Diagnostic value of non-enhanced computed tomography in identifying location of ruptured cerebral aneurysm in patients with aneurysmal subarachnoid haemorrhage

Sawicki, Marcin; Kościukiewicz, Krzysztof; Jeżewski, Dariusz; Chełstowski, Kornel; Gołofit, Piotr; Skoczylas, Michał; Gębka, Michał; Grabizna, Kornelia; Kołaczyk, Katarzyna; Zwarzany, Łukasz; Sagan, Leszek; Poncyljusz, Wojciech

doi:10.5603/pjnns.a2020.0007

Cited by 5 publications

(4 citation statements)

References 13 publications

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“…Ruptured aneurysm localisation rates on NECT and digitally subtracted angiograms vary from 52% to 80%, with studies reporting high sensitivities in localising anterior communicating, anterior cerebral and middle cerebral artery aneurysms. 21 , 22 , 23 , 24 In these studies, performed in the acute phase, the haemorrhage pattern was identified and causative aneurysm prediction was performed. As the current study was performed in the chronic phase of ASAH, SWI was able to detect haemosiderin distal to the areas of the initial haemorrhage load, thus creating complexity in the localisation of the maximum site of haemosiderin.…”

Section: Discussionmentioning

confidence: 99%

“…Maximum haemosiderin staining in the Sylvian cisterns was seen with ipsilateral middle cerebral (PPV = 31.25%), posterior communicating (PPV = 50%) and distal internal carotid arteries aneurysms (PPV = 18.75%) and hence was not specific for ruptured MCA aneurysms as observed in previous studies in the acute phase. 21 , 22 , 23 , 24 This is thought to be related to CSF flow dynamics and deposition of haemosiderin. Figure 6 demonstrates an example of localised haemosiderin and haematoma related to the Sylvian fissure.…”

Section: Discussionmentioning

confidence: 99%

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Why SWI? The sensitivity of susceptibility weighted imaging in aneurysmal subarachnoid haemorrhage in the chronic phase

Wang

Harrichandparsad

Amod

2023

South African Journal of Radiology

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Background: Incidentally detected unruptured intracranial aneurysms have a prevalence of 3% with some predisposed to rupture and others remaining static. Diagnostic knowledge of previous aneurysmal subarachnoid haemorrhage (ASAH) in the chronic phase could identify patients requiring treatment.Objectives: To assess the sensitivity of susceptibility weighted imaging (SWI) in the detection of ASAH at 3 months post ictus and determine any influencing effects.Method: A retrospective chart analysis of 46 patients with ASAH who underwent post-embolisation SWI imaging at 3 months. The SWI and available initial CT brain scans or CT reports were evaluated and correlated with patient demographics and clinical severity.Results: Susceptibility weighted imaging indicated a sensitivity of 95.7% in the detection of ASAH at 3 months. Increased number of haemosiderin zones on SWI correlated with older patient age (p = 0.0003). Clinical severity (World Federation Neurosurgical Societies Score) showed a tendency towards a statistically relevant relationship (p = 0.07). No statistically significant relationship was identified between the number of haemosiderin zones and initial CT modified Fisher score (p = 0.34) or the causative aneurysm location (p = 0.37).Conclusion: Susceptibility weighted imaging is sensitive in the detection of ASAH at 3 months, increasing in sensitivity with patient age and higher initial clinical severity.Contribution: In patients presenting in the subacute to chronic phase with a clinically suspicious history of previous aneurysm rupture but without convincing CT or spectrophotometry evidence, SWI can detect previous rupture. This can identify patients who could benefit from endovascular treatment and those who can safely undergo follow-up imaging.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Why SWI? The sensitivity of susceptibility weighted imaging in aneurysmal subarachnoid haemorrhage in the chronic phase

Wang

Harrichandparsad

Amod

2023

South African Journal of Radiology

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“…Aneurysm detection could be expected by assessing the distribution of SAH, the site of the largest clot, the difference in attenuation, and the presence of mural calcification. A recent study performed on patients with SAH and multiple cerebral aneurysms found that NCCT can identify the source of bleeding with high accuracy for ACA, ACom, and MCA aneurysms, especially with the presence of intracranial hemorrhage (ICH)[ 10 ]. Our results showed excellent inter-observer agreement for detecting acute hydrocephalus with a variable degree of acute ventricular dilation, yet only 15% of our cases need management by EVD.…”

Section: Discussionmentioning

confidence: 99%

Interobserver reliability of computed tomography angiography in the assessment of ruptured intracranial aneurysm and impact on patient management

