Computed tomographic angiography as the primary diagnostic study in spontaneous subarachnoid hemorrhage.
OBJECTIVE
To evaluate the utility of computed tomographic angiography (CTA) as the primary diagnostic investigation in patients with spontaneous subarachnoid hemorrhage (SAH), and to correlate the results with intraoperative findings in those with ruptured aneurysms.


METHODS
A retrospective review of 243 patients with spontaneous SAH was performed. The patients selected were those with acute SAH confirmed by noncontrast head computed tomography or by cerebrospinal fluid findings from a lumbar puncture. Patients subsequently underwent preoperative three-dimensional CTA as the sole or primary diagnostic study. The results of the CTA were correlated with the intraoperative findings in those patients undergoing emergent surgical clipping of acutely ruptured intracranial aneurysms.


RESULTS
CTA correctly detected the ruptured aneurysm in 170 of the 171 cases, which required surgical clipping. Our data demonstrates that CTA has a 99.4% detection rate in acutely ruptured aneurysms as compared to intraoperative findings [confidence interval 97.8-99.9%].


CONCLUSIONS
CTA can provide prompt and accurate diagnostic and anatomic information in the setting of SAH with an excellent detection rate in acute ruptured aneurysms. These findings suggest an increased role for CTA in the evaluation of cerebral aneurysms.
Nijjar
Satnam
S
Section of Neurology, Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada. Satnam.Nijjar@utoronto.ca
Patel
Bijal
B
McGinn
Greg
G
West
Michael
M
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002533:Cerebral Angiography / Q000379:methods*; D003287:Contrast Media; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013345:Subarachnoid Hemorrhage / Q000000981:diagnostic imaging*; D014057:Tomography, X-Ray Computed
D003287:Contrast Media