Frequency of Adequate Contrast Opacification of the Major Intracranial Venous Structures with CT Angiography in the Setting of Intracerebral Hemorrhage: Comparison of 16- and 64-Section CT Angiography Techniques — Delgado Almandoz et al. 32 (5): 839 — American Journal of
What’s Hotlight? American Journal of Neuroradiology 32:839-845, May 2011
© 2011 American Society of Neuroradiology
BRAIN
Frequency of Adequate Contrast Opacification of the Major Intracranial Venous Structures with CT Angiography in the Setting of Intracerebral Hemorrhage: Comparison of 16- and 64-Section CT Angiography Techniques
J.E. Delgado Almandoza,c, H.S. Sua,P.W. Schaefera, J.N. Goldsteinb,S.R. Pomerantza, M.H. Leva, R.G. Gonzálezaand J.M. Romero
aFrom the Division of Neuroradiology (J.E.D.A., H.S.S., P.W.S., S.R.P., M.H.L., R.G.G.)
bDepartment of Radiology, and Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
cDivision of Neuroradiology (J.E.D.A.), Mallinckrodt Institute of Radiology, Washington University, St. Louis, Missouri.
Please address correspondence to Josser E. Delgado Almandoz, MD, Division of Neuroradiology, Mallinckrodt Institute of Radiology, Washington University, Campus Box 8131, 510 S Kingshighway Blvd, St. Louis, MO 63110; e-mail: delgadoj
BACKGROUND AND PURPOSE: DVST is an important cause of ICH because its treatment mayrequire anticoagulation or mechanical thrombectomy. We aimedto determine the frequency of adequate contrast opacificationof the major intracranial venous structures in CTAs performedfor ICH evaluation, which is an essential factor in excludingDVST as the ICH etiology.
MATERIALS AND METHODS: Two readers retrospectively reviewed CTAs performed in 170 consecutivepatients with ICH who presented to our emergency departmentduring a 1-year period to determine by consensus whether qualitatively,contrast opacification in each of the major intracranial venousstructures was adequate to exclude DVST. “Adequate contrastopacification” was defined as homogeneous opacification of thevenous structure examined. “Inadequate contrast opacification”was defined as either inhomogeneous opacification or nonopacificationof the venous structure examined. Delayed scans, if obtained,were reviewed by the same readers blinded to the first-passCTAs to determine the adequacy of contrast opacification inthe venous structures according to the same criteria. In patientswho did not have an arterial ICH etiology, the same readersdetermined if thrombosis of an inadequately opacified intracranialvenous structure could have potentially explained the ICH bycorrelating the presumed venous drainage path of the ICH withthe presence of inadequate contrast opacification within thevenous structure draining the venous territory of the ICH. CTAswere performed in 16- or 64-section CT scanners with bolus-tracking,scanning from C1 to the vertex. Patients with a final diagnosisof DVST were excluded. We used the Pearson 
2 test to determinethe significance of the differences in the frequency of adequatecontrast opacification within each of the major intracranialvenous structures in scans obtained using either a 16- or 64-sectionMDCTA technique.
RESULTS: Fifty-eight patients were evaluated with a 16-section MDCTAtechnique (34.1%) and 112 with a 64-section technique (65.9%).Adequate contrast opacification within all major noncavernousintracranial venous structures was significantly less frequentin first-pass CTAs performed with a 64-section technique (33%)than in those performed with a 16-section technique (60%, Pvalue < .0001). Delayed scans were obtained in 50 patients,all of which demonstrated adequate contrast opacification inthe major noncavernous intracranial venous structures. In 142patients with supratentorial or cerebellar ICH without an underlyingarterial etiology, we found that thrombosis of an inadequatelyopacified major intracranial venous structure could have potentiallyexplained the ICH in 38 patients (26.8%), most examined witha 64-section technique (86.8%).
CONCLUSIONS: Inadequate contrast opacification of the major intracranialvenous structures is common in first-pass CTAs performed forICH evaluation, particularly if performed with a 64-sectiontechnique. Acquiring delayed scans appears necessary to confidentlyexclude DVST when there is strong clinical or radiologic suspicion.
Abbreviations: AVM, arteriovenous malformation • CTA, CT angiogram • DVST, dural venous sinus thrombosis • ICH, intracerebral hemorrhage • INR, international normalized ratio • IVH, intraventricular hemorrhage • MDCTA, multidetector CT angiography • NCCT, noncontrast CT
