Multidetector row CT angiography in spontaneous lobar intracerebral hemorrhage: a prospective comparison with conventional angiography

Abstract

Background and purpose: The aim of our study was to assess the accuracy of multidetector row CT angiography (MDCTA) in the detection of the underlying vascular abnormalities causing spontaneous lobar intracerebral hemorrhage (ICH) compared with conventional digital subtraction angiography (DSA).

Materials and methods: Seventy-eight patients who underwent MDCTA with use of a 16-detector row scanner and DSA were prospectively included in this study. Each study was assessed by 2 independent blinded neuroradiologists; decisions were made in consensus. Findings on CT angiograms, including the original axial data, multiplanar reformations, and volume-rendered images with and without automated bone segmentation, were used to identify the underlying causes of ICH.

Results: Twenty-two of the 78 patients (28.2%) exhibited angiographic abnormalities, including aneurysms of the proximal arteries (n = 9), arteriovenous malformations (n = 7), Moyamoya disease (n = 4), and aneurysms of the distal arteries (n = 2). MDCTA detected the underlying vascular abnormalities in 21 patients except 1 case of small arteriovenous malformation. Overall sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of MDCTA for detection of underlying vascular abnormalities were 95.5%, 100%, 100%, 98.2%, and 98.7%, respectively.

Conclusions: MDCTA is a highly accurate imaging technique in the diagnosis of underlying vascular abnormalities in patients with spontaneous lobar ICH.

Fig 1.

A 46-year-old man with an aneurysm of the distal MCA. A, Unenhanced CT scan demonstrates hemorrhage (arrow) in the right parietal lobe with mild surrounding edema. B and C, Left anterior oblique projection of the volume-rendered image (B) and the coronal multiplanar reformatted image (C) from MDCTA demonstrates a 2.5-mm saccular aneurysm (arrow) at the distal branch of the right MCA with an upward orientation of the sac. Note the relationship of the hematoma (arrowheads) to the aneurysm. D, DSA image of the right ICA, anteroposterior projection, shows the same aneurysm (arrow), which was confirmed at surgical exploration.

Fig 2.

A 29-year-old man with an arteriovenous malformation. A, Unenhanced CT scan demonstrates hemorrhage (arrow) in the right frontal lobe. B, Volume-rendered MDCTA image, lateral projection, clearly demonstrates the abnormal collections of vessels in the right frontal lobe (arrowhead) and the enlarged draining cortical veins (arrows). C, Corresponding DSA image of the right ICA confirms these findings, demonstrating the nidus (arrowhead) and the early draining veins (arrows).

Fig 3.

A 28-year-old woman with Moyamoya disease. A, Unenhanced CT scan demonstrates pericallosal hematoma (arrow) with extension of hemorrhage into the lateral ventricle. B, Volume-rendered MDCTA image with bone subtraction, anteroposterior projection, demonstrates symmetric occlusion of the bilateral proximal MCAs (arrows). MDCTA image fails to show collateral vessels. C and D, Corresponding DSA images of the right (C) and left (D) carotid arteries, anteroposterior projection, confirm occlusion of the bilateral proximal MCAs (arrows). In addition, reconstitution of the distal MCAs via fine collateral vessels is also noted.