH with mass effect — k 0.78 to 0.85; filling defect — k 0.95 to 1.0; intracerebral hemorrhage — k 1.0; focal edema k 1.0; subdural hemorrhage — k 0.61 to 0.83). Dominant intraventricular hemorrhage revealed significant association with DSA to locate ruptured aneurysms (Fisher’s exact test — Pr <  = P (< 0.001)). With non-missing data, frequency of correct ratings to locate rupture site was 66/67 (99%) in axial plane, 59/66 (89%) in coronal plane, 64/67 (96%) in sagittal plane and 77/77 (100%) in combined 3 planes.

Conclusions

Multiplanar CT head is more successful than axial plane CT alone for the localization of aneurysm rupture sites in SAH.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

Data availability

N/A.

Code availability

N/A.

References

  1. Scotti G, Ethier R, Melançon D et al (1977) Computed tomography in the evaluation of intracranial aneurysms and subarachnoid hemorrhage. Radiology 123:85–90. https://doi.org/10.1148/123.1.85

    Article  CAS  PubMed  Google Scholar 

  2. Liliequist B, Lindqvist M, Valdimarsson E (1977) Computed tomography and subarachnoid hemorrhage. Neuroradiology 14:21–26

    Article  CAS  Google Scholar 

  3. Weisberg LA (1979) Computed tomography in aneurysmal subarachnoid hemorrhage. Neurology 29:802–808

    Article  CAS  Google Scholar 

  4. van Gijn J, van Dongen KJ (1980) Computed tomography in the diagnosis of subarachnoid haemorrhage and ruptured aneurysm. Clin Neurol Neurosurg 82:11–24

    Article  Google Scholar 

  5. Silver AJ, Pederson ME Jr, Ganti SR et al (1981) CT of subarachnoid hemorrhage due to ruptured aneurysm. AJNR Am J Neuroradiol 2:13–22

    CAS  PubMed  PubMed Central  Google Scholar 

  6. Nehls DG, Flom RA, Carter LP, Spetzler RF (1985) Multiple intracranial aneurysms: determining the site of rupture. J Neurosurg 63:342–348

    Article  CAS  Google Scholar 

  7. Kayama T, Sugawara T, Sakurai Y, Ogawa A, Onuma T, Yoshimoto T (1991) Early CT features of ruptured cerebral aneurysms of the posterior cranial fossa. Acta Neurochir (Wien) 108:34–39. https://doi.org/10.1007/BF01407664

    Article  CAS  Google Scholar 

  8. Sadato N, Numaguchi Y, Rigamonti D, Salcman M, Gellad FE, Kishikawa T (1991) Bleeding patterns in ruptured posterior fossa aneurysms: a CT study. J Comput Assist Tomogr 15:612–617. https://doi.org/10.1097/00004728-199107000-00016

    Article  CAS  PubMed  Google Scholar 

  9. Hino A, Fujimoto M, Iwamoto Y, Yamaki T, Katsumori T (2000) False localization of rupture site in patients with multiple cerebral aneurysms and subarachnoid hemorrhage. Neurosurgery 46:825–830. https://doi.org/10.1097/00006123-200004000-00011

    Article  CAS  PubMed  Google Scholar 

  10. Tryfonidis M, Evans AL, Coley SC, Hodgson TL, Connolly DJ, Romanowski CA et al (2007) The value of radio-anatomical features on non-contrast CT scans in localizing the source in aneurysmal subarachnoid haemorrhage. Clin Anat 20:618–623. https://doi.org/10.1002/ca.20475

    Article  CAS  PubMed  Google Scholar 

  11. Orning JL, Shakur SF, Alaraj A, Behbahani M, Charbel FT, Aletich VA et al (2018) Accuracy in identifying the source of subarachnoid hemorrhage in the setting of multiple intracranial aneurysms. Neurosurgery 83:62–68. https://doi.org/10.1093/neuros/nyx339

