Can Computed Tomography Angiography of the Brain Replace Lumbar Puncture in the Evaluation of Acute‐onset Headache After a Negative Noncontrast Cranial Computed Tomography Scan?

Objectives: The primary goal of evaluation for acute‐onset headache is to exclude aneurysmal subarachnoid hemorrhage (SAH). Noncontrast cranial computed tomography (CT), followed by lumbar puncture (LP) if the CT is negative, is the current standard of care. Computed tomography angiography (CTA) of the brain has become more available and more sensitive for the detection of cerebral aneurysms. This study addresses the role of CT/CTA versus CT/LP in the diagnostic workup of acute‐onset headache. Methods: This article reviews the recent literature for the prevalence of SAH in emergency department (ED) headache patients, the sensitivity of CT for diagnosing acute SAH, and the sensitivity and specificity of CTA for cerebral aneurysms. An equivalence study comparing CT/LP and CT/CTA would require 3,000 + subjects. As an alternative, the authors constructed a mathematical probability model to determine the posttest probability of excluding aneurysmal or arterial venous malformation (AVM) SAH with a CT/CTA strategy. Results: SAH prevalence in ED headache patients was conservatively estimated at 15%. Representative studies reported CT sensitivity for SAH to be 91% (95% confidence interval [CI] = 82% to 97%) and sensitivity of CTA for aneurysm to be 97.9% (95% CI = 88.9% to 99.9%). Based on these data, the posttest probability of excluding aneurysmal SAH after a negative CT/CTA was 99.43% (95% CI = 98.86% to 99.81%). Conclusions: CT followed by CTA can exclude SAH with a greater than 99% posttest probability. In ED patients complaining of acute‐onset headache without significant SAH risk factors, CT/CTA may offer a less invasive and more specific diagnostic paradigm. If one chooses to offer LP after CT/CTA, informed consent for LP should put the pretest risk of a missed aneurysmal SAH at less than 1%. ACADEMIC EMERGENCY MEDICINE 2010; 17:444–451 © 2010 by the Society for Academic Emergency Medicine     

Sensitivity of newer-generation computed tomography scanners for subarachnoid hemorrhage: a Bayesian analysis

Background

Subarachnoid hemorrhage (SAH) is a life-threatening condition considered in patients presenting to the emergency department (ED) with acute and severe-onset headache. Currently, the practice pattern for suspected SAH is to perform a non-contrasted computed tomography (CT) scan of the head, followed by lumbar puncture (LP) if the CT is negative. Newer-generation 16-slice CT scanners have been shown in one study to be very sensitive for SAH.

Objective

We sought to validate these findings at our institution by retrospectively analyzing the sensitivity of our 16-slice or better CT scanner and performing a bayesian analysis with the results.

Methods

We utilized ED electronic medical records and the Department of Neurosurgery research database to search for patients admitted from the ED with a diagnosis of SAH from January 1, 2005 to December 31, 2008. We found a total of 134 patients admitted with SAH during this time frame.

Results

Average age was 53.8 years; 62% were female. Presenting complaint was headache in 57%, paresthesia or weakness in 7%, unresponsive in 10%, confusion or altered mental status in 5%, and “other” in 10%. Sensitivity of 16-slice or better CT scanner in our study was 131/134, or 97.8% (95% confidence interval 93.1–99.4%). No patient with a negative CT had a lesion requiring intervention.

Conclusion

Our study confirms the high sensitivity of 16-slice or better CT scanners for SAH. This calls into question the need for LP after negative head CT when 16-slice CT or better is used.     

