OBJECTIVE: We studied the diagnostic power of blood distribution on CT (performed within 72 hours after the bleed) for the site of ruptured aneurysm in 168 consecutive patients with subarachnoid hemorrhage with either a single aneurysm or no aneurysm on the four-vessel angiogram or postmortem examination. METHODS: A neurosurgeon and a neuroradiologist blind to the results of the angiography independently scored the distribution of blood on the CT and predicted the site of the ruptured aneurysm. RESULTS: Overall agreement among raters was 52% and chance-adjusted agreement (kappa) was 0.42 (weighted kappa value 0.47). A parenchymal cerebral hematoma was an excellent predictor for the site of a ruptured aneurysm but was present in only a minority of cases (15%). The next most valid predictor was blood distribution on CT in patients with a ruptured anterior cerebral artery aneurysm or anterior communicating artery aneurysm (sensitivity 0.79, specificity 0.96, and positive predictive value 0.79 for rater 1; sensitivity 0.77, specificity 0.97, and positive predictive value 0.90 for rater 2). The validity of the predictive value of blood distribution on CT in patients with a ruptured aneurysm of the middle cerebral artery, internal carotid artery, or posterior circulation arteries was either inconsistent between raters or low. CONCLUSION: With the exception of the presence of a parenchymal hematoma, the site of the ruptured aneurysm can be predicted by CT only in ruptured anterior cerebral artery or anterior communicating artery aneurysms.
OBJECTIVE: We studied the diagnostic power of blood distribution on CT (performed within 72 hours after the bleed) for the site of ruptured aneurysm in 168 consecutive patients with subarachnoid hemorrhage with either a single aneurysm or no aneurysm on the four-vessel angiogram or postmortem examination. METHODS: A neurosurgeon and a neuroradiologist blind to the results of the angiography independently scored the distribution of blood on the CT and predicted the site of the ruptured aneurysm. RESULTS: Overall agreement among raters was 52% and chance-adjusted agreement (kappa) was 0.42 (weighted kappa value 0.47). A parenchymal cerebral hematoma was an excellent predictor for the site of a ruptured aneurysm but was present in only a minority of cases (15%). The next most valid predictor was blood distribution on CT in patients with a ruptured anterior cerebral artery aneurysm or anterior communicating artery aneurysm (sensitivity 0.79, specificity 0.96, and positive predictive value 0.79 for rater 1; sensitivity 0.77, specificity 0.97, and positive predictive value 0.90 for rater 2). The validity of the predictive value of blood distribution on CT in patients with a ruptured aneurysm of the middle cerebral artery, internal carotid artery, or posterior circulation arteries was either inconsistent between raters or low. CONCLUSION: With the exception of the presence of a parenchymal hematoma, the site of the ruptured aneurysm can be predicted by CT only in ruptured anterior cerebral artery or anterior communicating artery aneurysms.
Authors: Jean Marie U-King-Im; Brendan Koo; Rikin A Trivedi; Nicholas J Higgins; Keng Y Tay; Justin J Cross; Nagui M Antoun; Jonathan H Gillard Journal: Eur Radiol Date: 2005-02-12 Impact factor: 5.315
Authors: Nazli Janjua; Adnan I Qureshi; Adnan Qureshi; Jawad F Kirmani; Giuseppe Lanzino; Gene Sung; Jose I Suarez; Ali Ebrahimi; Afshin A Divani; Afshin Divani Journal: Neurocrit Care Date: 2005 Impact factor: 3.210
Authors: Einat Slonimsky; Kent Upham; Sarah Pepley; Tao Ouyang; Tonya King; Marco Fiorelli; Krishnamoorthy Thamburaj Journal: Emerg Radiol Date: 2022-01-24