Yield of CT Angiography and Contrast-Enhanced MR Imaging in Patients with Dizziness

Fakhran, Saeed; Alhilali, Lea; Branstetter, Barton F.

doi:10.3174/ajnr.a3325

Cited by 27 publications

(26 citation statements)

References 34 publications

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“…carotid stenosis and intracranial aneurysms) as well as allowing a post-contrast acquisition of the head for assessment of pathological enhancement. Regarding the use of CTA in patients with acute dizziness, Fakhran et al 19 described a diagnostic efficacy of CTA of 2.2% with a therapeutic efficacy of 1.3%. On the other hand, Chen et al 20 found that the presence of calcifications on CTA is a factor that could predict an ischaemic stroke but does not improve the sensitivity.…”

Section: Discussionmentioning

confidence: 99%

Limited usefulness of routine head and neck CT angiogram in the imaging assessment of dizziness in the emergency department

et al. 2021

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Objective To assess the usefulness of head and neck computed tomography angiogram for the investigation of isolated dizziness in the emergency department in detecting significant acute findings leading to a change in management in comparison to non-contrast computed tomography scan of the head. Methods Patients presenting with isolated dizziness in the emergency department investigated with non-contrast computed tomography and computed tomography angiogram over the span of 36 months were included. Findings on non-contrast computed tomography were classified as related to the emergency department presentation versus unrelated/no significant abnormality. Similarly, computed tomography angiogram scans were classified as positive or negative posterior circulation findings. Results One hundred and fifty-three patients were imaged as a result of emergency department presentation with isolated dizziness. Fourteen cases were diagnosed clinically as of central aetiology. Non-contrast computed tomography was positive in three patients, all with central causes with sensitivity 21.4%, specificity 100%, positive predictive value 100%, negative predictive value 92.6% and accuracy 92.8%. Computed tomography angiogram was positive for angiographic posterior circulation abnormalities in five cases, and only two of them had a central cause of dizziness, with sensitivity 14.3%, specificity 97.7%, positive predictive value 40%, negative predictive value 91.46% and accuracy 92.1%. Conclusion Both non-contrast computed tomography and computed tomography angiogram of the head and neck have low diagnostic yield for the detection of central causes of dizziness, However, non-contrast computed tomography has higher sensitivity and positive predictive value than computed tomography angiogram, implying a lack of diagnostic advantage from the routine use of computed tomography angiogram in the emergency department for the investigation of isolated dizziness. Further studies are required to determine the role of computed tomography angiogram in the work-up of isolated dizziness in the emergency department.

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Section: Discussionmentioning

confidence: 99%

Limited usefulness of routine head and neck CT angiogram in the imaging assessment of dizziness in the emergency department

et al. 2021

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“…Ahsan et al, [ 1 ] found 6.17% positive findings and 0.74% clinically significant findings for patients who were examined with CT or MR; they included patients with vertigo and dizziness, excluded patients with a history of stroke, brain tumour, brain surgery and other neurological disorder. Fakhran et al, [ 20 ] reported 3% positive findings on CT and MR examination performed with contrast; they excluded patients with the focal neurological deficit. Our research revealed 6.9% of clinically significant emergency examinations in patients with vertigo, without focal neurological abnormalities.…”

Section: Discussionmentioning

confidence: 99%

Value of Head CT Scan in the Emergency Department in Patients with Vertigo without Focal Neurological Abnormalities

Pavlović¹,

Milosevic²,

Trtica³

et al. 2018

Open Access Maced J Med Sci

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BACKGROUND:Vertigo is a common symptom and reason for admission to the emergency department (ED).AIM:This research aimed to determine the incidence of clinically significant findings on computed tomography (CT) in patients with vertigo without focal neurological abnormalities in the ED.MATERIAL AND METHODS:The results of the native CT scans in the ED were retrospectively analysed. Exclusion criteria included: focal neurological abnormalities, underlying malignancy, brain metastasis, previous brain operation, headache, fever, nausea, vomiting, head trauma, coagulopathy. As a clinically significant finding, we took into an account tumour, haemorrhage and acute ischemic lesion. 72 patients fulfilled the set criteria, present vertigo, without focal neurological abnormalities. Out of 72 patients with a median age of 62 (23-87) years old, 54% of the patients were female, and 46% were male.RESULTS:Normal CT findings were found in 44 patients (61.1%), 28 patients (38.9%) had pathological findings, out of that number 23 (31.9%) findings were clinically irrelevant and 5 (6.9%) were clinically significant. Out of the 5 clinically significant findings, tumour process was found in 3 (4.2%) patients, haemorrhage was found in 1 (1.4%) patient, and the ischemic lesion was found in 1 (1.4%) patient. Additional evaluation of five clinically significant findings showed a change of initial diagnosis in one case, but the significance of the finding remained the same.CONCLUSION:Our study demonstrates a low diagnostic yield of head CT examination with 6.9% of clinically significant findings in patients with vertigo without focal neurological abnormalities.