Prevalence of Herniation and Intracranial Shift on Cranial Tomography in Patients With Subarachnoid Hemorrhage and a Normal Neurologic Examination

Objectives: Patients frequently present to the emergency department (ED) with headache. Those with sudden severe headache are often evaluated for spontaneous subarachnoid hemorrhage (SAH) with noncontrast cranial computed tomography (CT) followed by lumbar puncture (LP). The authors postulated that in patients without neurologic symptoms or signs, physicians could forgo noncontrast cranial CT and proceed directly to LP. The authors sought to define the safety of this option by having senior neuroradiologists rereview all cranial CTs in a group of such patients for evidence of brain herniation or midline shift. Methods: This was a retrospective study that included all patients with a normal neurologic examination and nontraumatic SAH diagnosed by CT presenting to a tertiary care medical center from August 1, 2001, to December 31, 2004. Two neuroradiologists, blinded to clinical information and outcomes, rereviewed the initial ED head CT for evidence of herniation or midline shift. Results: Of the 172 patients who presented to the ED with spontaneous SAH diagnoses by cranial CT, 78 had normal neurologic examinations. Of these, 73 had initial ED CTs available for review. Four of the 73 (5%; 95% confidence interval [CI] = 2% to 13%) had evidence of brain herniation or midline shift, including three (4%; 95% CI = 1% to 12%) with herniation. In only one of these patients was herniation or shift noted on the initial radiology report. Conclusions: Awake and alert patients with a normal neurologic examination and SAH may have brain herniation and/or midline shift. Therefore, cranial CT should be obtained before LP in all patients with suspected SAH. ACADEMIC EMERGENCY MEDICINE 2010; 17:423–428 © 2010 by the Society for Academic Emergency Medicine     

Subarachnoid hemorrhage diagnosis by computed tomography and lumbar puncture: Are fifth generation CT scanners better at identifying subarachnoid hemorrhage?

This study sought to determine the sensitivity and specificity of modern computed tomography (CT) scans for the diagnosis of subarachnoid hemorrhage (SAH). No studies have been done recently with fifth generation CT scanners to look at the diagnosis of SAH. A retrospective chart review was done of Emergency Department (ED), laboratory, and hospital records at Pitt County Memorial Hospital in Greenville, North Carolina over 1 year from January 1, 2002 to December 31, 2002. Patients presented with headache and had a CT scan of the head with a fifth generation multi-detector CT scanner followed by a lumbar puncture (LP) to rule out SAH. There were 177 patients who presented to the ED with headache and went on to have a CT scan and an LP to rule out SAH. No patients who had a negative CT were found to have a subarachoid hemorrhage. It is concluded that fifth generation CT scanners are probably more sensitive than earlier scanners at detecting SAH.     

CTA联合全脑血流灌注成像在蛛网膜下腔出血后的临床应用

目的：探讨CTA联合全脑灌注成像在蛛网膜下腔出血（SAH）后的临床应用价值。方法：SAH病人29例,通过双源CT全脑血流灌注（PBV）检查,重建CTA图像和PBV图像,在检出动脉瘤等同时,以灌注参数评估SAH后脑血管痉挛及其所致的脑缺血改变情况。结果：29例病人中检出27例的28个动脉瘤。额、颞、顶、枕叶及小脑PBV值SAH组分别为11.17±3.13;10.92±2.91;11.08±2.53;9.88±3.01;19.83±5.12,对照组分别为17.10±3.60;15.98±5.03;15.84±3.53;16.14±1.86;23.54±4.64,额、顶、枕叶差异显著（P<0.05）;存活组与死亡组各脑叶PBV值均未见显著性差异;优势出血侧和非优势出血侧低灌注出现情况无显著性差异。结论：CTA联合全脑PBV灌注成像能够在诊断SAH出血原因的同时显示脑血管痉挛引起的脑组织缺血改变。     

