open access

Vol 54, No 1 (2020)
Research paper
Published online: 2020-01-22
Submitted: 2019-05-01
Accepted: 2019-11-05
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Diagnostic value of non-enhanced computed tomography in identifying location of ruptured cerebral aneurysm in patients with aneurysmal subarachnoid haemorrhage

Marcin Sawicki, Krzysztof Kościukiewicz, Dariusz Jeżewski, Kornel Chełstowski, Piotr Gołofit, Michał M. Skoczylas, Michał Gębka, Kornelia Grabizna, Katarzyna Kołaczyk, Łukasz Zwarzany, Leszek Sagan, Wojciech Poncyljusz
DOI: 10.5603/PJNNS.a2020.0007
·
Pubmed: 31967317
·
Neurol Neurochir Pol 2020;54(1):47-53.

open access

Vol 54, No 1 (2020)
Research paper
Published online: 2020-01-22
Submitted: 2019-05-01
Accepted: 2019-11-05

Abstract

Background. In patients with SAH and multiple aneurysms, the ruptured lesion must be identified to prevent recurrent bleeding.

Aim of the study.
To assess the diagnostic value of non-enhanced computed tomography (NECT) in identifying the rupture site in patients with subarachnoid haemorrhage (SAH) and multiple aneurysms.

Material and methods.
We included patients with SAH revealed by NECT and multiple aneurysms detected on computed tomography angiography (CTA) in whom a ruptured aneurysm was identified during neurosurgery. Two radiologists predicted the location of the ruptured aneurysm based on the distribution of the SAH and location of intracerebral haematoma (ICH) by NECT.

Results.
Eighty-three patients with a mean age of 55.7 ± 14.4 years were included. Ruptured aneurysms were significantly larger (mean size 7.7 ± 4.7 mm) than unruptured aneurysms (mean size 5.9 ± 4.5 mm; p = 0.014). Interobserver agreement was 0.86 (p < 0.001). Overall sensitivity and specificity of radiological prediction were 78.3% (95% CI, 68.6%-87.1%) and 96.4% (95% CI, 94.3%-97.8%) respectively. Overall PPV and NPV were 78.3% (95% CI, 67.6%-86.3%) and 96.8% (95% CI, 94.8%-98.1%) respectively. The sensitivity and PPV for aneurysms in the anterior communicating, anterior, and middle cerebral arteries appeared to be significantly higher than in other locations (p = 0.015 and 0.019 respectively). Analysis of independent predictive factors of correct radiological location revealed that ICH predisposes to a correct radiological diagnosis with an odds ratio of 8.57 (95% CI, 1.07-68.99; p = 0.03).

Conclusions.
NECT has a high diagnostic value in identifying the source of bleeding in patients with multiple aneurysms for anterior circulation aneurysms, especially with coexisting ICH. For other locations, NECT is not reliable enough to base treatment decisions upon.

Abstract

Background. In patients with SAH and multiple aneurysms, the ruptured lesion must be identified to prevent recurrent bleeding.

Aim of the study.
To assess the diagnostic value of non-enhanced computed tomography (NECT) in identifying the rupture site in patients with subarachnoid haemorrhage (SAH) and multiple aneurysms.

Material and methods.
We included patients with SAH revealed by NECT and multiple aneurysms detected on computed tomography angiography (CTA) in whom a ruptured aneurysm was identified during neurosurgery. Two radiologists predicted the location of the ruptured aneurysm based on the distribution of the SAH and location of intracerebral haematoma (ICH) by NECT.

Results.
Eighty-three patients with a mean age of 55.7 ± 14.4 years were included. Ruptured aneurysms were significantly larger (mean size 7.7 ± 4.7 mm) than unruptured aneurysms (mean size 5.9 ± 4.5 mm; p = 0.014). Interobserver agreement was 0.86 (p < 0.001). Overall sensitivity and specificity of radiological prediction were 78.3% (95% CI, 68.6%-87.1%) and 96.4% (95% CI, 94.3%-97.8%) respectively. Overall PPV and NPV were 78.3% (95% CI, 67.6%-86.3%) and 96.8% (95% CI, 94.8%-98.1%) respectively. The sensitivity and PPV for aneurysms in the anterior communicating, anterior, and middle cerebral arteries appeared to be significantly higher than in other locations (p = 0.015 and 0.019 respectively). Analysis of independent predictive factors of correct radiological location revealed that ICH predisposes to a correct radiological diagnosis with an odds ratio of 8.57 (95% CI, 1.07-68.99; p = 0.03).

Conclusions.
NECT has a high diagnostic value in identifying the source of bleeding in patients with multiple aneurysms for anterior circulation aneurysms, especially with coexisting ICH. For other locations, NECT is not reliable enough to base treatment decisions upon.

Get Citation

Keywords

intracranial aneurysm, multidetector computed tomography, observer variation, subarachnoid haemorrhage

About this article
Title

Diagnostic value of non-enhanced computed tomography in identifying location of ruptured cerebral aneurysm in patients with aneurysmal subarachnoid haemorrhage

Journal

Neurologia i Neurochirurgia Polska

Issue

Vol 54, No 1 (2020)

Pages

47-53

Published online

2020-01-22

DOI

10.5603/PJNNS.a2020.0007

Pubmed

31967317

Bibliographic record

Neurol Neurochir Pol 2020;54(1):47-53.

Keywords

intracranial aneurysm
multidetector computed tomography
observer variation
subarachnoid haemorrhage

Authors

Marcin Sawicki
Krzysztof Kościukiewicz
Dariusz Jeżewski
Kornel Chełstowski
Piotr Gołofit
Michał M. Skoczylas
Michał Gębka
Kornelia Grabizna
Katarzyna Kołaczyk
Łukasz Zwarzany
Leszek Sagan
Wojciech Poncyljusz

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