Elmokadem,

Elged,

Abdel Razek

et al. 2023

World J Radiol

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BACKGROUND Aneurysmal subarachnoid hemorrhage is an emergency that can lead to a high mortality rate and many severe complications. It is critical to make a rapid radiological evaluation of ruptured intracranial aneurysms (RIAs) to determine the appropriate surgical treatment. AIM To assess the reliability of computed tomography angiography (CTA) in assessing different features of ruptured intracranial aneurysm and its impact on patient management. METHODS The final cohort of this study consisted of 146 patients with RIAs (75 male and 71 female) who underwent cerebral CTA. Their age ranged from 25 to 80, and the mean age ± SD was 57 ± 8.95 years. Two readers were asked to assess different features related to the aneurysm and perianeurysmal environment. Inter-observer agreement was measured using kappa statistics. Imaging data extracted from non-contrast computed tomography and CTA were considered to categorize the study population into two groups according to the recommended therapeutic approach. RESULTS The inter-observer agreement of both reviewers was excellent for the detection of aneurysms (K = 0.95, P = 0.001), aneurysm location (K = 0.98, P = 0.001), and (K = 0.98, P = 0.001), morphology (K = 0.92, P = 0.001) and margins (K = 0.95, P = 0.001). There was an excellent interobserver agreement for the measurement of aneurysm size (K = 0.89, P = 0.001), neck (K = 0.85, P = 0.001), and dome-to-neck ratio (K = 0.98, P = 0.001). There was an excellent inter-observer agreement for the detection of other aneurysm-related features such as thrombosis (K = 0.82, P = 0.001), calcification (K = 1.0, P = 0.001), bony landmark (K = 0.89, P = 0.001) and branch incorporation (K = 0.91, P = 0.001) as well as perianeurysmal findings including vasospasm (K = 0.91, P = 0.001), perianeurysmal cyst (K = 1.0, P = 0.001) and associated vascular lesions (K = 0.83, P = 0.001). Based on imaging features, 87 patients were recommended to have endovascular treatment, while surgery was recommended in 59 patients. 71.2% of the study population underwent the recommended therapy. CONCLUSION CTA is a reproducible promising diagnostic imaging modality for detecting and characterizing cerebral aneurysms.

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“…However, small aneurysms remain the cause of a significant percentage of aneurysmal SAH [4]. Up to 30% of patients with acute aneurysmal SAH have multiple intracranial aneurysms [5,6]. Correct identification of a ruptured aneurysm in this condition is crucial for treatment planning.…”

Section: Introductionmentioning

confidence: 99%

Significance of aneurysm wall enhancement on high-resolution vessel wall magnetic resonance imaging in clinical management of patients with intracranial aneurysms

Zwarzany

Sawicki

Poncyljusz

2020

Neurol Neurochir Pol.

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Introduction. The prevalence of intracranial aneurysms is estimated to be around 3% in the general population. Although these are often incidental findings, they potentially carry the risk of rupture, with all of the devastating consequences of SAH.State of the art. Several risk factors of aneurysm rupture have been identified, including aneurysm size, irregular shape, and location. Although it is widely accepted that the risk of rupture increases with size, small aneurysms remain the cause of a significant percentage of aneurysmal SAH. Up to 30% of patients with acute aneurysmal SAH have multiple aneurysms. Determining the site of rupture in these patients can be challenging, given that the results of imaging studies and clinical symptoms are sometimes inconclusive. It would be extremely useful to identify new imaging biomarkers of aneurysm instability which could have an impact on patient management and qualification for treatment. High-resolution vessel wall magnetic resonance imaging (HR-VW MRI) opens up new possibilities for improved characterisation of intracranial vasculature. One of the most promising clinical applications of this new imaging tool is the evaluation of intracranial aneurysms.Clinical implications. Aneurysm wall enhancement (AWE) on HR-VW MRI is believed to be a marker for wall inflammation and, potentially, for aneurysm instability. In this article, we summarise the published literature on AWE with special emphasis on its use in determining the site of rupture in the setting of acute SAH in patients with multiple aneurysms, as well as its role in identifying unruptured aneurysms which are at the greatest risk of rupture.Future directions. More and larger studies are needed to definitively establish the role of AWE on HR-VW MRI in the diagnostic workup of patients with intracranial aneurysms.

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Diagnostic value of non-enhanced computed tomography in identifying location of ruptured cerebral aneurysm in patients with aneurysmal subarachnoid haemorrhage

Cited by 5 publications

References 13 publications

Why SWI? The sensitivity of susceptibility weighted imaging in aneurysmal subarachnoid haemorrhage in the chronic phase

Why SWI? The sensitivity of susceptibility weighted imaging in aneurysmal subarachnoid haemorrhage in the chronic phase

Interobserver reliability of computed tomography angiography in the assessment of ruptured intracranial aneurysm and impact on patient management

Significance of aneurysm wall enhancement on high-resolution vessel wall magnetic resonance imaging in clinical management of patients with intracranial aneurysms

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