三维CT血管重建成像在急性蛛网膜下腔出血的应用分析

目的：探讨三维CT血管重建成像在急性蛛网膜下腔出血的应用及局限性分析。方法：对147例CT表现为急性蛛网膜下腔出血患者进行CTA检查,由神经和放射两名医生对结果分析,对CTA阴性以及诊断有争议患者进行DSA检查。结果：在147例急性蛛网膜下腔出血患者中,109例患者3D-CTA结合出血CT图像确诊动脉瘤,瘤体直径2-12mm,均在手术或者介入治疗中证实;其余病例中,7例CT图像有明显的责任灶的蛛网膜下腔出血,3D-CTA阴性,通过DSA发现并经手术证实为动脉瘤,23例普通CT表现为中脑周围出血以及均匀弥漫蛛网膜下腔出血病例CTA提示阴性患者DSA检查也为阴性;3例CTA可疑动脉瘤均被DSA证实为动脉起始的壶腹,CTA在诊断颅内动脉瘤的敏感性和特异性分别为94％和100％。结论：对急性蛛网膜下腔出血患者使用CTA筛查是相对快捷、低风险检查方式,但结果的分析需结合CT图像出血形式以及放射和神经外科医生共同阅片可以完成CTA的诊断效能。     

Attitudes and Judgment of Emergency Physicians in the Management of Patients with Acute Headache

OBJECTIVES: There is little evidence guiding physicians in the evaluation of acute headache to rule out nontraumatic subarachnoid hemorrhage (SAH). The authors assessed emergency physicians in: 1) their pretest accuracy for predicting SAH, 2) their comfort with not ordering either head computed tomography (CT) or lumbar puncture (LP) in patients with acute headache, and 3) their comfort with not ordering head CT before performing LP in patients with acute headache. METHODS: This two-and-a-half-year prospective cohort study was conducted in three tertiary care university emergency departments with 51 emergency physicians. Consecutive patients more than 15 years of age with a nontraumatic, acute headache (onset to peak headache less than one hour) and normal results on neurologic examination were enrolled. Patients known to have cerebrospinal fluid shunt, aneurysm, or brain neoplasm, and patients with recurrent headaches of the same intensity/character as their current headache were excluded. Physicians recorded their pretest probability for SAH and their comfort with performing either no tests or an LP without first obtaining head CT. RESULTS: The authors enrolled 747 patients (mean age 42.8 years; 60.1% female; 77.0% their worst headache; 83.4% had CT and/or LP), including 50 (6.7%) with SAHs. Physicians reported being "uncomfortable" or "very uncomfortable" with performing no test in 75.4% of cases and being "uncomfortable" or "very uncomfortable" with performing LP without CT in 49.6% of cases. The area under the receiver operating characteristic (ROC) curve for SAH was 0.85 (95% CI = 0.80 to 0.91). CONCLUSIONS: Physicians were able to moderately discriminate SAH from other causes of headache before diagnostic testing.     

中脑周围非动脉瘤性蛛网膜下腔出血的影像学诊断

目的 中脑周围非动脉瘤性蛛网膜下腔出血(PNSAH)是脑血管造影(CAG)阴性的蛛网膜下腔出血(SAH)中的一种独特且预后较佳的亚型。本探讨其影像学特点和诊断。方法：回顾性分析我科连续收治的30例PNSAH。所有患均进行CT和全脑血管造影，23例进行了MR检查，25例行CT血管造影(CTA)检查。结果：CT上SAH位于脑干周围的脑池内．Fisher分级2—3级。CAG、CTA均无阳性发现，早期MR可见脑池内的出血灶，晚期MR正常。结论：PNSAH具有典型的CT表现，但CAG可明确排除其他部位出血。首次CAG和CTA检查均正常的典型患．1个月后可只行CTA而省略CAG复查。诊断PNSAH必须排除椎基底脑动脉瘤。     

Subarachnoid Hemorrhage Diagnosis: Lumbar Puncture Is Still Needed When the Computed Tomography Scan Is Normal

