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Role of CT Angiography in Evaluation of Intracranial Hemorr

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Amro Esmat

on 14 October 2016

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Transcript of Role of CT Angiography in Evaluation of Intracranial Hemorr

Role of CT Angiography in Evaluation of Intra-cranial Hemorrhage
BY: Amro Ahmed Esmat Abdel Rahman
M.B.B.Ch, Zagazig University
Resident in Radio diagnosis department
Zagazig University


Prof. Dr. Khaled Mohammed Shawky
Professor of Radiodiagnosis,
Faculty of medicine, Zagazig University

Prof. Dr. Elsayed Hamed Zidan
Assistant Professor of Radiodiagnosis,
Faculty of medicine, Zagazig University

Dr. Heba Abdel Monem Elsayed
Lecturer of Radiodiagnosis,
Faculty of medicine, Zagazig University
Thank you!
Intra-cranial hemorrhage may occur within brain parenchyma or the surrounding meningeal spaces. Intracerebral hemorrhage is more likely to result in death or major disability than ischemic stroke or subarachnoid hemorrhage.
Hence, the importance of evaluating the efficacy of CTA in detecting the cause of intra-cranial hemorrhage (ICH) and its ability to display the vascular anatomy in order to choose appropriate treatment.
1- To assess the diagnostic efficacy and efficiency of CTA in evaluation of intracranial hemorrhage.

2-To accurately delineate the Aneurysm and to better diagnose the associated anomalies to improve clinical management and proper intervention.

Role of CTA
CT angiography (CTA) is increasingly used to assess a vascular underlying cause, particularly in cases of subarachnoid haemorrhage, or intraparenchymal haemorrhage.
In addition, CT scanning is useful for localizing the source of bleeding. This is particularly important in cases of multiple intracranial aneurysms, which occur in 20% of patients.
It is the standard imaging technique for the detection of intracranial aneurysms, arteriovenous malformations (AVMs), and fistulae.
Aim of the work
Many cases of intra-cranial hemorrhage are of unknown etiology. Our purpose is to evaluate the usefulness of helical CT angiography (CTA) in the detection and characterization of the underlying cause.
Subjects and methods
A-Site of the study:
Radio diagnosis Department, Zagazig university hospitals

Type: comprehensive sample.
Sample size : calculated to be 30 patients, taken as a comprehensive sample, as all cases fulfilling the inclusion criteria admitted during the period of study 6 months will be included, as rate 5 cases/ month .

Patient inclusion criteria:
1. Any age group and sex.
2. Any patient with intracranial hemorrhage.
Patient exclusion criteria:
1. Patients with allergic reaction to contrast media.
2. Pregnant or lactating females.
3. Renal dysfunction (serum creatinine = 1.6mg/dl).
4. Ongoing bronchospasm.
5. Hemodynamic instability
6. Patients presented with secondary intracranial hemorrhage (history of uncontrolled hypertension, bleeding tendency & trauma)

Operational design:

A. Type of the study:

Cross sectional study.

B. Steps of performance:

1. Complete history taking.
2. Full clinical examination
3. Revising imaging results.
4. Analysis of the results.
5. Preparing conclusion and recommendations

1. Liebeskind D. et al.: Intracranial Hemorrhage, http://emedicine.medscape.com/article/1163977-overview, Medscape, 2016

2. Jayaraman MV, Mayo-Smith WW, Tung GA, Haas RA, Rogg JM, Mehta NR, Doberstein CE (2004) Detection of intracranial aneurysms: multi-detector row CT angiography compared with DSA. Radiology 230(2):510–518

3. Goddard AJ, Tan G, Becker J (2005) Computed tomography angiography for the detection and characterization of intra-cranial aneurysms: current status. Clin Radiol 60(12):1221–1236

4. Goel A., Gaillard F. et al., Intracranial haemorrhage, http://radiopaedia.org/articles/intracranial-haemorrhage, Radiopaedia 2014

5. Gershon A. et al, Imaging in Subarachnoid Hemorrhage, http://emedicine.medscape.com/article/344342-overview#a7, Medscape 2016.

6. Bederson JB, Connolly ES Jr, Batjer HH, Dacey RG, Dion JE, Diringer MN, et al. Guidelines for the Management of Aneurysmal Subarachnoid Hemorrhage. A Statement for Healthcare Professionals From a Special Writing Group of the Stroke Council, American Heart Association. Stroke. 2009 Jan 22. [Medline].

A, Midarterial phase anteroposterior projection DSA image shows a small saccular aneurysm at the supraclinoid internal carotid artery (short arrow). Note larger anterior communicating artery aneurysm (long arrow). Anterior choroidal artery aneurysm is mostly obscured by overlying internal carotid artery bifurcation (arrowhead).

B, 3D posteroanterior projection CTA image with lateral angulation shows aneurysm sac (short arrow). Anterior communicating artery (long arrow) and anterior choroidal artery (arrowhead) aneurysms are also well seen.
Patient 19, aneurysm 33. Example of ability of 2D and 3D helical CTA to visualize intracavernous carotid aneurysms.

A, Axial view 2D multiplanar reformatted image, obtained at the level of the sella turcica, shows a 2.7-mm saccular aneurysm of the left carotico-ophthalmic region (arrow).

B, Sagittal view 2D multiplanar reformatted image shows an inferiorly projecting saccular aneurysm (arrow).

C, Volume-rendered mediolateral projection helical CTA image shows a small inferiorly projecting aneurysm sac (arrow).
D, Arterial phase lateral projection DSA image shows the small inferiorly projecting aneurysm sac shown in A–C (arrow)

Admission brain computed tomography (CT) scan shows

Right frontal intracerebral hemorrhage (ICH) with a mass effect by ipsilateral ventricle compression (A).

Right three-dimensional digital subtraction angiogram (3D-DSA) shows the rupture point of the middle cerebral artery (MCA) bifurcation aneurysm projecting superiorly (B).
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