CT diagnosis of non-traumatic subarachnoid haemorrhage in patients with brain edema

Avrahami, E; Katz, Rami; Rabin, Alon; Friedman, V.

doi:10.1016/s0720-048x(97)00162-9

Cited by 56 publications

(32 citation statements)

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“…Various methods of quantification, including measurement of HU, subtracting the values of grey and white matter from the cerebrospinal fluid or measuring both against a skull water phantom (8,9,10), have been used to differentiate between grey and white matter. Generally, a decreased distinction between grey and white matter in CT predicts a poor outcome after cerebral insult.…”

Section: Discussionmentioning

confidence: 99%

Limited Evaluation of Image Quality Produced by a Portable Head CT Scanner (CereTom) in a Neurosurgery Centre

Abdullah¹,

Adnan

Rahman

et al. 2017

MJMS

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Introduction: Computed tomography (CT) is the preferred diagnostic toolkit for head and brain imaging of head injury. A recent development is the invention of a portable CT scanner that can be beneficial from a clinical point of view.Aim: To compare the quality of CT brain images produced by a fixed CT scanner and a portable CT scanner (CereTom).Methods: This work was a single-centre retrospective study of CT brain images from 112 neurosurgical patients. Hounsfield units (HUs) of the images from CereTom were measured for air, water and bone. Three assessors independently evaluated the images from the fixed CT scanner and CereTom. Streak artefacts, visualisation of lesions and grey-white matter differentiation were evaluated at three different levels (centrum semiovale, basal ganglia and middle cerebellar peduncles). Each evaluation was scored 1 (poor), 2 (average) or 3 (good) and summed up to form an ordinal reading of 3 to 9.Results Conclusions: Results of the study showed a significant difference in image quality produced by the fixed CT scanner and CereTom, with the latter being more inferior than the former. However, HUs of the images produced by CereTom do fulfil the recommendation of the ACR. To date, only a few studies have been conducted to evaluate the image quality produced by a portable head CT scanner. Thus, we designed this study to evaluate the quality of CT brain images produced by a portable head CT scanner, CereTom, by comparing it with that of a fixed CT scanner in terms of the presence of streak artefacts, grey-white matter differentiation and visualisation of lesions. CT numbers (HUs) were measured for air, water and bone in the images produced by the portable CT scanner. Keywords Materials and Methods SubjectsThis work was a single-centre retrospective study involving trauma and non-trauma patients admitted with intracranial pathology to the Neurosurgery Centre, Hospital Sultanah Aminah Johor Bharu (HSAJB), Malaysia, within four months from 1 December 2014 until 31 March 2015. The National Medical Research and Ethics Committee of the Ministry of Health, Malaysia, approved the study.Patient registry of the admission record was screened together with the record book for portable CT scanner (CereTom) imaging in a duration of four months. Images from the same patient who had CT brain imaging performed from both CereTom and the fixed CT scanner within 48 h apart were selected. CT brain images harbouring intracranial pathology were taken from traumatic and non-traumatic patients of all age groups and sex. Images captured more than 48 h apart between the fixed CT scanner and CereTom or if any surgical intervention had been conducted between these imaging were excluded. Prominent artefacts from external devices preventing a clear assessment of CereTom images, fixed CT images or both were also excluded from this study. A final list of 112 pairs of imaging films of not more than 48 h apart were selected with no sampling conducted. MeasuresThe CT numbers (HUs) of all the selected images from C...

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Section: Discussionmentioning

confidence: 99%

Limited Evaluation of Image Quality Produced by a Portable Head CT Scanner (CereTom) in a Neurosurgery Centre

Abdullah¹,

Adnan

Rahman

et al. 2017

MJMS

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“…Several investigators have reported that head CT images of such patients sometimes show high-attenuation areas (HDAs) along the cisterns or cortical sulci, mimicking subarachnoid hemorrhage (SAH), which was ruled out at autopsy or after a lumbar puncture and CSF examination. [1][2][3][4][5][6][7][8][9][10][11][12] These SAH-like findings were first described by Spiegel et al in 1986. 1 They reported that 10 patients with marked brain edema associated with a brain tumor or cerebral infarction showed SAH-like HDAs along the interhemispheric fissure and tentorium cerebelli on CT; in all 10 patients, intracranial hemorrhage was ruled out at autopsy.…”