Objectives: To determine the sensitivity of third-generation CT scanners for diagnosed nontraumatic subarachnoid hemorrhage (SAH) and to assess the impact of symptom duration on sensitivity.
Methods: A retrospective chart review was performed in a university-affiliated tertiary care hospital with an annual ED volume of >100,000 patients. The target population was all patients who presented to the ED from January 1991 to September 1994 with symptoms suggestive of SAH and who had a final diagnosis of nontraumatic SAH based on either a positive CT scan or positive spinal fluid analysis. Patients referred from outside facilities were included if they had a CT done at the study site. All CT scans were done using third-generation scanners. Official CT scan reports were used to categorize scans as positive or negative.
Results: There were 140 patients identified with SAH, with a mean age of 56 years (range 10–88). The sensitivity of CT in the diagnosis of nontraumatic SAH when performed at or before 12 hours of symptom duration was 100% (80/80), and 81.7% (49/60) after 12 hours of symptom duration (95% CI 95–100% and 69.5–90.4%, respectively; p < 0.0001). Eleven of the 140 patients had a negative CT and positive spinal fluid analysis, yielding an overall sensitivity of 92.1% (129/140).
Conclusion: The sensitivity of third-generation CT scans for SAH decreases with time from the onset of symptoms. In this sample population, CT was able to detect all patients scanned ^12 hours after symptom onset. Although the study demonstrated good sensitivity of CT scan reports for SAH when the scan was performed after S12 hours of symptom onset, additional real-time experience is needed to better define the potential risk of a missed SAH should this population not receive the customary lumbar puncture examination in the setting of a negative CT scan.     

Clinical Predictors of Significant Findings on Head Computed Tomographic Angiography

Background: Although head computed tomographic angiography (CTA) is a sensitive tool for the evaluation of neurological symptoms in the emergency department (ED), little is known about which clinical signs predict significant CTA findings. Objectives: To identify clinical factors that predict significant findings on head CTA in patients presenting to the ED with neurological complaints. Methods: Retrospective chart review of consecutive adult patients undergoing head CTA over a 6-month period in an urban, tertiary care ED with an annual volume of 76,000. Significant head CTA findings were defined as clinically significant neurological abnormalities undetected by previous imaging studies. Demographics, chief complaint, results of the neurological examinations (NE), and head non-contrast computed tomography (CT) results were used as predictors of significant head CTA. All predictors with a univariate p < 0.2 using Pearson's chi-squared were entered stepwise into a multivariable logistic regression including odds ratios (OR), with inclusion restricted to p < 0.05. Results: Chart review yielded 456 cases; 215 (47%) were male. Mean age was 62 (SD 20) years. There were 189 patients (41%) with abnormal CTAs. Multivariable logistic regression indicated five variables that predicted a clinically significant CTA: abnormal CT (OR 3.72), chief complaint of subarachnoid hemorrhage-type headache (OR 2.30), and motor deficit (OR 2.23), visual deficit (OR 2.23), and other focal deficit (OR 2.18) on NE. A chief complaint of trauma (OR 0.23) predicted a normal CTA. Conclusions: Specific historical and focal neurological findings are useful for predicting clinically significant findings on head CTA.     

Revolution CT行冠状动脉联合胸腹主动脉成像

目的 观察Revolution CT用于冠状动脉联合胸腹主动脉CT血管造影(CTA)的价值.方法 采用Revolution CT分别对A组、B组、C组各40例疑诊冠状动脉和/或主动脉病变患者行冠状动脉联合胸腹主动脉CTA、常规冠状动脉CTA及常规胸腹主动脉CTA.记录患者有效辐射剂量(ED),比较A组与B组、A组与C组...     

Lumbar Puncture First: An Alternative Model for the Investigation of Lone Acute Sudden Headache

Subarachnoid hemorrhage (SAH) is a diagnosis often considered in patients presenting to the ED with acute sudden headaches, but with normal physical examinations. Standard of care today is for these patients to be investigated by noncontrast CT scan followed by lumbar puncture (LP) for negative CTs. However, given that most investigated patients have benign headaches, most of the CT and LP results are normal. The authors studied, by means of a theoretical analysis, the impact of an alternative diagnostic model, in which LP would be the first (and, in most cases, only) diagnostic test for patients suspected of SAH who met lone acute sudden headache (LASH) criteria. Given reasonable assumptions, for every 100 patients investigated, the "LP-first" model would result in 79 to 83 fewer CT scans and only seven to 11 additional LPs, as compared with traditional strategies. Among ED headache patients meeting LASH criteria, the authors believe use of this model could result in more efficient use of resources, minimal additional morbidity, and equal diagnostic accuracy for SAH.     

