Value of delayed MRI in angiogram-negative subarachnoid haemorrhage.

Journal article

AIM: To assess the efficacy of delayed magnetic resonance imaging (MRI) in identifying a structural cause for angiogram-negative subarachnoid haemorrhage. MATERIALS AND METHODS: All patients presenting with spontaneous subarachnoid haemorrhage who had negative computed tomography (CT) angiography and catheter angiography between 2006 and 2012 were reviewed. RESULTS: During the 6 year period, 1023 angiograms were performed for a new presentation of subarachnoid haemorrhage. Of these, 242 (23.7%) did not show a cause for the haemorrhage. A second catheter angiogram was performed in 48 patients, and aneurysms were identified in two patients. Of the remaining 240 patients, 131 underwent a subsequent MRI brain. One hundred and five (80.2%) MRI examinations were performed 4 or more weeks after angiography. In two patients, cavernomas were identified as the likely bleeding source. In both patients, the pattern of subarachnoid haemorrhage surrounding a small intraparenchymal haemorrhage on the initial CT suggested the diagnosis. Thirty-nine patients underwent MRI of the cervical spine, none of which identified a cause for the haemorrhage. None of the patients re-presented to our centre during the 6 year study period. CONCLUSION: Delayed MRI following angiogram-negative subarachnoid haemorrhage has a low (1.5%) yield and is not routinely necessary. MRI may be useful to characterize the diagnosis in patients with clinical or radiological features of an underlying abnormality such as a cavernoma.

Authors: Woodfield, J; Rane, N; Cudlip, S; Byrne, J

• Publication status: Published
• Journal: Clinical radiology
• Volume: 69
• Issue: 4
• Pages: 350-356
• Publication date: 2014-04-01
• DOI: 10.1016/j.crad.2013.11.002
• EISSN: 1365-229X
• ISSN: 0009-9260
• Language: English
• Keywords: Adolescent; Male; Great Britain; Aged; Magnetic Resonance Imaging; Adult; Aged, 80 and over; Time Factors; Brain; Angiography, Digital Subtraction; Middle Aged; Spine; Treatment Outcome; Subarachnoid Hemorrhage; Tomography, X-Ray Computed; Follow-Up Studies; Female; Humans; Retrospective Studies; Cerebral Angiography