Cho Won Ho, Choi Hyuk Jin, Nam Kyoung Hyup, Lee Jae Il
Department of Neurosurgery, Medical Research Institute, Pusan National University College of Medicine and Hospital, Busan, Korea.
J Cerebrovasc Endovasc Neurosurg. 2015 Dec;17(4):324-30. doi: 10.7461/jcen.2015.17.4.324. Epub 2015 Dec 31.
Contrast extravasation on computed tomography angiography (CTA) is rare but becoming more common, with increasing use of CTA for various cerebral vascular diseases. We report on two cases of spontaneous subarachnoid hemorrhage (SAH) in which the CTA showed an upper basilar trunk saccular lesion suggesting ruptured aneurysm. However, immediate subsequent digital subtraction angiography (DSA) failed to show a vascular lesion. In one case, repeated follow up DSA was also negative. The patient was treated conservatively and discharged without any neurologic deficit. In the other case, the patient showed sudden mental deterioration on the third hospital day and her brain CT showed rebleeding. The immediate follow up DSA showed contrast stagnation in the vicinity of the upper basilar artery, suggestive of pseudoaneurysm. Double stents deployment at the disease segment was performed. Due to the frequent use of CTA, contrast extravasation is an increasingly common observation. Physicians should be aware that basilar artery extravasation can mimic the appearance of an aneurysm.
计算机断层血管造影（CTA）上的造影剂外渗很少见，但随着CTA在各种脑血管疾病中的使用增加，这种情况正变得越来越普遍。我们报告了两例自发性蛛网膜下腔出血（SAH）病例，其中CTA显示基底动脉上段有囊状病变，提示动脉瘤破裂。然而，随后立即进行的数字减影血管造影（DSA）未能显示血管病变。在一例中，重复的随访DSA结果也为阴性。该患者接受了保守治疗并出院，没有任何神经功能缺损。在另一例中，患者在住院第三天突然出现精神恶化，脑部CT显示再次出血。立即进行的随访DSA显示基底动脉上段附近有造影剂滞留，提示假性动脉瘤。在病变部位进行了双支架置入。由于CTA的频繁使用，造影剂外渗是一种越来越常见的现象。医生应意识到基底动脉外渗可能会模仿动脉瘤的表现。