    Article  PubMed  Google Scholar 

  12. Westerlaan HE, van Dijk JM, Jansen-van der Weide MC et al (2011) Intracranial aneurysms in patients with subarachnoid hemorrhage: CT angiography as a primary examination tool for diagnosis—systematic review and meta-analysis. Radiology 258:134–145. https://doi.org/10.1148/radiol.10092373

    Article  PubMed  Google Scholar 

  13. Hochberg AR, Rojas R, Thomas AJ, Reddy AS, Bhadelia RA (2011) Accuracy of on-call resident interpretation of CT angiography for intracranial aneurysm in subarachnoid hemorrhage. AJR Am J Roentgenol 197:1436–1441. https://doi.org/10.2214/AJR.11.6782

    Article  PubMed  Google Scholar 

  14. Amrhein TJ, Mostertz W, Matheus MG, Maass-Bolles G, Sharma K, Collins HR et al (2017) Reformatted images improve the detection rate of acute traumatic subdural hematomas on brain CT compared with axial images alone. Emerg Radiol 24:39–45. https://doi.org/10.1007/s10140-016-1440-z

    Article  PubMed  Google Scholar 

  15. Noguchi K, Ogawa T, Fujita H, Inugami A, Okudera T, Uemura K et al (1997) Filling defect sign in CT diagnosis of ruptured aneurysm. Neuroradiology 39:480–482. https://doi.org/10.1007/s002340050449

    Article  CAS  PubMed  Google Scholar 

  16. Wallace AN, Vyhmeister R, Dines JN, Chatterjee AR, Kansagra AP, Viets R et al (2016) Evaluation of an anatomic definition of non-aneurysmal perimesencephalic subarachnoid hemorrhage. J Neurointerv Surg 8:378–385. https://doi.org/10.1136/neurintsurg-2015-011680

    Article  PubMed  Google Scholar 

  17. Landis JR, Koch GG (1977) The measurement of observer agreement for categorical data. Biometrics 33:159–174

    Article  CAS  Google Scholar 

  18. Kallmes DF, Lanzino G, Dix JE, Dion JE, Do H, Woodcock RJ et al (1997) Patterns of hemorrhage with ruptured posterior inferior cerebellar artery aneurysms: CT findings in 44 cases. AJR Am J Roentgenol 169:1169–1171. https://doi.org/10.2214/ajr.169.4.9308484

    Article  CAS  PubMed  Google Scholar 

  19. van der Jagt M, Hasan D, Bijvoet HW, Pieterman H, Dippel DW, Vermeij FH, Avezaat CJ (1999) Validity of prediction of the site of ruptured intracranial aneurysms with CT. Neurology 52:34–39. https://doi.org/10.1212/wnl.52.1.34

    Article  PubMed  Google Scholar 

  20. Karttunen AI, Jartti PH, Ukkola VA, Sajanti J, Haapea M. (2003) Value of the quantity and distribution of subarachnoid haemorrhage on CT in the localization of a ruptured cerebral aneurysm. Acta Neurochir (Wien) 145:655–661; discussion 661. https://doi.org/10.1007/s00701-003-0080-8

  21. Nowak G, Schwachenwald D, Schwachenwald R, Kehler U, Müller H, Arnold H (1998) Intracerebral hematomas caused by aneurysm rupture. Experience with 67 cases. Neurosurg Rev 21:5–9. https://doi.org/10.1007/BF01111478

    Article  CAS  PubMed  Google Scholar 

  22. Abbed KM, Ogilvy CS (2003) Intracerebral hematoma from aneurysm rupture. Neurosurg Focus 15(4):E4

    Article  Google Scholar 

  23. Mrfka M, Pistracher K, Augustin M, Kurschel-Lackner S, Mokry M (2013) Acute subdural hematoma without subarachnoid hemorrhage or intraparenchymal hematoma caused by rupture of a posterior communicating artery aneurysm: case report and review of the literature. J Emerg Med 44(6):e369–e373. https://doi.org/10.1016/j.jemermed.2012.11.073

