Advertisement

Emergency Radiology

, Volume 16, Issue 3, pp 195–201 | Cite as

Accuracy of CT angiography for the diagnosis of vascular abnormalities causing intraparenchymal hemorrhage in young patients

  • Javier M. RomeroEmail author
  • Maddy Artunduaga
  • N. Paola Forero
  • Josser Delgado
  • Kiran Sarfaraz
  • Joshua N. Goldstein
  • R Gilberto Gonzalez
  • Pamela W. Schaefer
Original Article

Abstract

The objective of this study is to measure the accuracy of multidetector CT angiography (MD CTA) in the detection of vascular abnormalities in patients ≤40 years with spontaneous intraparenchymal hemorrhage (IPH) presenting to the emergency department. After institutional review board approval, a retrospective study was performed of 43 consecutive patients ≤40 years, who presented to our emergency department with IPH and that were evaluated with MD CTA. MD CTA images were reviewed by a neuroradiologist to determine IPH location, presence of a vascular abnormality, and associated extraparenchymal hemorrhage. Diagnostic accuracy was measured comparing it to the available reference standards, which included conventional catheter angiogram (CCA), surgical macroscopic findings, and pathology results. Medical records were reviewed for risk factors and correlation with final diagnosis. MD CTA demonstrated an accuracy of 97.7%, with a sensitivity of 96.4% (95% CI 0.79–0.99) and a specificity of 100% (95% CI 0.74–0.99) for the detection of vascular abnormalities in young patients with IPH. Additionally, MD CTA had a PPV of 100%, and the NPV 93.8% in this population. Of the 43 patients included in the study, 28 patients (65%) had a causative vascular etiology for the IPH. Among the 28 patients with vascular etiologies for the IPH, 11 had an AVM (39.2%), nine a ruptured aneurysm (32.14%), seven dural venous sinus thrombosis (25%), and one had vasculitis (3.57%). MD CTA is highly accurate in the detection of vascular abnormalities in the setting of IPH, which as a group represents the most frequent etiology of IPH among patients age ≤40 years. MD CTA performed in the Emergency Department provides accurate, rapid and critical presurgical and premedical treatment information in young patients with IPH.

