Three-dimensional computerized tomography angiography in patients with hyperacute intracerebral hemorrhage

Object. The authors confirm the usefulness of extravasation detected on thr ee-dimensional computerized tomography (3D-CT) angiography in the diagnosis of continued hemorrhage and establishment of its cause in patients with ac ute intracerebral hemorrhage (ICH). Methods. Thirty-one patients with acute ICH in whom noncontrast and 3D-CT a ngiography had been performed within 12 hours of the onset of hemorrhage an d in whom conventional cerebral angiographic studies were obtained during t he chronic stage were prospectively studied. Noncontrast CT scanning was re peated within 24 hours of the onset of ICH to evaluate hematoma enlargement . Findings indicating extravasation on 3D-CT angiography, including any abnor mal area of high density on helical CT scanning, were observed in five pati ents; three of these demonstrated hematoma enlargement on follow-up CT stud ies. Thus, specificity was 60% (three correct predictions among five positi ves) and sensitivity was 100% (19 correct predictions among 19 negatives). Evidence of extravasation on SD-CT angiography indicates that there is pers istent hemorrhage and correlates with enlargement of the hematoma. Regarding the cause of hemorrhage, five cerebral aneurysms were visualized in four patients, and two diagnoses of moyamoya disease and one of unilater al moyamoya phenomenon were made with the aid of 3D-CT angiography. Emergen cy surgery was performed without conventional angiography in one patient wh o had an aneurysm, and it was clipped successfully. Conclusions. Overall, 3D-CT angiography was found to be valuable in the dia gnosis of the cause of hemorrhage and in the detection of persistent hemorr hage in patients with acute ICH.