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The Value of Computed Tomography Angiography in Determining Treatment Allocation for Aneurysmal Subarachnoid Hemorrhage

Neurocritical Care volume 9, pages 300–306 (2008)Cite this article

Abstract

Background and Purpose

Computed tomography (CT) and CT angiography (CTA) are frequently the initial imaging modalities used in the evaluation of patients with suspected aneurysmal subarachnoid hemorrhage (SAH). It remains unclear whether CTA can provide adequate information to determine best treatment modality (endovascular versus surgical) for ruptured intracranial aneurysms.

Methods

Pertinent clinical and radiological information of consecutive patients with aneurysmal SAH who underwent CTA on a 64-slice multidetector CT (MDCT) scanner were independently reviewed by five endovascular specialists. Subsequently, the interobserver reliability was calculated.

Results

A total of 21 consecutive patients with aneurysmal SAH detected on CTA were reviewed. Of the total of 105 reviews, in 65% a treatment allocation decision was made. Responses were, 26% either treatment; 18% endovascular only; 18% surgical only; and 3% neither treatment. In the remaining 35% it was considered that CTA images were inadequate to make a decision for treatment allocation and more information was requested. Interobserver reliability was poor between endovascular specialists (k = 0.2). The reliability was higher among endovascular/vascular neurosurgeons (k = 0.34) and physicians with >5 years of faculty experience (k = 0.55).

Conclusion

When 64-slice MDCT angiography is used in the evaluation of aneurysmal SAH, the information obtained is adequate to determine treatment modality allocation in two-thirds of the cases. The agreement on best treatment modality varied across primary specialty, practice experience, and site of fellowship completion.

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Authors and Affiliations

  1. Department of Neurology, Zeenat Qureshi Stroke Research Center, University of Minnesota, MMC 295, 420 Delaware St. S.E, Minneapolis, MN, 55455, USA

    Jefferson T. Miley, Robert A. Taylor, Vallabh Janardhan, Ramachandra Tummala & Adnan I. Qureshi

  2. Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA

    Giuseppe Lanzino

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  1. Jefferson T. Miley
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  2. Robert A. Taylor
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  3. Vallabh Janardhan
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  4. Ramachandra Tummala
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  5. Giuseppe Lanzino
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  6. Adnan I. Qureshi
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Correspondence to Jefferson T. Miley.

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Miley, J.T., Taylor, R.A., Janardhan, V. et al. The Value of Computed Tomography Angiography in Determining Treatment Allocation for Aneurysmal Subarachnoid Hemorrhage. Neurocrit Care 9, 300–306 (2008). https://doi.org/10.1007/s12028-008-9109-4

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  • DOI: https://doi.org/10.1007/s12028-008-9109-4

Keywords

  • Subarachnoid hemorrhage
  • Intracranial aneurysm
  • Computed tomography angiography
  • Endovascular
  • Interobserver
  • Kappa