The role of computed tomography angiogram in intracranial hemorrhage. Do the benefits justify the known risks in everyday practice?

Abstract

Background: Intracranial hemorrhage is a commonly encountered medical problem frequently evaluated by computed tomography angiography (CTA). In CTA, there is radiation exposure and possible adverse effects of intravenous contrast administration. Therefore, the yield of this diagnostic tool needs to be explored in a heterogeneous group of daily encountered patients to provide insight into the risks and benefits of CTA. Objective: To evaluate the role of cerebral CTA in patients with CT-confirmed or clinically suspected intracranial hemorrhage. Methods: This retrospective study included all patients who underwent cerebral CTA for evaluation of intracranial hemorrhage that was diagnosed by a plain CT scan or suspected clinically from January 1, 2010, to May 30, 2018. All the scans were evaluated for abnormalities of the cerebral arteries in the CTA. Results: One hundred twenty patients were included, 74 % were males, and the mean age was 46 years. Approximately 18 % were trauma patients. Overall, CTA was abnormal in 52 % of cases, aneurysms were found in 27 %, and arteriovenous malformation (AVM) in 8 %. Among 82 patients who had a hemorrhage on the plain CT scans, 54 % had normal CTA, 28 % showed aneurysm, and 11 % showed AVM. In trauma patients, the most common CTA finding was normality (48 %), followed by aneurysms (19 %) and dissection (14 %). In non-trauma patients, the most common CTA finding was normality (49 %), followed by aneurysms (28 %) and AVM (10 %). Conclusions: CTA is a valuable diagnostic tool for intracranial hemorrhage because it detected abnormalities related to the hemorrhage in 42 % of patients. However, because more than half (58 %) of the patients had normal CTAs or showed CTA findings that were not relevant to the hemorrhage, clinical judgment should be exhausted before exposing them to radiation and intravenous contrast risks.