Keywords

MD CTA STROKE Neuroradiology Angiography Young Accuracy CTA 

References

  1. 1.
    Broderick J, Connolly S, Feldmann E, Hanley D, Kase C, Krieger D, Mayberg M, Morgenstern L, Ogilvy CS, Vespa P, Zuccarello M (2007) Guidelines for the management of spontaneous intracerebral hemorrhage in adults: 2007 update: A guideline from the American heart association/American stroke association stroke council, high blood pressure research council, and the quality of care and outcomes in research interdisciplinary working group. Stroke 38:2001–2023. doi: 10.1161/STROKEAHA.107.183689 PubMedCrossRefGoogle Scholar
  2. 2.
    Qureshi AI, Tuhrim S, Broderick JP, Batjer HH, Hondo H, Hanley DF (2001) Spontaneous intracerebral hemorrhage. N Engl J Med 344:1450–1460. doi: 10.1056/NEJM200105103441907 PubMedCrossRefGoogle Scholar
  3. 3.
    Kim J, Smith A, Hemphill JC 3rd, Smith WS, Lu Y, Dillon WP, Wintermark M (2008) Contrast extravasation on ct predicts mortality in primary intracerebral hemorrhage. AJNR Am J Neuroradiol 29:520–525. doi: 10.3174/ajnr.A0859 PubMedCrossRefGoogle Scholar
  4. 4.
    Drury I, Whisnant JP, Garraway WM (1984) Primary intracerebral hemorrhage: Impact of ct on incidence. Neurology 34:653–657PubMedGoogle Scholar
  5. 5.
    Ruiz-Sandoval JL, Cantu C, Barinagarrementeria F (1999) Intracerebral hemorrhage in young people: Analysis of risk factors, location, causes, and prognosis. Stroke 30:537–541PubMedGoogle Scholar
  6. 6.
    Bevan H, Sharma K, Bradley W (1990) Stroke in young adults. Stroke 21:382–386PubMedGoogle Scholar
  7. 7.
    Al-Jarallah A, Al-Rifai MT, Riela AR, Roach ES (2000) Nontraumatic brain hemorrhage in children: Etiology and presentation. J Child Neurol 15:284–289. doi: 10.1177/088307380001500503 PubMedCrossRefGoogle Scholar
  8. 8.
    Laissy JP, Normand G, Monroc M, Duchateau C, Alibert F, Thiebot J (1991) Spontaneous intracerebral hematomas from vascular causes. Predictive value of ct compared with angiography. Neuroradiology 33:291–295. doi: 10.1007/BF00587808 PubMedCrossRefGoogle Scholar
  9. 9.
    Zhu XL, Chan MS, Poon WS (1997) Spontaneous intracranial hemorrhage: Which patients need diagnostic cerebral angiography? A prospective study of 206 cases and review of the literature. Stroke 28:1406–1409PubMedGoogle Scholar
  10. 10.
    Abu Bakar I, Shuaib IL, Mohd Ariff AR, Naing NN, Abdullah JM (2005) Diagnostic cerebral angiography in spontaneous intracranial haemorrhage: a guide for developing countries. Asian J Surg 28:1–6PubMedGoogle Scholar
  11. 11.
    Griffiths PD, Beveridge CJ, Gholkar A (1997) Angiography in non-traumatic brain haematoma. An analysis of 100 cases. Acta Radiol 38:797–802PubMedGoogle Scholar
  12. 12.
    Halpin SF, Britton JA, Byrne JV, Clifton A, Hart G, Moore A (1994) Prospective evaluation of cerebral angiography and computed tomography in cerebral haematoma. J Neurol Neurosurg Psychiatry 57:1180–1186. doi: 10.1136/jnnp.57.10.1180 PubMedCrossRefGoogle Scholar
  13. 13.
    Ohtani R, Kazui S, Tomimoto H, Minematsu K, Naritomi H (2003) Clinical and radiographic features of lobar cerebral hemorrhage: hypertensive versus non-hypertensive cases. Intern Med 42:576–580. doi: 10.2169/internalmedicine.42.576 PubMedCrossRefGoogle Scholar
  14. 14.
    Loes DJ, Smoker WR, Biller J, Cornell SH (1987) Nontraumatic lobar intracerebral hemorrhage: CT/angiographic correlation. AJNR Am J Neuroradiol 8:1027–1030PubMedGoogle Scholar
  15. 15.
    Goddard AJ, Tan G, Becker J (2005) Computed tomography angiography for the detection and characterization of intra-cranial aneurysms: current status. Clin Radiol 60:1221–1236. doi: 10.1016/j.crad.2005.06.007 PubMedCrossRefGoogle Scholar
  16. 16.
    Rosand J, Eckman MH, Knudsen KA, Singer DE, Greenberg SM (2004) The effect of warfarin and intensity of anticoagulation on outcome of intracerebral hemorrhage. Arch Intern Med 164:880–884. doi: 10.1001/archinte.164.8.880 PubMedCrossRefGoogle Scholar
  17. 17.
    The Arteriovenous Malformation Study Group (1999) Arteriovenous malformations of the brain in adults. N Engl J Med 340:1812–1818. doi: 10.1056/NEJM199906103402307 CrossRefGoogle Scholar
  18. 18.
    Jordan LC, Hillis AE (2007) Hemorrhagic stroke in children. Pediatr Neurol 36:73–80. doi: 10.1016/j.pediatrneurol.2006.09.017 PubMedCrossRefGoogle Scholar
  19. 19.
    Burger IM, Murphy KJ, Jordan LC, Tamargo RJ, Gailloud P (2006) Safety of cerebral digital subtraction angiography in children: Complication rate analysis in 241 consecutive diagnostic angiograms. Stroke 37:2535–2539. doi: 10.1161/01.STR.0000239697.56147.77 PubMedCrossRefGoogle Scholar
  20. 20.
    Brenner DJ, Hall EJ (2007) Computed tomography—an increasing source of radiation exposure. N Engl J Med 357:2277–2284. doi: 10.1056/NEJMra072149 PubMedCrossRefGoogle Scholar
  21. 21.
    Cohnen M, Wittsack HJ, Assadi S, Muskalla K, Ringelstein A, Poll LW, Saleh A, Modder U (2006) Radiation exposure of patients in comprehensive computed tomography of the head in acute stroke. AJNR Am J Neuroradiol 27:1741–1745PubMedGoogle Scholar
  22. 22.
    de Bruijn SF, Stam J, Vandenbroucke JP (1998) Increased risk of cerebral venous sinus thrombosis with third-generation oral contraceptives. Cerebral venous sinus thrombosis study group. Lancet 351:1404. doi: 10.1016/S0140-6736(05)79442-3 PubMedCrossRefGoogle Scholar
  23. 23.
    Liu AC, Segaren N, Cox TS, Hayward RD, Chong WK, Ganesan V, Saunders DE (2006) Is there a role for magnetic resonance imaging in the evaluation of non-traumatic intraparenchymal haemorrhage in children? Pediatr Radiol 36:940–946. doi: 10.1007/s00247-006-0236-9 PubMedCrossRefGoogle Scholar
  24. 24.
    Papadias A, Taha A, Sgouros S, Walsh AR, Hockley AD (2007) Incidence of vascular malformations in spontaneous intra-cerebral haemorrhage in children. Childs Nerv Syst 23:881–886. doi: 10.1007/s00381-007-0322-9 PubMedCrossRefGoogle Scholar
  25. 25.
    Goldstein JN, Fazen LE, Snider R, Schwab K, Greenberg SM, Smith EE, Lev MH, Rosand J (2007) Contrast extravasation on ct angiography predicts hematoma expansion in intracerebral hemorrhage. Neurology 68:889–894. doi: 10.1212/01.wnl.0000257087.22852.21 PubMedCrossRefGoogle Scholar

Copyright information

© Am Soc Emergency Radiol 2008

Authors and Affiliations

  • Javier M. Romero
    • 1
    Email author
  • Maddy Artunduaga
    • 1
  • N. Paola Forero
    • 1
  • Josser Delgado
    • 1
  • Kiran Sarfaraz
    • 1
  • Joshua N. Goldstein
    • 2
  • R Gilberto Gonzalez
    • 1
    • 2
  • Pamela W. Schaefer
    • 1
  1. 1.Department of Radiology, Massachusetts General HospitalHarvard Medical SchoolBostonUSA
  2. 2.Department of Emergency Medicine, Massachusetts General HospitalHarvard Medical SchoolBostonUSA

Personalised recommendations