Prediction of aneurysm location based on pattern of bleed on CT scan

Introduction: Computed tomography (CT) is the ‘gold standard’ for detecting subarachnoid hemorrhage (SAH) and digital subtraction angiography (DSA) for visualizing the vascular pathology. There is some correlation between the pattern (based on Fisher grading) and location of bleed on CT scan and ev...

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Autores principales:	Binod Rajbhandari, Mohan Raj Sharma, Sushil Krishna Shilpakar, Gopal Sedain, Amit Pradhanang, Ram Kumar Shrestha, Prakash Kafle, Dipendra Kumar Shrestha, Pushpa Raj Koirala
Formato:	article
Lenguaje:	EN
Publicado:	Society of Surgeons of Nepal 2018
Materias:	Aneurysm Computed Tomography Digital Subtraction Angiography Prediction Surgery RD1-811
Acceso en línea:	https://doaj.org/article/75ccf7f3795048ebae8cf97fe5714dc1
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spelling	oai:doaj.org-article:75ccf7f3795048ebae8cf97fe5714dc12021-12-05T19:15:58ZPrediction of aneurysm location based on pattern of bleed on CT scan10.3126/jssn.v21i1.243701815-39842392-4772https://doaj.org/article/75ccf7f3795048ebae8cf97fe5714dc12018-06-01T00:00:00Zhttps://www.nepjol.info/index.php/JSSN/article/view/24370https://doaj.org/toc/1815-3984https://doaj.org/toc/2392-4772 Introduction: Computed tomography (CT) is the ‘gold standard’ for detecting subarachnoid hemorrhage (SAH) and digital subtraction angiography (DSA) for visualizing the vascular pathology. There is some correlation between the pattern (based on Fisher grading) and location of bleed on CT scan and eventual location of cerebral aneurysm(s). Our aim was to assess the correlation between distribution of hemorrhage on the initial CT scan and eventual site of the ruptured aneurysm at our institution. Methods: This retrospective review of prospectively collected data consisted of 50 patients with SAH over 8 months period. CT scan of patients performed within 72 hours after the ictus with suspected SAH were included in the study. Four neurosurgeons, who had at least three years of experience after being qualified, who were blind to the imaging studies, analyzed and scored independently the quantity and distribution of the hemorrhage on CT. Their prediction of the site of the ruptured aneurysm was recorded and this was correlated with the CT angiography (CTA) and/ or DSA findings. Results: Overall accuracy of prediction was 71.6 % (68.2-75%). Parenchymal cerebral hematoma was an excellent predictor for the site of a ruptured aneurysm but was present in only a few cases (16%). The next valid predictor was blood distribution on CT for ruptured anterior communicating artery (ACom) and middle cerebral artery (MCA) aneurysms (89.4% and 85% respectively). Pattern of blood on CT together with CTA/DSA findings was found to be reliable for identifying the ruptured aneurysm in patients with multiple aneurysms in all cases. Conclusion: The quantity and pattern of the blood on CT is a fairly reliable and quick tool for locating a ruptured MCA or ACom aneurysms. It is not, however, reliable for locating other ruptured aneurysms. Binod RajbhandariMohan Raj SharmaSushil Krishna ShilpakarGopal SedainAmit PradhanangRam Kumar ShresthaPrakash KafleDipendra Kumar ShresthaPushpa Raj KoiralaSociety of Surgeons of NepalarticleAneurysmComputed TomographyDigital Subtraction AngiographyPredictionSurgeryRD1-811ENJournal of Society of Surgeons of Nepal, Vol 21, Iss 1 (2018)
institution	DOAJ
collection	DOAJ
language	EN
topic	Aneurysm Computed Tomography Digital Subtraction Angiography Prediction Surgery RD1-811
spellingShingle	Aneurysm Computed Tomography Digital Subtraction Angiography Prediction Surgery RD1-811 Binod Rajbhandari Mohan Raj Sharma Sushil Krishna Shilpakar Gopal Sedain Amit Pradhanang Ram Kumar Shrestha Prakash Kafle Dipendra Kumar Shrestha Pushpa Raj Koirala Prediction of aneurysm location based on pattern of bleed on CT scan
description	Introduction: Computed tomography (CT) is the ‘gold standard’ for detecting subarachnoid hemorrhage (SAH) and digital subtraction angiography (DSA) for visualizing the vascular pathology. There is some correlation between the pattern (based on Fisher grading) and location of bleed on CT scan and eventual location of cerebral aneurysm(s). Our aim was to assess the correlation between distribution of hemorrhage on the initial CT scan and eventual site of the ruptured aneurysm at our institution. Methods: This retrospective review of prospectively collected data consisted of 50 patients with SAH over 8 months period. CT scan of patients performed within 72 hours after the ictus with suspected SAH were included in the study. Four neurosurgeons, who had at least three years of experience after being qualified, who were blind to the imaging studies, analyzed and scored independently the quantity and distribution of the hemorrhage on CT. Their prediction of the site of the ruptured aneurysm was recorded and this was correlated with the CT angiography (CTA) and/ or DSA findings. Results: Overall accuracy of prediction was 71.6 % (68.2-75%). Parenchymal cerebral hematoma was an excellent predictor for the site of a ruptured aneurysm but was present in only a few cases (16%). The next valid predictor was blood distribution on CT for ruptured anterior communicating artery (ACom) and middle cerebral artery (MCA) aneurysms (89.4% and 85% respectively). Pattern of blood on CT together with CTA/DSA findings was found to be reliable for identifying the ruptured aneurysm in patients with multiple aneurysms in all cases. Conclusion: The quantity and pattern of the blood on CT is a fairly reliable and quick tool for locating a ruptured MCA or ACom aneurysms. It is not, however, reliable for locating other ruptured aneurysms.
format	article
author	Binod Rajbhandari Mohan Raj Sharma Sushil Krishna Shilpakar Gopal Sedain Amit Pradhanang Ram Kumar Shrestha Prakash Kafle Dipendra Kumar Shrestha Pushpa Raj Koirala
author_facet	Binod Rajbhandari Mohan Raj Sharma Sushil Krishna Shilpakar Gopal Sedain Amit Pradhanang Ram Kumar Shrestha Prakash Kafle Dipendra Kumar Shrestha Pushpa Raj Koirala
author_sort	Binod Rajbhandari
title	Prediction of aneurysm location based on pattern of bleed on CT scan
title_short	Prediction of aneurysm location based on pattern of bleed on CT scan
title_full	Prediction of aneurysm location based on pattern of bleed on CT scan
title_fullStr	Prediction of aneurysm location based on pattern of bleed on CT scan
title_full_unstemmed	Prediction of aneurysm location based on pattern of bleed on CT scan
title_sort	prediction of aneurysm location based on pattern of bleed on ct scan
publisher	Society of Surgeons of Nepal
publishDate	2018
url	https://doaj.org/article/75ccf7f3795048ebae8cf97fe5714dc1
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Prediction of aneurysm location based on pattern of bleed on CT scan

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