宽体探测器CT胰腺轴位灌注“一站式”成像的可行性

目的 探讨Revolution CT胰腺轴位灌注"一站式"成像的可行性。方法 收集接受Revolution CT上腹部轴位CT灌注（CTP）扫描的患者13例（CTP组）,测量胰腺的CTP参数,提取最佳时期CTA及3期增强图像,并记录整个灌注期的辐射剂量。收集同期行全腹3期增强及CTA扫描者18例（对照组）,采用螺旋扫描模式。2组患者胰腺均无病变。评价2名观察者测得各CTP参数和对胰十二指肠上动脉（SPDA）图像主观评分的一致性。比较2组SPDA图像的主观评分和CTA图像SPDA以及3期增强图像胰腺的CT值、图像噪声、CNR和SNR。结果 2名观察者测得CTP参数一致性良好（ICC均>0.75）。灌注期有效辐射剂量为（24.52±0.01）mSv。2名观察者对2组CTA图像SPDA的主观评分结果一致性较好（Kappa=0.629、0.769）,2组评分中位数均为5分;CTP组SPDA的CT值、CNR、SNR均高于对照组（P均<0.05）。CTP组静脉期、平衡期的胰腺CT值、CNR、SNR均高于对照组（P均<0.05）。结论 Revolution CT胰腺轴位灌注"一站式"成像,在获得稳定的胰腺CTP定量数据的同时,可提取图像质量相仿甚至更佳的胰腺3期强化图像,并可获得更优质的胰周CTA图像,有很好的临床应用前景。     

蛛网膜下腔出血的DSA和CT结果研究

研究蛛网膜下腔出血的数字减影血管造影和ＣＴ检查的价值。材料与方法：对８０例２４小时内ＣＴ检查和ＳＡＨ无颅内血肿的患者行ＤＳＡ检查。结果：一次ＳＡＨ患者脑动脉瘤３２例,正常２９例,１９例二次ＳＡＨ患者全部为脉其中１６例再次出血发生在发病后７－１８天。     

CTA在急诊动脉瘤夹闭术中的应用

目的探讨CT血管造影（CTA）在脑动脉瘤诊断中以及急诊手术中的应用价值。方法对28例自发性蛛网膜下腔出血（SAH）患者行CTA检查,确定动脉瘤位置、大小、指向后行经急诊夹闭手术,根据于术结果对照CTA检查的准确性。结果CTA显示后交通动脉瘤12例,前交通动脉瘤6例,脉络膜前动脉瘤5例,大脑中动脉瘤3例,胼周动脉瘤1例,1例CTA未发现动脉瘤后经DSA检查为前交通动脉瘤。结论CTA在动脉瘤急性破裂出血的诊断中具有快速无创准确的优点,并对手术处理具有指导作用。     

Contribution of indirect computed tomography venography to computed tomography angiography of the chest for the diagnosis of thromboembolic disease in two United States emergency departments

