Role of Multislice Computerized Tomographic Angiography in Vasospasm Following Aneurysmal Subarachnoid Hemorrhage

ABSTRACT

OBJECTIVE: We evaluate the role of multislice computerized tomographic angiography(MCTA) in the diagnosis of intracranial vasospasm following subarachnoid hemorrhage(SAH) in patients suspected of having vasospasm on clinical ground. METHODS: Between October 2003 and June 2005, patients with ruptured cerebral aneurysms of the anterior circulation clipped within 3 days of the onset were included. We performed follow-up MCTAs in patients who were suspected to have vasospasm on transcranial doppler sonography(TCD) findings and clinical grounds. Based on the clinical presentation of symptomatic vasospasm, we investigated the correlation between clinical, TCD, and MCTA signs of vasospasm and evaluated the role of MCTA in vasospasm. RESULTS: One hundred one patients met the inclusion criteria and symptomatic vasospasm developed in 25 patients (24.8%). We performed follow-up MCTAs in 28 patients. MCTA revealed spasm in the vessels of 26 patients. The sensitivity of MCTA was 100%. Among the 26 patients with MCTA evidence of vasospasm, 3 patients had TCD signs of vasospasm after symptomatic vasospasm presentation. Another 3 patients with symptomatic vasospasm had no TCD signs of vasospasm in daily serial recordings. Six other patients without symptomatic vasospasm showed MCTA evidence of vasospasm (false positive result) but these patients had also positive TCD signs of vasospasm. Volume rendering(VR) images tended to show significantly more exaggerated vasospasm than maximum intensity projection(MIP) images. The mean cerebral blood flow velocity of both proximal segment of the middle cerebral artery (M1) was significantly correlated with each reduced M1 diameter on MCTA (P<0.05). CONCLUSION: MCTA could be a useful tool for evaluation and planning management of critically ill patients suspected of having vasospasm; however, more randomized controlled trials are necessary to assess these points definitively.