The Usefulness of 3D-CT Angiography as a Screening Tool for Vascular Abnormalities in Spontaneous ICH Patients

ABSTRACT

OBJECTIVE: We investigated the incidence of the vascular abnormalities associated with spontaneous intracerebral hemorrhage (ICH) using three-dimensional computed tomographic angiography (3D-CTA). METHODS: We prospectively assessed consecutive 76 patients with spontaneous intracerebral hemorrhage (ICH) who underwent 3D-CTA between June 2003 and May 2005. The patients with a recent history of trauma or mainly subarachnoid hemorrhage were excluded. We investigated relationship between vascular abnormality and ICH location. The findings of 3D-CTA were classified as one of three patterns with ICH; type A (without evidence of vascular abnormality), type B (with no vascular abnormality as the source of hemorrhage, but with incidental vascular abnormality), and type C (presence of a vascular abnormality as the source of hemorrhage). RESULTS: Sites of ICH were lobar 26, basal ganglia 23, thalamus 17, posterior fossa 6 and dominant intraventricular hemorrhage (IVH) 4. Among 76 patients, sixteen (21.1%) vascular abnormalities were noted excluding 13 cases of stenoocclusive disease. Sixteen cases included 6 cases of cerebral aneurysms (7.9%), 5 moyamoya diseases (6.6%), 4 arteriovenous malformations (5.3%) and 1 dural sinus thrombosis (1.3%). Lobar ICH (30.8%) had a higher vascular abnormalities than other types, and younger age (<40) group had a higher incidence of vascular abnormalities than old age group. The patterns of 3D-CTA include sixty cases (79.0%) of type A, 6 cases (7.8%) of type B and 10 cases (13.2%) of type C. The vascular abnormalities were found in 8 (13.5%) of 59 hypertensive patients and 8 (47.0%) of 17 non-hypertensive patients (p=0.006). CONCLUSION: 3D-CT angiography is considered a useful screening tool for ICH patients with suspected cerebrovascular abnormalities and should be considered in such clinical settings, especially in lobar type and in non-hypertensive younger patients.