Detection of Intracranial Arterial Stenosis Using Transcranial Color-Coded Duplex Sonography, Computed Tomographic Angiography, and Digital Subtraction Angiography

Background: The causes of angiogram-negative subarachnoid hemorrhage (SAH) on initial angiography, which accounts for 10–30% of spontaneous SAH, are heterogeneous and still unclear. We report a case of nonaneurysmal SAH, in which initial computed tomographic angiography (CTA) showed no source of bleeding, but the subsequent digital subtraction angiography (DSA) revealed contrast extravasation from the basilar artery without aneurysms. Case Description: A 67-year-old woman with a medical history of hypertension presented as SAH of World Federation of Neurological Surgeons Grade II. CTA on admission did not show any cause of bleeding and DSA was subsequently performed to show contrast extravasation from a perforator of the middle third of the basilar artery without aneurysms during the subsequent DSA, resulting in profound deterioration SAH and neurological status. The patient was conservatively treated. Follow-up DSAs on days 2 and 16 showed no source of bleeding as well. Conclusion: Although the precise cause of bleeding in this case is uncertain, SAH might be caused by local dissection of the basilar artery perforator, and the bleeding site might heal spontaneously without forming of a pseudoaneurysm.

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Role of digital subtraction angiography in detection of intracranial aneurysms compared with computed tomographic angiography

Sri Lanka Journal of Radiology ◽

10.4038/sljr.v5i1.76 ◽

2019 ◽

Vol 5 (1) ◽

pp. 19

Author(s):

S. Maniharan ◽

A. D. P. Athukorala ◽

D. L. N. Pullaperuma ◽

S. Pirasath ◽

I. N. Lekamge

Keyword(s):

Digital Subtraction Angiography ◽

Intracranial Aneurysms ◽

Computed Tomographic Angiography ◽

Digital Subtraction ◽

Computed Tomographic ◽

Tomographic Angiography

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Comparison of Computed Tomographic Angiography with Digital Subtraction Angiography in the Diagnosis of Cerebral Aneurysms: A Meta-analysis

Neurosurgery ◽

10.1227/01.neu.0000047895.82857.eb ◽

2003 ◽

Vol 52 (3) ◽

pp. 624-631 ◽

Cited By ~ 149

Author(s):

E. Thomas Chappell ◽

Federico Castro Moure ◽

Matthew C. Good

Keyword(s):

Digital Subtraction Angiography ◽

Standard Method ◽

World Literature ◽

Meta Analysis ◽

Cerebral Aneurysms ◽

Computed Tomographic Angiography ◽

Digital Subtraction ◽

Computed Tomographic ◽

Number Of Patients ◽

Tomographic Angiography

Abstract OBJECTIVE To compare a novel diagnostic radiological technique, computed tomographic angiography (CTA), with the standard method, namely digital subtraction angiography (DSA), in the diagnosis of cerebral aneurysms. METHODS A comprehensive search of the world literature on CTA was performed. Articles that reported on prospective comparisons of CTA and DSA in the evaluation of patients suspected of harboring cerebral aneurysms were selected for data extraction. Suitable statistical methods were applied to the extracted data for meta-analysis. RESULTS Twenty-one references met the criteria for use in the meta-analysis. Unweighted calculations based on data for 1251 patients resulted in a sensitivity of 0.933 (93.3%; range, 75.4–100%) and a specificity of 0.878 (87.8%; range, 0–100%). When the studies were weighted for the number of patients in each study, the sensitivity decreased slightly, to 0.927 (92.7%), and the specificity decreased more substantially, to 0.772 (77.2%). CONCLUSION On the basis of this meta-analysis, DSA remains the standard method. However, many who use CTA have reported it to be as good as or better than DSA in the diagnosis and treatment of cerebral aneurysms, as well as being of less risk and discomfort to their patients and easier and less expensive to perform.

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