Article Figures & Data
Figures
- Fig 1.
A 44-year-old woman presenting with weakness of the right arm and leg, clinically attributed to cerebrovascular vasospasm 6 days after SAH related to a ruptured saccular aneurysm of the left MCA bifurcation, which was clipped (bold arrow). DSA showed moderate vasospasm on the distal carotid segment and severe vasospasm on the A1 segment of the left ACA and the M1 and proximal M2 segments of the left MCA (A, black arrowheads). Maximum intensity projection (MIP) MSCTA image before (B) and after (C) intra-arterial infusion of nimodipine showing resolution of the vasospasm (white arrowheads), and followed by the resolution of the symptoms. At pretreatment PCT, MTT was increased in the left MCA territory (D), CBF was normal (E), and a slight increase in CBV (F) was observed, representing vasospasm related auto regulation mechanisms.
- Fig 2.
A 44-year-old man with right-sided hemiparesis attributed to cerebrovascular vasospasm occurring 9 days after SAH consecutive to a ruptured aneurysm of the anterior communicating artery, treated by surgical clipping. DSA (A) showed moderate vasospasm on M1 segment of left MCA and focal severe vasospasm on the M2 segment (arrowheads). These findings were confirmed by MIP MSCTA reconstruction (B) and volume-rendered MSCTA reconstruction (C). Perfusion CT performed during the same CT session revealed an increase in MTT (D) and a decrease in rCBF (E), with slight increase of rCBV (F). This pattern of perfusion alterations corresponds to a reversible ischemic lesion consecutive to vasospasm. The patient was then treated by a local intra-arterial nimodipine infusion and a balloon angioplasty of the left M1 segment.
- Fig 3.
A 52-year-old man with symptoms of cerebrovascular vasospasm 5 days after SAH. He was treated with a surgical clipping of a ruptured aneurysm of the anterior communicating artery (AcomA). A first postoperative angiogram showed no abnormalities. Actual DSA (A) showed an absence of the distal segments of the right AcomA (black arrowheads), interpreted as secondary to a very tight vasospasm. Posteroanterior (B) MIP reconstructions of the AcomA at MSCTA confirmed the lack of enhancement of the right AcomA. A nonenhanced cerebral CT (not shown) disclosed a vague hypoattenuation in the territory of the right AcomA. Perfusion CT results confirmed an irreversible ischemic lesion in the territory of the right AcomA, characterized by an increased MTT (C), a decreased rCBF (D), and a decreased rCBV (E). Thus, no specific endovascular treatment of the right AcomA was undertaken.
Tables
- Table 1:
Sensitivity, specificity (95% confidence limits in parentheses), positive predictive value, negative predictive value, and accuracy of MSCTA (compared with DSA) in the depiction of intracranial vasospasms, depending on anatomic location
Location of Vasospasm Sensitivity (%) Specificity (%) Positive Predictive Value (%) Negative Predictive Value (%) Accuracy (%) Distal carotid artery 45 (16–74) 100 100 83 85 A1 segment 87.5 (71–100) 100 100 92 95 M1 segment 100 96 (88–100) 93 100 97 A2 segment 100 100 100 100 100 M2 segment 100 100 100 100 100 Basilar artery 100 100 100 100 100 Total 87.7 (79–96) 99.2 (98–100) 98.3 94.1 95.4 Note:—MSCTA indicates multisection CT angiography; DSA, digital substraction angiography. Posterior cerebral artery location was not reported because no vasospasm was found on this segment.
- Table 2:
Sensitivity, specificity (95% confidence limits in parentheses), positive predictive value, negative predictive value, and accuracy of MSCTA in the characterization of intracranial vasospasms at the level of the distal internal carotid artery and the intracranial cerebral arteries
Vasospasm Grade True-Positive False-Positive False-Negative True-Negative Sensitivity (%) Specificity (%) Accuracy (%) Positive Predictive Value (%) Negative Predictive Value (%) Mild-Moderate Distal ICA 3 0 6 34 33.3 (64–3) 100 86 100 85 Intracranial cerebral arteries 33 6 5 183 86.8 (76–98) 96.8 (94–99) 95.2 84.6 97.3 Severe Distal ICA 2 0 0 34 100 100 100 100 100 Intracranial cerebral arteries 13 1 4 183 76.5 (57–96) 99.5 (98–100) 97.5 92.9 97.9 Note:—MSCTA indicates multisection CT angiography; ICA, internal carotid artery.
- Table 3:
Sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of perfusion CT in the characterization of intracranial vasospasms
Vasospasm Grade Sensitivity (%) Specificity (%) Accuracy (%) Positive Predictive Value (%) Negative Predictive Value (%) Mild-Moderate 20 100 38.5 100 27.3 Severe 90 100 92.3 100 75
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