Article Highlights
Neurosurgery 2002 Oct;51(4):939-43
Evaluation of vasospasm after subarachnoid hemorrhage by use of multislice computed tomographic angiography.
Otawara Y, Ogasawara K, Ogawa A, Sasaki M, Takahashi K.
Summary: The authors performed multislice CTA and DSA on 20 patients with SAH within 72 hours of admission. Multislice CTA and DSA were repeated on Day 7 to assess cerebral vasospasm. They showed that the degree of vasospasm as revealed by multislice CTA correlated significantly with the degree of vasospasm revealed by DSA (P < 0.0001). The level of agreement via CTA and DSA in the overall, proximal, and distal segments of the cerebral arteries was 91.6, 90.8, and 92.3%, respectively. The authors concluded that multislice CTA can detect angiographic vasospasm after SAH with accuracy equal to that of DSA.
Commentary: The authors raise the question of whether multi-slice CTA can replace conventional angiography for the evaluation of vasospasm. The article highlights the evolving role of CTA. As image quality improves with CTA this modality may increasingly have a role as a screening modality prior to angiography. Disadvantages of the technique occur in situations where clip or coil artifact obscure the vessel of interest and in the lack of being able to proceed directly to treatment. Nonetheless, it may obviate angiography in cases where spasm can not be ruled out by other means. ~B.Carter, M.D.