Abstract

INTRODUCTION

The purpose of our study is to evaluate rate of aneurysms and subarachnoid hemorrhage (SAH) detected in cranial computed tomography angiography (CTA) in patients with severe headache in emergency conditions and to determine relationship between SAH and aneurysm.

METHODS

In this study total of 289 patients (142 male, 147 female, avarage age 51.8, range 18-87) who had undergone CTA due to headache were evaluated. Firstly, non-contrast series were evaluted for presence of SAH. Later, angiographic images were evaluted for presence of aneurysm. Sensitivity, specificity, positive and negative predictive values in non-enhanded CT to estimate the presence of aneurysm depending on presence of SAH were calculated with chi-square test. Additionally, with kappa analysis the correlation between the presence of SAH and aneurysm was evaluated.

RESULTS

Among 289 patients who had undergone CTA due to severe headache, aneurysms were detected in 132 patients, while no aneurysm was found in 157 patients. Concerning the non-enhanced series, SAH was detected in 142 patients and in 81 patients among them, aneurysms were detected, while no aneurysm was found in the remaining 61 patients. On the other hand, among 147 patients without SAH, 51 patients had aneurysm, whereas in 96 of them no aneurysm was found. According to these findings, the sensitivity, specificity, positive and negative predictive values of CT to estimate presence of aneurysm depending on presence of SAH were calculated 61%, 61%, 57% and 65%, respectively. Also, kappa analysis revealed poor correlation between presence of SAH and aneurysm.

DISCUSSION AND CONCLUSION

Absence of SAH in non-enhanced CT makes the diagnosis of ruptured aneurysm less probable, it doesn't rule out presence of aneurysm. On the other hand, use of CTA for every kind of headache isn't appropriate. The best approach in diagnostic algorithm is to follow appropriate steps considering clinical symptoms of patients as the most important determinant.