ABSTRACT
Introduction:
Subarachnoid hemorrhage (SAH) involves the extravasation of blood into the subarachnoid space and is a critical condition with high mortality and morbidity rates. Nontraumatic causes, predominantly ruptured cerebral aneurysms, account for approximately 85% of cases. Early and accurate diagnosis using advanced imaging modalities such as multidetector computed tomography (MDCT) angiography is crucial for effective management.
Materials and Methods:
A hospital-based cross-sectional study was conducted over 24 months. Forty patients clinically suspected or diagnosed with nontraumatic SAH were evaluated using MDCT angiography. Data included demographics, clinical presentation, and imaging findings, which were analyzed using statistical methods.
Results:
Among 40 participants, 29 had positive findings on MDCT angiography. Aneurysms were the most common abnormality (65%), predominantly located in the anterior circulation (47.5%). The sensitivity of MDCT angiography was 89.65% compared to non-enhanced CT. Key risk factors included hypertension and smoking. Gender analysis revealed a higher incidence in females (82.3%) compared to males (65.2%).
Discussion:
MDCT angiography is effective for diagnosing and planning interventions for SAH. It reliably detects aneurysm characteristics, including size, shape, and location, aiding in risk assessment and treatment planning. Its role as a noninvasive alternative to digital subtraction angiography is emphasized.
Conclusion:
MDCT angiography is a valuable tool in evaluating nontraumatic SAH, providing critical insights for prompt and accurate diagnosis, risk stratification, and therapeutic planning.
KEYWORDS: Cerebral aneurysm, imaging, MDCT angiography, nontraumatic hemorrhage, subarachnoid hemorrhage
INTRODUCTION
Subarachnoid hemorrhage (SAH) refers to the presence of blood within the subarachnoid space, typically due to trauma or rupture of intracranial aneurysms. Nontraumatic SAH, although less frequent, poses significant diagnostic and therapeutic challenges. Cerebral aneurysms are responsible for the majority of nontraumatic SAH cases, followed by arteriovenous malformations (AVMs) and other vascular anomalies.[1,2,3]
Advances in imaging technologies have revolutionized the diagnostic approach to SAH. Multidetector computed tomography (MDCT) angiography, with its noninvasive nature and high-resolution imaging, is emerging as a primary diagnostic modality. It offers detailed anatomical visualization of cerebral vasculature, enabling clinicians to detect aneurysms and other vascular abnormalities with precision.[4,5,6,7]
This study evaluates the role of MDCT angiography in identifying nontraumatic SAH, analyzing its diagnostic accuracy, common findings, and implications for clinical management. By comparing MDCT angiography with non-enhanced CT (NECT), this research highlights the strengths of MDCT in guiding therapeutic interventions and improving patient outcomes.
MATERIALS AND METHODS
This hospital-based cross-sectional study was conducted over 24 months at the Rajendra Institute of Medical Sciences (RIMS), Ranchi. The study included 40 patients clinically suspected or diagnosed with nontraumatic SAH. Patients were recruited from the emergency, medicine, and neurosurgery departments. The eligibility criteria included clinically suspected nontraumatic SAH or incidentally detected SAH on CT brain imaging. Exclusion criteria were contraindications to contrast agents, recent surgical interventions, bleeding disorders, or refusal to participate.
Written informed consent was obtained from all participants. Imaging was performed using a 128-slice MDCT scanner, employing standardized protocols. Key parameters included a section thickness of 1.25 mm with 1-mm overlap, a pitch of 3 for the head, and 6 for the neck. Data collected included demographics, clinical symptoms, and imaging findings such as aneurysm size, location, and associated vascular anomalies. Statistical analysis was performed using mean, standard deviation, and Fisher’s exact test to assess the sensitivity and diagnostic accuracy of MDCT angiography.
RESULTS
The study comprised 40 participants, with 23 males and 17 females. The age group most commonly affected was 40–49 years (32%), followed by 50–59 years (23%) [Table 1]. MDCT angiography detected positive findings in 29 cases (72.5%), with aneurysms being the predominant abnormality. Among these, 19 aneurysms were located in the anterior circulation (47.5%), and seven in the posterior circulation (17.5%). Additionally, AVMs were identified in three cases (7.5%).
Table 1.
Age Distribution of Participants
| Age Group (years) | Number of Participants | Percentage |
|---|---|---|
| 20–29 | 2 | 5% |
| 30–39 | 6 | 15% |
| 40–49 | 13 | 32% |
| 50–59 | 9 | 23% |
| 60–69 | 8 | 20% |
| 70–79 | 2 | 5% |
NECT findings were positive in 32 cases (80%), while MDCT angiography identified additional abnormalities in three cases missed by NECT. The sensitivity of MDCT angiography was calculated at 89.65% for detecting aneurysms [Table 2]. Gender-specific analysis showed a higher incidence of aneurysms in females (82.3%) compared to males (65.2%).
Table 2.
Comparison of NECT and MDCT Findings
| Imaging Modality | Positive Cases | Negative Cases | Total |
|---|---|---|---|
| NECT | 32 | 8 | 40 |
| MDCT Angiography | 29 | 11 | 40 |
DISCUSSION
MDCT angiography has proven to be a highly effective imaging modality for diagnosing nontraumatic SAH. Its high-resolution imaging capabilities enable accurate visualization of aneurysms, AVMs, and other vascular anomalies.[8] The sensitivity of MDCT angiography (89.65%) underscores its superiority over NECT in detecting vascular abnormalities, particularly smaller aneurysms and lesions near the skull base.[9]
Gender disparities observed in this study, with a higher incidence of aneurysms in females, align with existing literature attributing these differences to hormonal factors, particularly estrogen’s protective effects. Postmenopausal women, with reduced estrogen levels, show increased vulnerability to aneurysm formation and rupture.[10,11]
The study also highlighted the clinical utility of MDCT angiography in treatment planning. Detailed characterization of aneurysms—including size, shape, and aspect ratio—is crucial for risk stratification and determining therapeutic approaches. Anterior circulation aneurysms, which accounted for 47.5% of cases, were more common than posterior circulation aneurysms, consistent with global trends.[12]
In comparison to digital subtraction angiography, MDCT angiography offers a noninvasive alternative with reduced procedural risks. Its ability to generate three-dimensional reconstructions enhances surgical planning and improves outcomes.[13]
CONCLUSION
MDCT angiography is a pivotal tool in evaluating nontraumatic SAH. Its ability to accurately identify aneurysms and vascular abnormalities makes it indispensable for early diagnosis and treatment planning. Integration of MDCT angiography in clinical protocols can significantly improve outcomes for patients with nontraumatic SAH.
Conflicts of interest
There are no conflicts of interest.
Funding Statement
Nil.
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