BACKGROUND AND PURPOSE: Multidetector CT angiography (MDCTA) is emerging as the favored initial diagnostic examination in the evaluation of patients presenting with spontaneous intraparenchymal hemorrhage (IPH). This study aims to evaluate the diagnostic accuracy and yield of MDCTA for the detection of vascular etiologies in adult patients presenting to the emergency department with IPH. MATERIALS AND METHODS: We conducted a retrospective study of 623 consecutive adult patients presenting to the emergency department with IPH, who were evaluated with MDCTA during a 9-year period. CT angiograms were reviewed by 2 neuroradiologists to determine the IPH site and the presence of a vascular etiology. Patients with associated subarachnoid hemorrhage in the basal cisterns were excluded from the study. Medical records were reviewed for risk factors and correlation with final diagnosis. The diagnostic accuracy of MDCTA compared with conventional angiography, intraoperative evaluation, and pathologic findings was determined, when available. Multiple-variable logistic regression analysis was performed to determine clinical and radiologic factors that predict a higher yield of MDCTA. RESULTS: MDCTA demonstrated a vascular etiology in 91 patients (14.6%), with a sensitivity of 96%, specificity of 99%, and diagnostic accuracy of 98%. We found independent, statistically significant higher yields of MDCTA in patients with the following characteristics: 1) age younger than 46 years (47%); 2) lobar (20%) or infratentorial (16%) IPH, especially lobar IPH with associated intraventricular hemorrhage (25%); 3) female sex (18%); or 4) neither known hypertension nor impaired coagulation at presentation (33%). CONCLUSIONS: MDCTA is an accurate diagnostic examination in the evaluation of adult patients presenting with spontaneous IPH and should be performed in all patients with the aforementioned clinical and radiologic characteristics.
BACKGROUND AND PURPOSE: Multidetector CT angiography (MDCTA) is emerging as the favored initial diagnostic examination in the evaluation of patients presenting with spontaneous intraparenchymal hemorrhage (IPH). This study aims to evaluate the diagnostic accuracy and yield of MDCTA for the detection of vascular etiologies in adult patients presenting to the emergency department with IPH. MATERIALS AND METHODS: We conducted a retrospective study of 623 consecutive adult patients presenting to the emergency department with IPH, who were evaluated with MDCTA during a 9-year period. CT angiograms were reviewed by 2 neuroradiologists to determine the IPH site and the presence of a vascular etiology. Patients with associated subarachnoid hemorrhage in the basal cisterns were excluded from the study. Medical records were reviewed for risk factors and correlation with final diagnosis. The diagnostic accuracy of MDCTA compared with conventional angiography, intraoperative evaluation, and pathologic findings was determined, when available. Multiple-variable logistic regression analysis was performed to determine clinical and radiologic factors that predict a higher yield of MDCTA. RESULTS: MDCTA demonstrated a vascular etiology in 91 patients (14.6%), with a sensitivity of 96%, specificity of 99%, and diagnostic accuracy of 98%. We found independent, statistically significant higher yields of MDCTA in patients with the following characteristics: 1) age younger than 46 years (47%); 2) lobar (20%) or infratentorial (16%) IPH, especially lobar IPH with associated intraventricular hemorrhage (25%); 3) female sex (18%); or 4) neither known hypertension nor impaired coagulation at presentation (33%). CONCLUSIONS: MDCTA is an accurate diagnostic examination in the evaluation of adult patients presenting with spontaneous IPH and should be performed in all patients with the aforementioned clinical and radiologic characteristics.
Authors: Javier M Romero; H Bart Brouwers; Jingjing Lu; Josser E Delgado Almandoz; Hillary Kelly; Jeremy Heit; Joshua Goldstein; Jonathan Rosand; R Gilberto Gonzalez Journal: Stroke Date: 2013-09-10 Impact factor: 7.914
Authors: S J Kim; H K Lim; H Y Lee; C G Choi; D H Lee; D C Suh; S M Kim; J K Kim; B Krauss Journal: AJNR Am J Neuroradiol Date: 2012-01-12 Impact factor: 3.825
Authors: J E Delgado Almandoz; H S Su; P W Schaefer; J N Goldstein; S R Pomerantz; M H Lev; R G González; J M Romero Journal: AJNR Am J Neuroradiol Date: 2011-02-24 Impact factor: 3.825
Authors: Maged D Fam; Alice Pang; Hussein A Zeineddine; Steven Mayo; Agnieszka Stadnik; Michael Jesselson; Lingjiao Zhang; Rachel Dlugash; Wendy Ziai; Daniel Hanley; Issam A Awad Journal: Cerebrovasc Dis Date: 2017-02-28 Impact factor: 2.762