Summary.  Recent reports suggest that physicians in non-ambulatory settings can use indirect CT venography (CTV) of the lower extremities immediately following spiral CT angiography (CTA) of the chest to identify patients with a negative CTA who have thromboembolic disease identified on CTV. We sought to determine the frequency of isolated deep venous thrombosis (DVT) discovered on CTV in emergency department (ED) patients with complaints suggestive of pulmonary embolism (PE) yet having a negative CTA. This study was conducted in a suburban and urban ED where patients with symptoms suspicious for PE were primarily evaluated with CTA and CTV. A total of 800 patients were studied, including 360 from the suburban ED and 440 from the urban ED. 88 (11%) patients were diagnosed with thromboembolic disease by CTA, or CTV, or both. Seventy-three patients had a CTA of the chest that was positive for PE, 42 (5.2%) of whom had evidence of both PE on CTA and DVT on CTV. Fifteen patients (2%, 95% CI = 1–3%) had a negative CTA and were subsequently found to have isolated DVT on CTV, all of whom received anticoagulation therapy. These data suggest that indirect CT venography of immediately following CT angiography of the chest significantly increased the frequency of diagnosed thromboembolic disease requiring anticoagulation in ED patients with suspected PE.     

Sensitivity of New-generation Computed Tomography in Subarachnoid Hemorrhage

Objective: To determine the sensitivity of the initial new-generation CT (NGCT) scan interpretation for detection of acute nontraumatic subarachnoid hemorrhage (SAH) and to decide whether lumbar puncture (LP) should follow a "normal" NGCT scan.
Methods: A retrospective chart review was performed of patients admitted between March 1988 and July 1994 with proven SAH. Exclusion criteria were age <2 years, diagnosis other than acute SAH, history of head trauma within 24 hours before symptom onset, NGCT scan not done before diagnosis, and records not available. Patients were placed into two groups: symptom duration <24 hours (group 1) and >24 hours (group 2) prior to CT scan. The resolution of each NGCT scanner was recorded. An NGCT sceinner was defined as a third-generation scanner or more recent.
Results: Of 349 SAH patients, 181 met inclusion criteria. The sensitivity of NGCT scans for SAH was 93.1% for the group 1 patients ( n = 144) and 83.8% for the group 2 patients ( n = 37). The overall sensitivity was 91.2%. All the patients who had SAH not detected by NGCT scans were diagnosed by LP. There was no significant relationship between NGCT scanner resolution and sensitivity for SAH.
Conclusion: Initial interpretation of NGCT scans to detect SAH does not approach 100% sensitivity. A "normal" NGCT scan does not reliably exclude the need for LP in patients who have symptoms suggestive of SAH.     

Point‐of‐care Focused Cardiac Ultrasound for the Assessment of Thoracic Aortic Dimensions,Dilation, and Aneurysmal Disease

Objectives: Thoracic aortic aneurysm and thoracic aortic dissection are related and potentially deadly diseases that present with nonspecific symptoms. Transthoracic echocardiography (TTE) may detect thoracic aortic pathology and is being increasingly performed by the emergency physician at the bedside; however, the accuracy of point‐of‐care (POC) focused cardiac ultrasound (FOCUS) for thoracic aortic aneurysm and thoracic aortic dissection has not been studied. The objective of this pilot study was to explore the agreement, sensitivity, and specificity of FOCUS for thoracic aortic dimensions, dilation, and aneurysm compared with CT angiography (CTA) as the reference standard. Methods: This study was a retrospective pilot analysis of image and chart data on consecutive patients presenting to an urban, academic emergency department (ED) between January 2008 and June 2010, who had both a FOCUS and a CTA for suspicion of thoracic aorta pathology. Thoracic aorta dimensions were measured from recordings by three ultrasound‐trained emergency physicians blinded to any initial FOCUS and CTA results. CTA measurements were obtained by a radiologist blinded to the FOCUS results. Using cutoffs of 40 and 45 mm, we calculated the sensitivity and specificity of FOCUS for aortic dilation and aneurysm with the largest measurement on CT as the reference standard. Bland‐Altman plots with 95% limits of agreement were used to demonstrate agreement for aortic measurements, kappa statistics to assess the degree of agreement between tests for aortic dilation, and intraclass correlation for interobserver and intraobserver variability. Results: Ninety‐two patients underwent both FOCUS and CTA during the study period. Ten FOCUS studies had inadequate visualization for all measurements areas. Eighty‐two patients were included in the final analysis. Mean (±SD) age was 58.1 (±16.6) years and 58.5% were male. Sensitivity, specificity, and the observed kappa value (95% confidence interval [CI]) between FOCUS and CTA for the presence of aortic dilation at the 40‐mm cutoff were 0.77 (95% CI = 0.58 to 0.98), 0.95 (95% CI = 0.84 to 0.99), and 0.74 (95% CI = 0.58 to 0.90), respectively. The mean difference (95% limits of agreement) for the Bland‐Altman plots was 0.6 mm (?5.3 to 6.5) for the sinuses of Valsalva, 4 mm (?2.7 to 10.7) for the sinotubular junction, 1.5 mm (?5.8 to 8.8) for the ascending aorta, and 2.2 mm (?5.9 to 10.3) for the descending aorta. Conclusions: In this retrospective pilot study, FOCUS demonstrated good agreement with CTA measurements of maximal thoracic aortic diameter. FOCUS appears to be specific for aortic dilation and aneurysm when compared to CTA, but requires further prospective study. ACADEMIC EMERGENCY MEDICINE 2012; 19 :1–4 © 2012 by the Society for Academic Emergency Medicine     