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confidence: 96%

“…1 They reported that 10 patients with marked brain edema associated with a brain tumor or cerebral infarction showed SAH-like HDAs along the interhemispheric fissure and tentorium cerebelli on CT; in all 10 patients, intracranial hemorrhage was ruled out at autopsy. In 1998, on reviewing head CT examinations of 100 comatose patients with brain edema, Avrahami et al 2 found SAH-like findings along the cisterns and sulci in all of them and concluded that a CT diagnosis of SAH was unlikely. They proposed the term "pseudo-subarachnoid hemorrhage" (pseudo-SAH) for this phenomenon.…”

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confidence: 99%

Pseudo-Subarachnoid Hemorrhage Found in Patients with Postresuscitation Encephalopathy: Characteristics of CT Findings and Clinical Importance

Yuzawa

Higano²,

Mugikura

et al. 2008

AJNR Am J Neuroradiol

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“…[1][2][3] The key to differentiating true and pseudo-SAH is identifying the presence of severe cerebral oedema in the absence of a large amount of subarachnoid blood or a substantial parenchymal haematoma on a cranial CT scan. Cranial CT of pseudo-SAH will show the marked effacement of sulci and basal cisterns, slit-like ventricles, and poor grey-white matter differentiation.…”

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confidence: 99%

“…Cranial CT of pseudo-SAH will show the marked effacement of sulci and basal cisterns, slit-like ventricles, and poor grey-white matter differentiation. 1,2 Furthermore, the distribution of blood along the fissure and sulci exhibits irregular hyperdensity in true SAH, whereas it displays a smoother line in pseudo-SAH. …”

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confidence: 99%

Subarachnoid haemorrhage? Think again

2018

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A 69-year-old male patient was admitted to a hospital for acute cerebral infarction. During hospitalisation, he developed pneumonia, septic shock, bowel ischemia, and acute renal failure, and was transferred to our hospital for further treatment. On arrival, he underwent another non-contrast enhanced cranial computed tomography (CT), which suspected the presence of subarachnoid haemorrhage (SAH) (Figure 1). We then consulted a neurosurgeon urgently but additional image studies were avoided to prevent contrast agent-related nephrotoxicity. Subsequent radiology confirmed that the cranial CT displayed pseudo-SAH, which may have resulted from hypoxic encephalopathy-induced severe cerebral oedema.The patient was administered broadspectrum antibiotics, aggressive haemodynamic support for septic shock, and mannitol infusion for the cerebral oedema. However, the sepsis progressed and he died 6 days after admission from multiple organ failure.Marked cerebral oedema may develop in patients with hypoxic encephalopathy, severe head trauma, meningitis, postradiation therapy, and hypervolemia.1,2 Several studies have reported that cranial CT of such patients sometimes reveals increased attenuation along the basal cisterna or cortical sulci, which mimics SAH. [1][2][3] The key to differentiating true and pseudo-SAH is identifying the presence of severe cerebral oedema in the absence of a large amount of subarachnoid blood or a substantial parenchymal haematoma on a cranial CT scan. Cranial CT of pseudo-SAH will show the marked effacement of sulci and basal cisterns, slit-like ventricles, and poor grey-white matter differentiation. 1,2 Furthermore, the distribution of blood along the fissure and sulci exhibits irregular hyperdensity in true SAH, whereas it displays a smoother line in pseudo-SAH. ©Copyright C-T. Liu et al., 2017 Licensee PAGEPress, Italy Emergency Care Journal 2017 13:6681 doi:10.4081/ecj.2017.6681

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CT diagnosis of non-traumatic subarachnoid haemorrhage in patients with brain edema

Cited by 56 publications

References 8 publications

Limited Evaluation of Image Quality Produced by a Portable Head CT Scanner (CereTom) in a Neurosurgery Centre

Limited Evaluation of Image Quality Produced by a Portable Head CT Scanner (CereTom) in a Neurosurgery Centre

Pseudo-Subarachnoid Hemorrhage Found in Patients with Postresuscitation Encephalopathy: Characteristics of CT Findings and Clinical Importance

Subarachnoid haemorrhage? Think again

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