Follow-up neuroimaging after non-perimesencephalic, angiogram-negative subarachnoid hemorrhage.

IF 1.3 4区 医学 Q4 CLINICAL NEUROLOGY
Journal of neurosurgical sciences Pub Date : 2024-10-01 Epub Date: 2023-01-31 DOI:10.23736/S0390-5616.22.05686-7
Jean-Philippe Dufour, Menno R Germans, Emanuela Keller, Zsolt Kulcsàr, Luca Regli, Giuseppe Esposito
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引用次数: 0

Abstract

Background: In approximately 15% of spontaneous subarachnoid hemorrhage (SAH) patients, no bleeding source is found in the initial imaging. These patients can be categorized as either perimesencephalic (PM-SAH) or non-perimesencephalic (NP-SAH) subarachnoid hemorrhage patients. Follow-up imaging is routinely performed after NP-SAH to detect treatable etiologies; however, the optimal follow-up imaging protocol remains unclear. This study examines the optimal time interval to re-imaging and the performance of magnetic resonance imaging and angiography (MRI/A) in this setting.

Methods: In this retrospective study, the records of NP-SAH patients treated at the University Hospital of Zurich (Switzerland) from 2005 to 2018 were analyzed. Clinical and radiological data were collected. Re-imaging data was grouped according to imaging modality and divided into three time-categories after bleeding: short-term (<2 weeks), medium-term (2-8 weeks) and long-term (>8 weeks) re-imaging.

Results: Eighty-one NP-SAH patients were included. In 8 patients an aneurysm was diagnosed during re-imaging via digital subtraction angiography (9.9% diagnostic yield). Five aneurysms were detected at short-term in 81 patients (6.2% short-term yield) and three at medium-term re-imaging in 27 patients (11.1% medium-term yield). No aneurysms were found after 8 weeks in 56 patients. Five of these 8 patients also received MRI/A re-imaging, which was able to show the aneurysm in all 5 cases.

Conclusions: Our study emphasizes the importance of re-imaging in NP-SAH patients, which should be done both at short-term and at medium-term follow-up after the hemorrhage. Long-term re-imaging after 8 weeks might not be of diagnostic benefit. MRI/A might be considered as a possible noninvasive re-imaging modality in this setting.

非脑周血管造影阴性蛛网膜下腔出血后的后续神经影像学检查。
背景:大约 15%的自发性蛛网膜下腔出血(SAH)患者在最初的造影检查中没有发现出血源。这些患者可分为脑膜周围性(PM-SAH)或非脑膜周围性(NP-SAH)蛛网膜下腔出血患者。NP-SAH 后常规进行随访成像以检测可治疗的病因,但最佳随访成像方案仍不明确。本研究探讨了在这种情况下再次成像的最佳时间间隔以及磁共振成像和血管造影(MRI/A)的性能:在这项回顾性研究中,分析了 2005 年至 2018 年在苏黎世大学医院(瑞士)接受治疗的 NP-SAH 患者的病历。收集了临床和放射学数据。根据成像方式对再成像数据进行分组,并将出血后再成像分为三个时间类别:短期(8 周)再成像:结果:共纳入81例NP-SAH患者。结果:共纳入 81 例 NP-SAH 患者,其中 8 例患者在再次成像时通过数字减影血管造影术诊断出动脉瘤(诊断率为 9.9%)。81 名患者在短期检查中发现了 5 个动脉瘤(短期诊断率为 6.2%),27 名患者在中期再造影检查中发现了 3 个动脉瘤(中期诊断率为 11.1%)。56 名患者在 8 周后未发现动脉瘤。在这8名患者中,有5名患者还接受了核磁共振/A再成像检查,5例患者均显示出动脉瘤:我们的研究强调了对 NP-SAH 患者进行再次成像的重要性,在出血后的短期和中期随访中都应进行再次成像。8 周后的长期再成像可能对诊断无益。在这种情况下,MRI/A 可被视为一种可能的无创再成像方式。
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来源期刊
Journal of neurosurgical sciences
Journal of neurosurgical sciences CLINICAL NEUROLOGY-SURGERY
CiteScore
3.00
自引率
5.30%
发文量
202
审稿时长
>12 weeks
期刊介绍: The Journal of Neurosurgical Sciences publishes scientific papers on neurosurgery and related subjects (electroencephalography, neurophysiology, neurochemistry, neuropathology, stereotaxy, neuroanatomy, neuroradiology, etc.). Manuscripts may be submitted in the form of ditorials, original articles, review articles, special articles, letters to the Editor and guidelines. The journal aims to provide its readers with papers of the highest quality and impact through a process of careful peer review and editorial work.
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