Vessel-wall MRI in thunderclap headache: A useful tool to answer the riddle?

BackgroundFinding an intracranial aneurysm (IA) during a thunderclap headache (TCH) attack, represents a problem because it is necessary to distinguish whether the aneurysm is responsible for the headache as a warning leak or as an incidental finding. High-Resolution Vessel-Wall (HRVW) MRI sequences have been proposed to assess the stability of the wall, as it permits to detect the presence of aneurysmal wall enhancement (AWE). In fact, AWE has been confirmed due to inflammation, recognizable preceding rupture.Case 1: A 37-year-old woman with a migraine more intense than her usual. A CTA revealed a 10 mm AComA aneurysm without subarachnoid hemorrhage (SAH) and HRVW-MRI excluded AWE. The patient’s headache improved, and therefore, the aneurysm was considered an incidental finding, and the headache diagnosed as TCH attack. Subsequently, the aneurysm was surgically clipped, and typical migraine relapsed was reported at follow-up (FU).Case 2: A 67-year-old woman with no history of headaches underwent CTA for an abrupt onset of headache. A 7 mm right carotid-ophthalmic aneurysm with no sign of SAH was discovered. HRVW-MRI demonstrated AWE and thus, a TCH attack for a warning leak of an unstable wall was suspected. Endovascular coiling was immediately performed and at FU any further headache attack was reported.ConclusionsHRVW-MRI is useful in case of finding aneurysm as the cause of headaches, particularly the TCH attack. In fact, HRVW-MRI could assess the stability of the aneurysms wall, allowing different patient management and eventually the aneurysmal treatment.     

CT血管造影在急性蛛网膜下腔出血病因诊断中的作用

目的探讨ＣＴＡ成像诊断颅内动脉瘤引起急性蛛网膜下腔出血的作用。方法应用螺旋ＣＴ平扫诊断急性蛛网膜下腔出血３０例,应用计算机ＳＳＤ和ＭＩＰ软件进行脑血管三维成像（３ＤＣＴＡ）。结果ＣＴＡ诊断颅内动脉瘤１４例,其中前交通动脉瘤３例,右大脑中动脉（Ｍ１段）动脉瘤２例,右后交通动脉瘤２例,左后交通动脉瘤４例,基底动脉瘤２例,左侧椎动脉瘤颅内段动脉瘤１例。ＣＴＡ清楚显示颅内脑基底动脉瘤的部位、形态、大小、起源以及与周围脑血管和颅骨的解剖关系。结论ＣＴＡ对颅内动脉瘤引起的蛛网膜下腔出血病因诊断是一种快捷、安全、简单的检查方法,对外科手术方案的设计有指导作用