Houben M P W A, van Rooij W J J, Sluzewski M, Tijssen C C
Afd. Neurologie, St. Elisabeth Ziekenhuis, Postbus 90.151, 5000 LC Tilburg.
Ned Tijdschr Geneeskd. 2002 Apr 27;146(17):804-8.
To determine the yield of repeated angiography in patients with a non-perimesencephalic subarachnoid haemorrhage (SAH) and a negative first cerebral angiogram.
Retrospective.
All diagnostic data of patients with a spontaneous SAH admitted to the Department of Neurology, St. Elisabeth Hospital, Tilburg, the Netherlands, in the period 1 January 1992-30 June 2000 were analysed. Patients with a perimesencephalic haemorrhage on a CT-scan were excluded and follow-up was completed. A negative angiogram was considered false-negative, if an aneurysm was shown on a repeat angiogram or after a rebleed. These angiograms were reviewed.
A total of 333 patients with a spontaneous SAH were registered. Of these, 249 patients had one or more angiograms made, which resulted in 59 first angiograms being negative (24%). A total of 36 patients had a non-perimesencephalic SAH (26 women and 10 men; mean age: 54 years (range: 25-77)). In 25 of these 36 patients, angiography was repeated revealing 9 aneurysms. Four patients suffered from a rebleed after a previous negative angiogram. Altogether, in 13 of these 36 patients the first negative angiogram was false-negative (36%). In 5 of the 9 patients with a positive repeat angiogram, the first angiogram had been incorrectly assessed as negative.
Of the 36 patients with a non-perimesencephalic subarachnoid haemorrhage and a negative angiogram, 13 were revealed to have an aneurysm. Nine of these 13 aneurysms were demonstrated on a repeat angiogram. Technical and interpretation factors appeared to play an important role in missing an aneurysm on a cerebral angiogram.
确定非脑池周围蛛网膜下腔出血（SAH）且首次脑血管造影阴性的患者重复血管造影的检出率。
回顾性研究。
分析了1992年1月1日至2000年6月30日期间荷兰蒂尔堡圣伊丽莎白医院神经科收治的自发性SAH患者的所有诊断数据。排除CT扫描显示为脑池周围出血的患者并完成随访。如果在重复血管造影或再出血后发现动脉瘤，则认为首次血管造影阴性为假阴性。对这些血管造影进行了复查。
共登记了333例自发性SAH患者。其中，249例患者进行了一次或多次血管造影，59例首次血管造影为阴性（24%）。共有36例患者为非脑池周围SAH（26名女性和10名男性；平均年龄：54岁（范围：25 - 77岁））。在这36例患者中的25例中，重复进行了血管造影，发现9个动脉瘤。4例患者在先前血管造影阴性后发生再出血。总共，在这36例患者中的13例中，首次血管造影阴性为假阴性（36%）。在9例重复血管造影阳性的患者中，有5例首次血管造影被错误地评估为阴性。
在36例非脑池周围蛛网膜下腔出血且血管造影阴性的患者中，有13例被发现有动脉瘤。这13个动脉瘤中有9个在重复血管造影时被发现。技术和解读因素似乎在脑血管造影时漏诊动脉瘤方面起重要作用。
