title: Timely Antecedent CT or MRI Can Help Predict Hemorrhage Site of Posttreatment Head and Neck Cancer, With Digital Subtraction Angiography Used as the Reference Standard.
abstract: OBJECTIVE
  We investigated the timing of CT and MRI performed before digital subtraction angiography (DSA) in the prediction of hemorrhage sites in patients with head and neck cancers who present with acute oral or neck bleeding after receiving treatment.
  
  
  METHODS
  A total of 123 DSA examinations that evaluated 123 oral or neck bleeding events in 85 patients were analyzed. The last CT or MRI examinations performed within a time frame of 0-337 days before transarterial embolization were reviewed retrospectively, with three findings (pseudoaneurysm, air-containing necrotic tissue, and residual tumor) used to predict hemorrhage sites. DSA findings of pseudoaneurysm or active contrast extravasation were used as a reference standard. The sensitivity of CT and MRI for correctly predicting hemorrhage sites was used to determine the optimal timing of CT or MRI examinations performed before DSA.
  
  
  RESULTS
  A total of 8.9% of the DSA examinations (11/123) had equivocal findings but were followed by another bleeding event for which DSA findings were positive. CT or MRI was statistically significantly better at predicting hemorrhage sites in patients with bleeding events associated with nonhypopharyngeal cancers (p = 0.019) than in those with bleeding events associated with hypopharyngeal cancers. The sensitivity of CT or MRI in the prediction of hemorrhage sites was statistically significantly higher for the common carotid artery and the internal carotid artery when CT or MRI was performed less than 30 days before bleeding events occurred. Prediction of hemorrhagic sites was better with the use of CT angiography than with the use of enhanced CT or MRI, although it was not statistically significant.
  
  
  CONCLUSIONS
  DSA findings can temporarily be equivocal. CT or MRI examinations performed within 30 days of bleeding events can predict the site of hemorrhage. If no CT or MRI findings from the past 30 days are available, we suggest performing emergent CT angiography for the sake of obtaining better arterial detail.
authors.affiliation: 1 Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou, School of Medicine, Chang Gung University, No. 5 Fu Sing Rd, Kweishan, Taoyuan 333, Taiwan, ROC.
authors.forename: Yi-Kang
authors.initials: YK
authors.lastname: Ku
authors.affiliation: 1 Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou, School of Medicine, Chang Gung University, No. 5 Fu Sing Rd, Kweishan, Taoyuan 333, Taiwan, ROC.
authors.forename: Yon-Cheong
authors.initials: YC
authors.lastname: Wong
authors.affiliation: 1 Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou, School of Medicine, Chang Gung University, No. 5 Fu Sing Rd, Kweishan, Taoyuan 333, Taiwan, ROC.
authors.forename: Chen-Ju
authors.initials: CJ
authors.lastname: Fu
authors.affiliation: 2 Biostatistical Center for Clinical Research, Chang Gung Memorial Hospital at Linkou, School of Medicine, Chang Gung University, Taoyuan, Taiwan.
authors.forename: Hsiao-Jung
authors.initials: HJ
authors.lastname: Tseng
authors.affiliation: 1 Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou, School of Medicine, Chang Gung University, No. 5 Fu Sing Rd, Kweishan, Taoyuan 333, Taiwan, ROC.
authors.forename: Li-Jen
authors.initials: LJ
authors.lastname: Wang
authors.affiliation: 1 Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou, School of Medicine, Chang Gung University, No. 5 Fu Sing Rd, Kweishan, Taoyuan 333, Taiwan, ROC.
authors.forename: Chao-Jan
authors.initials: CJ
authors.lastname: Wang
authors.affiliation: 1 Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou, School of Medicine, Chang Gung University, No. 5 Fu Sing Rd, Kweishan, Taoyuan 333, Taiwan, ROC.
authors.forename: Shy-Chyi
authors.initials: SC
authors.lastname: Chin
mesh_terms: D000328:Adult; D000368:Aged; D015901:Angiography, Digital Subtraction; D002340:Carotid Artery Diseases / Q000175:diagnosis* / Q000628:therapy; D002533:Cerebral Angiography / Q000379:methods*; D003287:Contrast Media; D004621:Embolization, Therapeutic; D005260:Female; D006258:Head and Neck Neoplasms / Q000473:pathology* / Q000628:therapy*; D006470:Hemorrhage / Q000175:diagnosis*; D006801:Humans; D018810:Magnetic Resonance Angiography / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000379:methods*; D016896:Treatment Outcome
chemical_list: D003287:Contrast Media
keywords: carotid blowout syndrome; common carotid artery; downstream external carotid artery; internal carotid artery; proximal external carotid artery; transarterial embolization