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Comparison of CTA to DSA in Determining the Etiology of Spontaneous ICH

Published online by Cambridge University Press:  02 December 2014

Robert Yeung ,
Tabassum Ahmad ,
Richard I. Aviv ,
Lyne Noel de Tilly ,
Allan J. Fox  and
Sean P. Symons
Robert Yeung
Affiliation:
Division of Neuroradiology, Department of Medical Imaging, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
Tabassum Ahmad
Affiliation:
Division of Neuroradiology, Department of Medical Imaging, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
Richard I. Aviv
Affiliation:
Division of Neuroradiology, Department of Medical Imaging, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
Lyne Noel de Tilly
Affiliation:
Division of Neuroradiology, Department of Medical Imaging, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
Allan J. Fox
Affiliation:
Division of Neuroradiology, Department of Medical Imaging, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
Sean P. Symons*
Affiliation:
Division of Neuroradiology, Department of Medical Imaging, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
*
Neuroradiology, Department of Medical Imaging, Sunnybrook Health Sciences Centre; Department of Medical Imaging, University of Toronto, Sunnybrook Research Institute, Section of Neuroradiology, Ontario Medical Association, 2075 Bayview Avenue, Room AG31D, Toronto, Ontario, M4N 3M5, Canada
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Abstract

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Background and Purpose:

To compare the efficacy of computed tomographic angiography (CTA) to that of digital subtraction angiography (DSA) in the detection of secondary causes of intracerebral hemorrhage (ICH).

Methods:

Between January 2001 and February 2007 there were 286 patients that had both CTA and DSA for intracranial hemorrhage of all types. Those with primarily subarachnoid hemorrhage or recent trauma were excluded. Fifty-five patients formed the study cohort. Three reviewers independently analyzed the CTAs in a blinded protocol and classified them based on presence or absence of a secondary etiology. Results were compared with the reference standard DSA and kappa values determined for interobserver variability.

Results:

The overall sensitivity, specificity, positive predictive value, negative predictive value and accuracy of CTA were 89%, 92%, 91%, 91% and 91%, respectively. Kappa value for interobserver agreement ranged from 0.78 to 0.89. Two of four dural arteriovenous fistulas (dAVF) were missed on CTA by all three reviewers.

Conclusion:

CTA is nearly as effective as DSA at determining the cause of secondary intracerebral hemorrhage, but with a lower sensitivity for dAVFs. This supports the use of CTA as the first screening test in patients presenting with spontaneous ICH.

Type
Original Article
Information
Canadian Journal of Neurological Sciences , Volume 36 , Issue 2 , March 2009 , pp. 176 - 180
Copyright
Copyright © The Canadian Journal of Neurological 2009

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