"On the Spot": The Use of Four-Dimensional Computed Tomography Angiography to Differentiate a True Spot Sign From a Distal Intracranial Aneurysm

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Title:	"On the Spot": The Use of Four-Dimensional Computed Tomography Angiography to Differentiate a True Spot Sign From a Distal Intracranial Aneurysm
Author(s):	Jong, J.P.J. de; Kluijtmans, L.A. ; Amerongen, M.J. van; Prokop, M. ; Boogaarts, H.D. ; Meijer, F.J.A.
Publication year:	2017
Source:	World Neurosurgery, vol. 105, (2017), pp. 1037.e9-1037.e12
ISSN:	1878-8750
DOI:	https://doi.org/10.1016/j.wneu.2017.06.046
Publication type:	Article / Letter to editor
Please use this identifier to cite or link to this item : http://hdl.handle.net/2066/177788
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Subject:	Radboudumc 0: Other Research RIHS: Radboud Institute for Health Sciences Radboudumc 0: Other Research RIMLS: Radboud Institute for Molecular Life Sciences Radboudumc 15: Urological cancers RIHS: Radboud Institute for Health Sciences Radboudumc 16: Vascular damage RIHS: Radboud Institute for Health Sciences Radboudumc 9: Rare cancers RIHS: Radboud Institute for Health Sciences
Organization:	Amalia Childrens Hospital Paediatrics Laboratory Medicine Radiology & Nuclear Medicine Neurosurgery
Journal title:	World Neurosurgery
Volume:	vol. 105
Page start:	p. 1037.e9
Page end:	p. 1037.e12
Abstract:	BACKGROUND: Spontaneous intracerebral hemorrhage may arise from underlying abnormalities, including aneurysms. Computed tomography angiography (CTA) is widely used for the detection of possible underlying causes, which is important because it may have immediate therapeutic consequences. In addition, CTA is used to detect the so-called spot sign, indicating active hemorrhage, which carries a worse prognosis. However, CTA is a snapshot in time. Four-dimensional (4D) CTA is a dynamic type of imaging and has emerged as a valuable imaging technique for different neurovascular disorders. CASE DESCRIPTION: Two patients with intracerebral hemorrhage both showed an assumed spot sign on CTA, suggesting active hemorrhage. Additional 4D-CTA showed true active hemorrhage in one patient and a distal intracranial aneurysm in the other. This aneurysm was initially falsely interpreted as a spot sign on conventional CTA. CONCLUSIONS: Our case findings show how 4D-CTA can discern active bleeding from aneurysmal hemorrhage in cases with hemorrhagic stroke. This finding proves the additional value of this relatively new technique, because the detected underlying disorders have different therapeutic consequences in the acute setting.