Évaluation quantitative du vasospasme cérébral à l’angioscanner dans l’hémorragie sous arachnoïdienne anévrysmale

Abstract : Background and purpose — Assessment of large vessel cerebral vasospasm (CVS) with CT angiography (CTA) is commonly used in aneurysmal subarachnoid hemorrhage (aSAH) to monitor the risk of delayed cerebral ischemia (DCI). However, its accuracy is still debated in clinical practice. We aim to assess sensitivity, specificity and radiation dose of CTA and digital subtraction angiography (DSA) to compute CVS. Methods — Consecutive patients with aSAH who underwent both CTA and DSA within less than 6 hours at admission / during CVS period (within the 3rd / 4th-21st days after aSAH onset) were included. CVS was retrospectively computed on CTA and DSA for each anterior intracranial artery segment until the end of their 2nd segments by 2 readers (reader 1 / reader 2; 5-year / 10-year experienced radiologist / interventional neuroradiologist) in blinded conditions. Radiation dose to the eye and scalp were also compared prospectively in 1 phantom study and in 5 patients. Results — CVS was computed on a total of 210 arterial segments in 20 patients. The correlation between CTA and DSA was better for the reader 2, CTA performed under our local protocol, CTA with great visualization of distal arteries and segments without metallic artefacts. The best sensitivity and specificity of CTA to predict CVS ≥ 50% on DSA was obtained for a threshold ≥ 30% for the reader 2 (86% and 86% respectively). Under this value, no patient had CVS ≥ 50% on DSA. Radiation dose to the scalp and eye were respectively lower and tends to be higher for CTA compared to DSA. Conclusions — CTA in clinical practice may not be as excellent as reported to predict CVS on DSA. Its accuracy highly depends on observers’ experience. A threshold value of ≤ 30% may rule out CVS ≥ 50% on DSA. Radiation dose limitation is not a valid argument to substitute DSA with CTA.
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Master Thesis
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https://dumas.ccsd.cnrs.fr/dumas-02043038
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Submitted on : Wednesday, April 10, 2019 - 3:51:41 PM
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Mariam Soumah. Évaluation quantitative du vasospasme cérébral à l’angioscanner dans l’hémorragie sous arachnoïdienne anévrysmale. Imagerie. 2018. ⟨dumas-02043038⟩

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