Pre-surgical diagnostic imaging of aneurysmal subarachnoidal hemorrhages

Abstract

Аs a result of multiple studies and trials, international radiological and neurological societies have created guidelines with recommendations about evidence-based use of different imaging modalities for detection and characterization of intracerebral aneurysms and subarachnoid arterial hemorrhage (SAH). They recommend use of computed tomography (CT) and CT-angiography (CTA) as first-line modalities in SAH. The sensitivity and specificity of CTA performed with the state-of-the-art systems are very close to diagnostic parameters of catheter cerebral angiography. Magnetic resonance (MR) angiography (MRA) has practicaly the same diagnostic value in paticents with SAH and cerebral aneurysms, but it is less suited for emergent cases in comparison with CT. Catheter cerebral angiography stays a gold standard modality in difficult cases of SAH, when CTA or MRA cannot find the source of bleeding. Artificial intelligence may further increase the diagnostic value of CTA and MRA in detection of SAH and cerebral aneurysms and help with prognosis stratification.