학술논문
Abstract WP104: Radiographic Predictors Of Aneurysmal Etiology In Patients With Aneurysmal Pattern Subarachnoid Hemorrhage
Document Type
Article
Author
Source
Stroke (Ovid); February 2022, Vol. 53 Issue: Supplement 1 pAWP104-AWP104, 1p
Subject
Language
ISSN
00392499; 15244628
Abstract
Introduction:Spontaneous angiogram-negative subarachnoid hemorrhage (anSAH) can represent a diagnostic dilemma as there is no vascular etiology identified and patients may require further imaging, including multiple angiograms, and have prolonged hospital stays. We sought to determine radiographic predictors of aneurysmal cause based on admission non-contrast head CT.Methods:We performed a retrospective case control study of patients who were admitted for spontaneous subarachnoid hemorrhage (SAH) with suspected aneurysmal etiology to an academic center from 2016 to 2021. Patients with pure convexity SAH were excluded. We compared blood thickness (continuous variable) in the basal cisterns and Sylvian fissures and modified GRAEB scores on admission head CT between the two groups. We subsequently developed a predictive model to identify aneurysmal etiology.Results:Of 148 included patients (mean age 56 years [SD 12.7]; 55% female, 70% white), 61 were aneurysmal SAH (aSAH) and 87 were anSAH with no vascular etiology. Median modified GRAEB score was higher in aSAH than anSAH (6 [IQR2-10] vs 0 [IQR0-4], p<0.001). Mean blood thickness was greater in the Sylvian fissure (8mm [SD 5.8]vs 3mm [SD 5.2]; p<0.001), interpeduncular (9mm [SD 5.3]vs 6mm [SD 4.2]; p=0.005), quadrigeminal (3mm [SD 3.7] vs 1mm [SD 2]; p=0.003), crural (6mm [SD 3.7] vs 3mm [SD 2.2]; p=0.014), and ambient cisterns (6mm [SD 7.1] vs 3mm [SD 2.6], p=0.0015) in aSAH compared to anSAH, but less in prepontine cistern (3mm [SD 3.8] vs 5mm [5.2], p=0.006). Our 8-point scoring model is based on differences in radiographic features. Receiver operating characteristics (ROC) curve analysis showed high accuracy in predicting aneurysmal etiology (area under the curve [AUC] 0.79, 95% CI 0.70-0.88; odds ratio 1.45 per point increase, 95% CI 1.24-1.70; p<0.001).Conclusion:The proposed scoring tool can aid clinicians in predicting aneurysmal etiology in patients with aneurysmal pattern SAH using measurements from admission head CTs. Eliminating an aneurysmal etiology of anSAH earlier may reduce the need for further extensive work up, hospital length of stay and associated complications, thereby reducing health care related costs. This model needs to be validated in a larger multi-center study.