    Article  PubMed  Google Scholar 

  24. Kocak A, Ates O, Durak A, Alkan A, Cayli S, Sarac K (2009) Acute subdural hematomas caused by ruptured aneurysms: experience from a single Turkish center. Turk Neurosurg 19:333–337

    PubMed  Google Scholar 

  25. Omodaka S, Endo H, Niizuma K, Fujimura M, Endo T, Sato K et al (2018) Circumferential wall enhancement on magnetic resonance imaging is useful to identify rupture site in patients with multiple cerebral aneurysms. Neurosurgery 82:638–644. https://doi.org/10.1093/neuros/nyx267

    Article  PubMed  Google Scholar 

  26. Mayer PL, Awad IA, Todor R, Harbaugh K, Varnavas G, Lansen TA et al (1996) Misdiagnosis of symptomatic cerebral aneurysm. Prevalence and correlation with outcome at four institutions. Stroke 27:1558–1563. https://doi.org/10.1161/01.str.27.9.1558

    Article  CAS  PubMed  Google Scholar 

  27. Ramgren B, Siemund R, Nilsson OG, Höglund P, Larsson EM, Abul-Kasim K, Björkman-Burtscher IM (2015) CT angiography in non-traumatic subarachnoid hemorrhage: the importance of arterial attenuation for the detection of intracranial aneurysms. Acta Radiol 56:1248–1255. https://doi.org/10.1177/0284185114551976

    Article  PubMed  Google Scholar 

  28. Heit JJ, Pastena GT, Nogueira RG, Yoo AJ, Leslie-Mazwi TM, Hirsch JA, Rabinov JD (2016) Cerebral angiography for evaluation of patients with CT angiogram-negative subarachnoid hemorrhage: an 11-year experience. AJNR Am J Neuroradiol 37:297–304. https://doi.org/10.3174/ajnr.A4503

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  29. Kusumi M, Yamada M, Kitahara T, Endo M, Kan S, Iida H, Sagiuchi T, Fujii K (2005) Rerupture of cerebral aneurysms during angiography—a retrospective study of 13 patients with subarachnoid hemorrhage. Acta Neurochir (Wien) 147:831–837. https://doi.org/10.1007/s00701-005-0541-3

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Radiology, Penn State Health Milton Hershey Medical Center, Hershey, PA, 17036, USA

    Einat Slonimsky, Tao Ouyang & Krishnamoorthy Thamburaj

  2. Department of Imaging Sciences, University of Rochester Medical Center, Rochester, NY, USA

    Kent Upham

  3. Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA

    Sarah Pepley

  4. Department of Biostatistics, Penn State Health College of Medicine, Hershey, PA, USA

    Tonya King

  5. Department of Human Neuroscience, Sapienza University of Rome, Rome, Italy

    Marco Fiorelli

Authors
  1. Einat Slonimsky
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Kent Upham
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Sarah Pepley
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Tao Ouyang
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Tonya King
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Marco Fiorelli
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Krishnamoorthy Thamburaj
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Einat Slonimsky –Literature review, Methodology and Manuscript writing and review.

Kent Upham – Methodology and Manuscript review.

Sarah Pepley—Methodology and Manuscript review.

Tao Ouyang – Methodology.

Tonya King – Statistical analysis.

Marco Fiorelli – Methodology and Manuscript review.

Krishnamoorthy Thamburaj – Conceptualization, Literature review, Methodology, and Manuscript writing and review.

Corresponding author

Correspondence to Krishnamoorthy Thamburaj.

Ethics declarations

Ethics approval and consent to participate

IRB approval obtained. Waiver of consent with IRB approval.

Consent for publication

N/A

Conflict of interest

The authors declare that they have no conflict of interest.

Additional information

Publisher's note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Slonimsky, E., Upham, K., Pepley, S. et al. Multiplanar CT evaluation of aneurysm rupture signs in subarachnoid hemorrhage. Emerg Radiol 29, 427–435 (2022). https://doi.org/10.1007/s10140-022-02020-w

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10140-022-02020-w

Keywords

Search

Navigation