Intravenous flat-detector computed tomography angiography for symptomatic cerebral vasospasm following aneurysmal subarachnoid hemorrhage.
The study evaluated the diagnostic accuracy of intravenous flat-detector computed tomography (IV FDCT) angiography in assessing hemodynamically significant cerebral vasospasm in patients with subarachnoid hemorrhage (SAH) with digital subtraction angiography (DSA) as the reference. DSA and IV FDCT were conducted concurrently in patients suspected of having symptomatic cerebral vasospasm postoperatively. The presence and severity of vasospasm were estimated according to location (proximal versus distal). Vasospasm >50% was defined as having hemodynamic significance. Vasospasms <30% were excluded from this analysis to avoid spectrum bias. Twenty-nine patients (311 vessel segments) were measured. The intra- and interobserver agreements were excellent for depicting vasospasm (k = 0.84 and 0.74, resp.). IV FDCT showed a sensitivity of 95.7%, specificity of 92.3%, positive predictive value of 93.6%, and negative predictive value of 94.7% for detecting vasospasm (>50%) with DSA as the reference. Bland-Altman plots revealed good agreement of assessing vasospasm between the two tests. The discrepancy of vasospasm severity was more noted in the distal location with high-severity. However, it was not statistically significant (Spearman's rank test; r = 0.15, P = 0.35). Therefore, IV FDCT could be a feasible noninvasive test to evaluate suspected significant vasospasm in SAH.
Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Republic of Korea.
Jin Pyeong
JP
Jeon
Department of Neurosurgery, Bundang Jesaeng Hospital, Kwandong University College of Medicine, Bundang, Republic of Korea.
Seung Hun
SH
Sheen
Department of Neurosurgery, Hallym University College of Medicine, Chuncheon, Republic of Korea.
Yong-Jun
YJ
Cho
D000368:Aged; D015901:Angiography, Digital Subtraction; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D013345:Subarachnoid Hemorrhage / Q000000981:diagnostic imaging* / Q000473:pathology; D014057:Tomography, X-Ray Computed; D020301:Vasospasm, Intracranial / Q000000981:diagnostic imaging* / Q000473:pathology