3D Rotational Angiography After Non-Traumatic SAH.
OBJECTIVE
In about 15 % of patients with SAH no causative vascular lesions can be found in acute imaging with CTA and DSA. Usually, repeat DSA is mandatory and bears the usual risk of invasive angiography. The present study attempts to assess the diagnostic impact of 3 D rotational angiography in order to avoid repeat DSA.


METHODS
From January 2004 to December 2012, 649 patients with an acute non-traumatic SAH were examined. 91 patients with negative initial imaging diagnostics concerning the bleeding source were included in this study. These patients underwent a second angiography scan: 61 in 4-plane technique, and 30 with 2-plane technique and additional 3 D DSA. Two cohorts were compared: patients with repeat angiography in conventional 4-plane technique from 2004 to July 2008 and 2-plane technique with additional 3 D rotational DSA from 2008 to 2012. Statistical significance was verified by means of Fisher's exact test.


RESULTS
In the second DSA scan, 4 aneurysms in 4 patients (4/91; 4.4 %) were found and treated subsequently. Within the first 4.5 years of this study, 401 patients with SAH were treated and 61 of them underwent repeat angiography (15.2 %) compared to 30 of 248 patients (12.1 %) in the last 4.5 years of this study. In the first group we found 3 aneurysms during repeat angiography, and in the second group we found 1. No significance was reached (p = 0.29) but there was a tendency towards higher diagnostic security using 3D-DSA.


CONCLUSIONS
Using 3 D rotational DSA in initial imaging workup might help to reduce false-negative results concerning the bleeding source of acute SAH. At least because of this fact, 3 D rotational DSA should be part of the diagnostic workup after acute SAH.
Department of Diagnostic and Interventional Radiology and Neuroradiology, Univ. Duisburg-Essen, Medical Faculty, Essen.
A
A
Ringelstein
Hospital for Neurosurgery, University Hospital, Essen.
O
O
Mueller
Department of Diagnostic and Interventional Radiology and Neuroradiology, Univ. Duisburg-Essen, Medical Faculty, Essen.
C
C
Mönninghoff
Department of Diagnostic and Interventional Radiology and Neuroradiology, Univ. Duisburg-Essen, Medical Faculty, Essen.
M L
ML
Hahnemann
Hospital for Neurosurgery, University Hospital, Essen.
U
U
Sure
Department of Diagnostic and Interventional Radiology and Neuroradiology, Univ. Duisburg-Essen, Medical Faculty, Essen.
M
M
Forsting
Department of Diagnostic and Interventional Radiology and Neuroradiology, Univ. Duisburg-Essen, Medical Faculty, Essen.
M
M
Schlamann
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015901:Angiography, Digital Subtraction / Q000379:methods*; D001930:Brain Injuries / Q000000981:diagnostic imaging / Q000601:surgery; D002533:Cerebral Angiography / Q000379:methods*; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011856:Radiographic Image Enhancement / Q000379:methods; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D013345:Subarachnoid Hemorrhage / Q000000981:diagnostic imaging* / Q000601:surgery*; D014057:Tomography, X-Ray Computed / Q000379:methods*; D016896:Treatment Outcome; D019564:Unnecessary Procedures