Early experience with three-dimensional computed tomographic angiography in the management of subaracnoid hemorrhage and cerebral aneurysms

Objective: To demonstrate the usefulness of three-dimensional helicoidal computed tomographic angiography (angio-CT-3D) in the management of patients with acute subarachnoid hemorrhage (SAH). Materials and Methods: A CT helicoidal acquisition was obtained 20 s after the starting of an intravenous administration of 90 ml of non-ionic contrast injected at a rate of 2.5 ml/min. Axial images were transferred on a workstation obtaining images of the vascular tree in SSP (shadow surface display) and MIP (maximal intensity process) modes. A total of 20 patients with acute SAH were studied. Results: There were no false positive findings. One intact infraclinoidal carotid aneurysm was missed but two lesions not clearly showed in angiography were shown in angio-CT-3D study. One intact microaneurysm not seen in angiography nor in angio-CT-3D was found at surgery in the posterior communicating area. All bleeding lesions were found in angio-CT3D. Five patients with acute HSA were operated on based only on angio-CT-3D findings. Conclusion: Our experience suggest that angio-CT3D is useful in the rapid and accurate diagnosis of the cerebral aneurysm as the cause of SAH. In selected cases it is possible to operate on the lesion based only on angio-CT3D findings.