The Usefulness of 3D-CT Angiography as a Screening Tool for Vascular Abnormalities in Spontaneous ICH Patients

Abstract

IntroductionT he term spontaneous intracerebral hemorrhage (ICH) refers to all varieties of bleeding into the cerebral parenchyma in which 'trauma or other exogenous' factors do not play an essential part 24) . It constitutes a major neurosurgical problem. Its incidence varies from 10 to 32% of all cerebrovascular strokes in USA 19) , and from 27.3% to 47.6% in Korea 12,18) .Spontaneous ICH is caused more often by hypertension per se than by vascular abnormality secondarily 2,3) . Clinically, therefore, through investigations to detect any possible associated vascular abnormalities have not been routinely performed on the past. Conventional angiography remains the golden standard for diagnosis of vascular abnormality. But it is invasive, difficult in acutely ill patients, and carries definite risks 1) . Recently three-dimensional computerized tomographic angiography (3D-CTA) has shown to be promise as a highly sensitive and less invasive modality for determining the source of hemorrhage 8,23,29) . In this study, we have tired to screen any associated vascular abnormalities in spontaneous ICH using 3D-CTA.

Vascular imaging adds value in investigation of basal ganglia hemorrhage

“…[2][3][4][5]12 Notably, non-invasive vascular imaging occurred in 98.4% of our patients. Although conventional catheter angiography remains the gold standard for identifying underlying vascular lesions, it is an invasive procedure and carries significant risk.…”

“…8 The yield of vascular imaging in BGH is inversely related to both age and hypertension. [2][3][4][5]12 Toffol et al 13 concluded that vascular imaging is not indicated in hypertensive or normotensive patients with putaminal hemorrhages, especially if the patient is elderly, because all patients with putaminal hemorrhages had normal vascular imaging in their study. Zhu et al 2 found that in patients with putaminal, thalamic or posterior fossa ICH, the highest vascular imaging yield (48%) was in patients younger than 45 years of age without pre-existing hypertension; in older hypertensive patients the vascular imaging yield was 0%.…”

“…1 However, basal ganglia hemorrhage (BGH) with underlying vascular abnormalities are not rare, estimated to occur in 6.5% to 30.9% of all BGH, as detected by catheter angiography, or newer non-invasive techniques such as CT angiography (CTA) or magnetic resonance angiography (MRA). [2][3][4][5] These patients are at increased risk of rebleeding and hence detection of underlying lesions might well determine further treatment strategies. 6,7 There is a lack of consistency between the studies regarding selection criteria for vascular imaging examination following BGH.…”