Rana A K, Turner H E, Deans K A
AK Rana, Aberdeen Biomedical Imaging Centre, University of Aberdeen Lilian Sutton Building, Foresterhill, Aberdeen AB25 2ZD, UK.
J R Coll Physicians Edinb. 2013;43(3):200-6. doi: 10.4997/JRCPE.2013.303.
Patients with suspected subarachnoid haemorrhage, a normal noncontrast computed tomography (CT) and cerebrospinal fluid (CSF) evidence of haemoglobin breakdown products often undergo CT angiography (CTA). If this is normal, then invasive catheter angiography may be offered. In current clinical practice, haemoglobin breakdown products are detected by spectrophotometry rather than visible xanthochromia, and CTA is performed on multidetector scanners. The aim of this study was to determine if such patients should still have a catheter angiography, given the associated risks.
Patients positive for CSF spectrophotometry (n=26) were retrospectively identified from the clinical biochemistry information system and imaging data from the electronic radiology records were reviewed. Discharge letters were consulted to relate the biochemistry and radiology results to the final diagnosis.
15 patients with CT angiography were found. Nine patients had normal CT angiography. No causative aneurysms had been missed. One patient had small, coincidental aneurysms missed on initial reading of the CTA.
The likelihood of a clinically significant aneurysm in a patient who is CT negative, lumbar puncture positive and CTA negative is low. Double reporting of negative CT angiograms may be advisable.
疑似蛛网膜下腔出血的患者，若其非增强计算机断层扫描（CT）正常且脑脊液（CSF）有血红蛋白分解产物的证据，通常会接受CT血管造影（CTA）检查。若CTA结果正常，则可能会建议进行有创导管血管造影。在当前临床实践中，血红蛋白分解产物通过分光光度法而非可见的黄变来检测，且CTA在多排探测器扫描仪上进行。本研究的目的是鉴于相关风险，确定此类患者是否仍应进行导管血管造影。
从临床生物化学信息系统中回顾性识别出脑脊液分光光度法检测呈阳性的患者（n = 26），并查阅电子放射学记录中的影像数据。查阅出院小结，将生物化学和放射学结果与最终诊断相关联。
发现15例患者进行了CT血管造影。9例患者的CT血管造影结果正常。未遗漏任何有病因的动脉瘤。1例患者在初次阅读CTA时遗漏了小的、偶然发现的动脉瘤。
CT阴性、腰椎穿刺阳性且CTA阴性的患者中存在具有临床意义的动脉瘤的可能性较低。对阴性CT血管造影进行双重报告可能是可取的。
