CT Angiography for Differentiation between Intracerebral and Intra-Sylvian Hematoma in Patients with Ruptured Middle Cerebral Artery Aneurysms

BACKGROUND AND PURPOSE: ISHs and ICHs from ruptured MCA aneurysms can be difficult to distinguish on NCE-CT but may have a different impact on admission status and outcome. The presence of IHCEV on CTA may differentiate ISHs and ICHs.

MATERIALS AND METHODS: Two observers independently reviewed non-contrast-enhanced CT scans and CTAs of 71 patients with MCA aneurysm hematomas for the site of the hematoma, according to predefined characteristics, and for the presence of IHCEV. We compared CTAs with NCE-CT scans in which both observers were confident about hematoma localization. We calculated κ statistics for interobserver agreement, and RRs for poor clinical condition and poor outcome.

RESULTS: Agreement for IHCEV was almost perfect (κ, 0.87; 95% CI, 0.74–0.99). After consensus reading, 30 of 71 patients had IHCEV. In 28 of the 71 NCE-CT scans, both observers were confident as to the the site of the hematoma (κ, 0.55; 95% CI, 37%–73%). IHCEV were present in 10 of these 28 patients, of whom 9 had an ISH based on NCE-CT (positive predictive value, 90%; 95% CI, 55%–100%). In all 18 of 28 patients without IHCEV, the hematoma was not intra-Sylvian (negative predictive value, 100%; 95% CI, 82%–100%). Poor admission status occurred in 50% of patients with IHCEV and in 60% without IHCEV (RR, 1.2; 95% CI, 0.8–1.9). Poor outcome occurred in 63% of patients with IHCEV and in 65% without IHCEV (RR, 1.0; 95% CI, 0.7–1.5).

CONCLUSIONS: Although CTA could reliably and accurately differentiate the hematoma types, admission status and outcome were similar for both groups.