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“…5,7 Einungis um eða undir 1% af sjúklingum með svima án annarra taugaeinkenna greinast með slag eða aðra alvarlega miðtauga-kerfissjúkdóma. 1,4,6,8 Í okkar rannsókn var ítarlegum upplýsingum um einkenni ekki safnað, svo sem um staðbundin taugaeinkenni, og því erfitt að meta réttmaeti TS í hverju tilfelli fyrir sig. Stað-haefa má þó að steinaflakk sé í flestum tilfellum haegt að greina á tiltölulega einfaldan hátt með klínískri skoðun.…”

Section: Umraeðaunclassified

“…Yfirgnaefandi meirihluti bráða-TS rannsókna af heila hjá sjúk-lingum með svima er pantaður af laeknum bráðadeilda 6 og gera má ráð fyrir að sú sé einnig raunin á slysa-og bráðadeild Landpít-ala. Kostnaðurinn við TS af heila (án skuggaefnis) á Landspítala er um það bil 58.000 kr. Á þessu fjögurra mánaða rannsóknartímabili voru gerðar 65 TS hjá svimasjúklingum á slysa-og bráðadeild og kostnaður heilbrigðiskerfisins vegna þeirra því um 3.770.000 kr.…”

Section: Umraeðaunclassified

Svimi á bráðamóttöku - vantar á okkur klíníska nefið?

Örnólfsson¹,

Hjaltested²,

Margretardottir³

et al. 2016

LBL

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InngangurMargir laeknar finna til vanmáttar þegar kemur að því að vinna upp sjúklinga með svima. Líklega er hluti ástaeðunnar sú stað-reynd að svimi er huglaegt einkenni sem getur haft mjög ólíka þýðingu í hugum fólks. Snúningssvimi, óstöðugleiki, yfirliða-kennd og jafnvel ósértaek vanlíðan eru daemi um einkenni sem geta fallið undir kvörtun um svima. Önnur ástaeða getur verið sú að þó orsök svima sé oftast góðkynja getur alvarlegur sjúkdóm-ur sem krefst aðkallandi meðferðar legið á bakvið.1 Það er mikilvaegt að þekking og uppvinnsla á vandamálinu sé góð, ekki síst á bráðadeildum þar sem sjúklingar með svima eru stór hluti af öllum komum á bráðamóttöku. 2,3Niðurskurður til heilbrigðismála er viðvarandi víða um heim og ekki síst á Íslandi, sem gerir það að verkum að kostnaður í heilbrigðiskerfinu er til stöðugrar endurskoðunar. Eitt af því sem vert er að skoða er uppvinnsla svimasjúklinga sem oft er með þeim haetti að þeir gangast undir óþarfa rannsóknir með auknum kostnaði fyrir heilbrigðiskerfið sem og fyrir þá sjálfa.Markmið þessarar rannsóknar var að kanna umfang og gaeði uppvinnslu sjúklinga með svima á slysa-og bráðadeild Landspít-ala. Einnig að athuga hvort draga maetti úr kostnaði án þess að draga úr gaeðum þjónustunnar.Tillgangur: Markmið rannsóknarinnar var að kanna umfang og gaeði uppvinnslu sjúklinga með svima á slysa-og bráðadeild Landspítala. Efniviður og aðferðir: Allar komur á slysa-og bráðadeild á fjögurra mánaða tímabili þar sem svimi var aðalkvörtun sjúklings voru skoðaðar á afturskyggnan hátt. Þaettir sem leitað var eftir í sjúkraskrá voru tímalengd einkenna, sjúkdómsgreining, fjöldi rannsókna, rannsóknarniðurstöður og álit sérfraeðilaekna. Til að einfalda túlkun niðurstaðnanna var rannsóknum skipt í þrjá flokka; blóðprufur, myndgreiningu og álit sérfraeðings. Niðurstöður: Alls fundust 163 tilfelli. 28% greindust með svima frá inneyra og 32% voru útskrifaðir án sjúkdómsgreiningar. Fjögur prósent greindust með alvarlegan miðtaugakerfiskvilla. Í um þriðjungi tilfella voru gerðar rannsóknir úr öllum þremur rannsóknarflokkunum. Bráðatölvu-sneiðmynd af heila var gerð hjá 40% og segulómun af heila hjá 17%. Fengið var álit taugalaekna hjá 28%, háls,-nef-og eyrnalaeknis hjá 26% og hjartalaeknis hjá 2%. 11,6% (n=19) þessara sjúklinga lögðust inn á spítala, 53% á taugadeild, 42% á lyflaeknadeild og 5% á háls,-nef-og eyrnalaeknir. Ályktanir: Svimi er algengt einkenni hjá sjúklingum sem leita til slysa-og bráðadeildar Landspítala. Orsök svima er í flestum tilfellum góðkynja. Uppvinnsla svimasjúklinga er engu að síður oft viðamikil þar sem bráða-tölvusneiðmynd af heila er gerð í stórum hluta tilfella. Svimi á bráðamóttökunni -vantar okkur klíníska nefið? Efniviður og aðferðirSkoðað var á afturskyggnan hátt fjögurra mánaða tímabil frá 1. nóvember 2008 til 28. febrúar 2009. Öll tilfelli á slysa-og bráðadeild þar sem svimi var aðalkvörtun sjúklings, samkvaemt NOMESKOskráningarkerfinu, voru tekin inn í rannsóknina. Farið var yfir sjúkrasögu og rannsóknarniðurstöður en einnig voru skoðaðar endurkomur og viðbót...

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Yield of CT Angiography and Contrast-Enhanced MR Imaging in Patients with Dizziness

Cited by 27 publications

References 34 publications

Limited usefulness of routine head and neck CT angiogram in the imaging assessment of dizziness in the emergency department

Limited usefulness of routine head and neck CT angiogram in the imaging assessment of dizziness in the emergency department

Value of Head CT Scan in the Emergency Department in Patients with Vertigo without Focal Neurological Abnormalities

Svimi á bráðamóttöku - vantar á okkur klíníska nefið?

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