Cerebral aneurysm exclusion by CT angiography based on subarachnoid hemorrhage pattern: a retrospective study.
BACKGROUND
To identify patients with spontaneous subarachnoid hemorrhage for whom CT angiography alone can exclude ruptured aneurysms.


METHODS
An observational retrospective review was carried out of all consecutive patients with non-traumatic subarachnoid hemorrhage who underwent both CT angiography and catheter angiography to exclude an aneurysm. CT angiography negative cases (no aneurysm) were classified according to their CT hemorrhage pattern as "aneurismal", "perimesencephalic" or as "no-hemorrhage."


RESULTS
Two hundred and forty-one patients were included. A CT angiography aneurysm detection sensitivity and specificity of 96.4% and 96.0% were observed. All 35 cases of perimesencephalic or no-hemorrhage out of 78 CT angiography negatives also had negative angiography findings.


CONCLUSIONS
CT angiography is self-reliant to exclude ruptured aneurysms when either a perimesencephalic hemorrhage or no-hemorrhage pattern is identified on the CT within a week of symptom onset.
Department of Radiology, Centre Hospitalier Universitaire Vaudois and University of Lausanne, 1011 Lausanne, Switzerland.
Marc
M
Kelliny
Philippe
P
Maeder
Stefano
S
Binaghi
Marc
M
Levivier
Luca
L
Regli
Reto
R
Meuli
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017542:Aneurysm, Ruptured / Q000000981:diagnostic imaging*; D015901:Angiography, Digital Subtraction; D002533:Cerebral Angiography; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013345:Subarachnoid Hemorrhage / Q000000981:diagnostic imaging*
Ann Neurol. 1991 May;29(5):463-8
1859176
AJNR Am J Neuroradiol. 2007 Nov-Dec;28(10):1949-55
17898200
Stroke. 2004 Jul;35(7):1614-8
15166390
Neuroradiology. 2007 Dec;49(12):997-1007
17891387
Stroke. 1997 Dec;28(12):2572
9412654
Lancet. 1991 Oct 19;338(8773):964-8
1681340
J Neurosurg. 2002 Dec;97(6):1322-32
12507130
Neurosurgery. 2000 Mar;46(3):584-8
10719854
AJNR Am J Neuroradiol. 1991 Sep-Oct;12(5):829-34
1950905
AJNR Am J Neuroradiol. 2002 Aug;23(7):1199-205
12169480
AJNR Am J Neuroradiol. 2010 Apr;31(4):696-705
19942709
J Neurosurg. 1990 Jul;73(1):18-36
2191090
AJNR Am J Neuroradiol. 2003 Jun-Jul;24(6):1067-74
12812928
Neurosurgery. 2003 Mar;52(3):624-31; discussion 630-1
12590688
Neurol Res. 1996 Jun;18(3):220-6
8837056
Surg Neurol. 1993 Apr;39(4):320-3
8488453
Stroke. 1999 May;30(5):1103-9
10229751
Australas Radiol. 1993 May;37(2):156-60
8512504
J Vasc Interv Radiol. 2009 Apr;20(4):442-7
19246211
J Neurol Neurosurg Psychiatry. 1997 Sep;63(3):382-4
9328259
Neurosurgery. 2006 Oct;59(4):798-801; discussion 801-2
16915122
Stroke. 2000 Dec;31(12):2976-83
11108759
Neurology. 1985 Apr;35(4):493-7
3982634
Acta Neurochir (Wien). 1993;124(2-4):79-81
8304074
Lancet. 2007 Jan 27;369(9558):306-18
17258671
AJNR Am J Neuroradiol. 2008 May;29(5):976-9
18258703
J Emerg Med. 2005 Jul;29(1):23-7
15961003
J Neurosurg. 2003 Mar;98(3):529-35
12650424
AJNR Am J Neuroradiol. 2008 May;29(5):962-6
18258701
Neurosurgery. 1996 Sep;39(3):433-40; discussion 440
8875472
Surg Neurol. 2002 Mar;57(3):211
12009557
Clin Neurol Neurosurg. 2003 Apr;105(2):95-8
12691799
Acad Emerg Med. 1996 Sep;3(9):827-31
8870753
No Shinkei Geka. 1993 Oct;21(10):903-8
8413803
Neurosurgery. 2009 Aug;65(2):311-5; discussion 315
19625910
J Neurosurg. 2003 Apr;98(4):828-36
12691409
Surg Neurol. 2002 Mar;57(3):160-5; discussion 165-6
12009538
Neuroradiology. 2006 Nov;48(11):787-94
17009025
Surg Neurol. 1998 Jul;50(1):50-60; discussion 60-1
9657493
Neurosurgery. 2007 Dec;61(6):1139-50; discussion 1150-1
18162892
Acad Emerg Med. 1996 Jan;3(1):16-20
8749962
J Neurol Neurosurg Psychiatry. 1995 Mar;58(3):357-9
7897421