Abstract WP63: Clinical Utility of Whole-brain 4D-CTA Using a 320-detector Row CT Scanner in the Evaluation of Spontaneous Lobar Intracerebral Hemorrhage

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Purpose: We performed a retrospective study on the capacity of 320-detector row computed tomography (CT) scanners to detect vascular lesions in spontaneous intracerebral hemorrhage, particularly using whole-brain four-dimensional CT angiography (4D-CTA).

Materials and methods: Subjects were patients brought to our hospital emergency room between April 2011 and August 2015 who were diagnosed with spontaneous intracerebral hemorrhage by non-contrast CT. Contrast-enhanced CTA (including 4D-CTA) was performed for all patients with a 320-detector row CT scanner soon after confirming a hemorrhagic lesion. Patients with bleeding in common sites for subarachnoid hemorrhage, intraventricular hemorrhage, or hypertensive intracerebral hemorrhage (basal ganglia, thalamus, brain stem, or cerebellar dentate nucleus) were excluded. Evaluation items were:

-Hematoma size (estimated bleeding volume)

-Number and frequency (%) of cerebrovascular lesions detectable with 4D-CTA

-In patients who had cerebral angiography (CAG), the concordance rate between the detection rate and the Spetzler-Martin grade for AVMs or Cognard classification for dural arteriovenous fistulas (dAVFs) was calculated. Definitive diagnosis was made by consensus between two neuroradiologists.

Results: Subjects were 125 patients diagnosed with spontaneous intracerebral hemorrhage during the study period (72 men (57.6%); mean age, 58.4±17.2 years; range, 20-88 years; mean estimated bleeding volume, 17.5±12.6 mL). A vascular lesion was detected as the source of bleeding with 4D-CTA in 10 of the 125 patients (8.0%), of whom 5 had AVM, 3 had dAVF, 1 had Moyamoya disease, and 1 had obstruction of the superior sagittal sinus. In patients who underwent CAG at a later date, 4D-CTA offered almost the same diagnostic power as CAG.

Conclusion: Whole-brain 4D-CTA using a 320-detector row CT scanner was useful for diagnosing spontaneous intracerebral hemorrhage, particularly for detecting cerebrovascular lesions.

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