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Value of CTA/MRA in the setting of intraparenchymal hemorrhage in the emergency department

  • Diagnostic Neuroradiology
  • Published:
Neuroradiology Aims and scope Submit manuscript

Abstract

Purpose

To assess the diagnostic yield of computed tomography angiography (CTA)/magnetic resonance angiography (MRA) brain and neck ordered in the emergency department (ED) for patients who have intraparenchymal hemorrhage (IPH) on their initial noncontrast CT (NCCT) of the head.

Methods

In this retrospective study, we reviewed 156 patients presenting to the ED with nontraumatic IPH, documented on NCCT. We assessed if the subsequent CTA/MRA was positive, and collected data regarding the location of the bleed, patients’ age group, and presence/absence of associated SAH/IVH. Two neuroradiologists were asked to predict, based on age and NCCT appearance, whether the CTA/MRA would be positive or negative for demonstrating a vascular etiology of the hemorrhage.

Results

The yield of CTA/MRA head for patients above 75 years old was 2% (1/49), as the etiology for IPH in such age group was more commonly related to hypertensive bleed or amyloid angiopathy. The concomitant presence of subarachnoid hemorrhage (SAH) and intraventricular hemorrhage (IVH), particularly in patients younger than 75 years, correlated with a higher likelihood of a positive CTA. Statistically, the neuroradiologists were able to exclude a vascular source of the IPH based on CT appearance, bleed location, and patient’s age in over 92% of cases.

Conclusion

CTA/MRA for IPH has a lower yield in patients at older age and with deep gray matter distribution without SAH. Neuroradiologists were accurate at excluding a vascular source of the IPH in most cases. This study suggests that CTA/MRA can be omitted in certain scenarios, thereby preventing overutilization, and leading to optimal use of health care resources.

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Abbreviations

CTA:

Computed tomography angiography

MRA:

Magnetic resonance angiography

IPH:

Intraparenchymal hemorrhage

IVH:

Intraventricular hemorrhage

SAH:

Subarachnoid hemorrhage

NCCT:

Noncontrast computed tomography

ED:

Emergency department

CAA:

Cerebral amyloid angiopathy

NPV:

Negative predictive value

PPV:

Positive predictive value (PPV)

MRV:

MR venogram

AP/AC:

Antiplatelet/anticoagulant

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Funding

No funding was received for conducting this study.

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Authors and Affiliations

  1. Division of Neuroradiology, Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA

    Aline Camargo

  2. Department of Radiology, Milton S. Hershey Medical Center, Penn State Health, Hershey, PA, USA

    Thomas Zacharia, Sanghar Kanekar & Michael Bruno

  3. Division of Biostatistics and Bioinformatics, Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA

    Zizhong Tian & Shouhao Zhou

  4. Division of Neuroradiology, Department of Radiology and Radiological Science, The Russell H. Morgan, The Johns Hopkins Medical Institution, Baltimore, MD, USA

    David M. Yousem

Authors
  1. Aline Camargo
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  2. Thomas Zacharia
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  3. Sanghar Kanekar
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  4. Michael Bruno
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  5. Zizhong Tian
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  6. Shouhao Zhou
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  7. David M. Yousem
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Corresponding author

Correspondence to Aline Camargo.

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Conflict of interest

The authors have no competing interests to declare that are relevant to the content of this article.

Ethical approval

This is a retrospective chart review study. The Human Investigation Committee (IRB) of Penn State College of Medicine approved this study.

Informed consent

This is a retrospective study based on chart review; individual patient consent was waived. This study was conducted with Health Insurance Portability and Accountability Act compliance.

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Camargo, A., Zacharia, T., Kanekar, S. et al. Value of CTA/MRA in the setting of intraparenchymal hemorrhage in the emergency department. Neuroradiology 65, 97–103 (2023). https://doi.org/10.1007/s00234-022-03080-y

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  • DOI: https://doi.org/10.1007/s00234-022-03080-y

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