Klintz Tristan, Cordt Justus, Larsen Naomi, Hensler Johannes, Wodarg Fritz, Jansen Olav, Peters Sönke
Department of Radiology and Neuroradiology, University Hospital of Schleswig-Holstein, Kiel, Germany.
Neuroradiol J. 2025 Jun 17:19714009251348620. doi: 10.1177/19714009251348620.
Non- traumatic subarachnoid hemorrhage (SAH) constitutes a life-threatening event, which is caused in 85% by ruptured aneurysms. Identifying those aneurysms as the bleeding cause is essential for further therapy. This study explores whether relatively hypodense sparing of aneurysms in the blood-filled subarachnoid space (filling defect sign = FD) on nonenhanced CT scans (NECT) can help estimate aneurysm location and size. NECT of fifty patients with aneurysmal SAH, who were also examined with a catheter angiography, were retrospectively analyzed by three neuroradiologically experienced radiologists. They rated the aneurysm location and size by applying the FD. Logistic regression analysis was performed to determine if a correlation between aneurysm location, aneurysm size, Fisher score and the detectability of a FD exists. For quantitative analysis the average densities of the aneurysm were compared to that of surrounding structures. In 75% of the cases, the aneurysm was identified correctly by using the FD. The highest detection rate was given for MCA (90%) and BA aneurysms (90%). Aneurysm location ( = .019), size ( = .020), and the Fisher score ( = .008) significantly influenced aneurysm detection using the FD. The aneurysm size measured in correctly identified aneurysms correlated significantly with the sizes measured in the catheter angiography ( < .001). A cut-off point of 51 HU could be determined to distinguish aneurysm from surrounding SAH with a specificity of 92% and a sensitivity of 86%. In three-fourths aneurysm location and size can be determined on NECT using the FD. An additional quantitative analysis can support the diagnosis with a high specificity and sensitivity.
非创伤性蛛网膜下腔出血（SAH）是一种危及生命的事件，85% 由动脉瘤破裂引起。确定这些动脉瘤为出血原因对进一步治疗至关重要。本研究探讨在非增强CT扫描（NECT）上，充满血液的蛛网膜下腔中动脉瘤相对低密度的 sparing（充盈缺损征 = FD）是否有助于估计动脉瘤的位置和大小。对50例动脉瘤性SAH患者进行了NECT检查，这些患者同时还接受了导管血管造影检查，由三位有神经放射学经验的放射科医生进行回顾性分析。他们通过应用FD对动脉瘤的位置和大小进行评分。进行逻辑回归分析以确定动脉瘤位置、动脉瘤大小、Fisher评分与FD可检测性之间是否存在相关性。为进行定量分析，将动脉瘤的平均密度与周围结构的平均密度进行比较。在75% 的病例中，通过使用FD正确识别了动脉瘤。大脑中动脉（MCA）动脉瘤（90%）和基底动脉（BA）动脉瘤的检出率最高（90%）。动脉瘤位置（P = .019）、大小（P = .020）和Fisher评分（P = .008）对使用FD检测动脉瘤有显著影响。正确识别的动脉瘤测量大小与导管血管造影测量的大小显著相关（P < .001）。可以确定51HU的截断点来区分动脉瘤与周围的SAH，特异性为92%，敏感性为86%。在四分之三的病例中，可以使用FD在NECT上确定动脉瘤的位置和大小。额外的定量分析可以以高特异性和敏感性支持诊断。
